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患者女性,32岁。因心悸、气短伴全身水肿4个多月住院。检查:体温38.5 ℃。呼吸22次/min。心率120次/min,律齐。血压10.3/7.6KPa。呼吸急促,唇绀。颈静脉充盈,面部及四肢轻度水肿。肝肋下2cm,质中等,无触痛。实验室检查:血红蛋白109g/L,白细胞5.1×10~9/L,中性0.68,淋巴0.32。血沉15mm/h。X线胸透:心影中度增大。心电图检查:窦性心动过速。超声心动图示心包积液。住院后经抗心衰等治疗1周无效,心包穿刺抽出100ml血性液体,涂片未找到瘤细胞,细菌培养阴性。心脏摄片,示右心房有一圆形阴影,拟诊为肿瘤。住院25d因严重心衰亡死。尸检发现:右心房后壁上部有肿瘤一个,呈茄状,5cm×3cm×3cm大小,向上阻塞上腔静脉管腔约1cm,向下填塞心房腔及三尖瓣口。肿瘤表面
Female patient, 32 years old. Because of heart palpitations, shortness of breath with systemic edema more than 4 months of hospitalization. Check: Body temperature 38.5 °C. Breathe 22 times/min. Heart rate 120 beats/min, law. Blood pressure 10.3/7.6KPa. Shortness of breath, lips. The jugular veins are filled, and the face and limbs are slightly edematous. Liver ribs 2cm, medium quality, no tenderness. Laboratory tests: Hemoglobin 109 g/L, Leukocytes 5.1×10 9/L, Neutral 0.68, Lymph 0.32. ESR 15mm/h. X-ray chest: The heart shadow increases moderately. Electrocardiography: sinus tachycardia. Echocardiography pericardial effusion. After hospitalization, the treatment of anti-heart failure was invalid for 1 week. 100 ml of bloody fluid was removed by pericardiocentesis. No tumor cells were found in the smear and the bacterial culture was negative. The heart photograph shows a round shadow in the right atrium and is considered to be a tumor. 25d hospitalized due to severe heart failure. The autopsy found that there was a tumor in the upper part of the posterior wall of the right atrium, which was an eggplant-shaped, 5 cm×3 cm×3 cm in size. It obstructed the lumen of the superior vena cava by about 1 cm, and it was filled down to the atrium and tricuspid orifice. Tumor surface