Simó R, Mesa J, Obiols G, Domingo E, Lupon-Rosés J
Division of Endocrinology and Metabolism, Hospital General Vall d'Hebron, Universitat Autònoma de Barcelona, Spain.
Int J Card Imaging. 1987;2(3):161-4. doi: 10.1007/BF01784303.
We herein report the case of a 53-year-old white acromegalic patient with an abdominal mass due to massive cardiomegaly. The patient suffered from long lasting acromegaly refractary to bromocriptine, transsphenoidal surgery and radiotherapy. He had been previously diagnosed as having systemic hypertension, ischemic chest pain and congestive heart failure with marked cardiomegaly. The present admission was due to asthenia, anorexia and weight loss that were finally attributed to adrenal insufficiency secondary to radiotherapy. Plain abdomen X-ray suggested the presence of supramesocolic mass. A large cold area in the left hepatic lobe was detected on the radionuclide liver scan. Radionuclide angiography surprisingly identified the cold area as a vascular structure corresponding to the heart. A body CT scan revealed the heart was expanding between stomach and liver. Two-dimensional echocardiography showed marked enlargement of left ventricle. Cardiomegaly was probably multifactorial (chronic hypertension, ischemic heart disease and acromegaly). To our knowledge, this is the first reported case of massive cardiomegaly behaving as an intraabdominal mass. This possibility must be considered when invasive intraabdominal diagnostic procedures are to be done, particularly in an acromegalic patient.
我们在此报告一例53岁的白人肢端肥大症患者，因心脏巨大而出现腹部肿块。该患者患有长期的肢端肥大症，对溴隐亭、经蝶窦手术及放疗均无效。他此前被诊断患有系统性高血压、缺血性胸痛及充血性心力衰竭伴明显心脏增大。此次入院是由于乏力、厌食和体重减轻，最终归因于放疗继发的肾上腺功能不全。腹部X线平片提示结肠上区有肿块。放射性核素肝脏扫描显示左肝叶有一个大的冷区。放射性核素血管造影意外地将该冷区确定为与心脏相对应的血管结构。身体CT扫描显示心脏在胃和肝脏之间扩大。二维超声心动图显示左心室明显增大。心脏增大可能是多因素所致（慢性高血压、缺血性心脏病和肢端肥大症）。据我们所知，这是首例报告的表现为腹腔内肿块的巨大心脏增大病例。当要进行侵入性腹腔诊断操作时，尤其是在肢端肥大症患者中，必须考虑到这种可能性。
