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患儿男性,9岁,因心慌、胸闷20天,在外院胸透发现心影扩大收入院.查体:血压14.7/8.0Kpa,脉短拙,无紫绀,胸廓无畸形,双肺呼吸音清晰,无干湿罗音,心界向两侧扩大,未闻及杂音.心电图示心房纤颤.X线胸片:心界向两侧扩大,心胸比例0.69.超声心动图:四心腔切面可见左房后外侧有一9.4×8.2cm巨大无回声暗区与左房相通,多普勒取样容积置于左心耳处可探及双向血流,暗区无明显舒缩活动,暗区内可见一4.5×2.9cm强回声团,边界清晰.与左房相通开口约2.8cm,此囊腔壁与心脏壁相连,4条肺静脉清晰可见,均开口于左心房,超声诊断:1.左心耳瘤样扩张;2.左房粘液瘤.右室造影:可见大量造影剂置于左心房旁膨突部位并缓慢消退.在低温体外循环下行瘤体切除术,术中心包完整,切开心包左房室后突出一巨大薄壁瘤体,约9.6×8.0×6.0cm.其颈部与左心耳基部左房壁相连续,通入左房,开口约2.5cm.瘤体内可见4.6×3.5×3.0cm巨大血栓一枚.将瘤体于基部切除.病理报告:瘤体主要由纤维组织组成.术后两周治愈出院.诊断:左心房膨出瘤,瘤体附壁血栓.
The patient was a 9-year-old man with flustered palpitation and chest tightness for 20 days. He was found in the outer chest and enlarged his heart shadow. The examination showed that the blood pressure was 14.7/8.0 Kpa, the pulse was short, there was no purpura, the thorax was not deformed, and the breath sounds of the lungs were clear. , No wet and dry rales, the heart of the community to expand on both sides, no smell and noise. ECG shows atrial fibrillation. X-ray chest: heart to the sides to expand, cardiothoracic ratio of 0.69. Echocardiography: four chamber view visible There is a 9.4×8.2 cm large echo-free dark area behind the left atrium and the left atrium. The volume of the Doppler sample is placed at the left atrial appendage to detect two-way blood flow. There is no obvious systolic activity in the dark area, and there is a 4.5 in the dark area. ×2.9cm strong echo group, the boundary is clear. With the opening of the left atrial cavity about 2.8cm, the wall of the capsule is connected with the heart wall, 4 pulmonary veins are clearly visible, are all open in the left atrium, ultrasound diagnosis: 1. Left heart and ear growth 2. Left atrial myxoma. Right ventricular angiography: a large number of contrast agents can be seen in the left atrial palpation and slowly subside. In the hypothermic cardiopulmonary bypass tumor resection, surgery center package complete, cut after happy packet left atrioventricular A large, thin-walled tumor was highlighted, approximately 9.6 x 8.0 x 6.0 cm. Its neck was continuous with the left atrial wall of the left atrial appendage, leading to the left atrium with an opening of approximately 2.5 cm. A massive thrombus of 4.6 x 3.5 x 3.0 cm was seen inside. The tumor was removed at the base. Pathology report: The tumor was mainly composed of fibrous tissue. It was cured after two weeks of operation. Diagnosis: Left atrial bulging tumor, tumor wall attached thrombus.