淋巴瘤缓解后出现胸腔积液、呼吸困难1例

患，男性，77岁，诊断为非霍奇金淋巴瘤2年，胸闷、咳嗽5d。     

以双侧胸腔积液为表现的心脏粘液瘤1例

患者,男性,24岁,农民,因发热、胸闷、气短2月余,于2004年7月20日入院。患者于2004年5月初无明显原因地出现发热,体温最高38℃,口服巴米尔,体温可降至正常,但易反复,伴胸闷,气短。胸片示:双侧胸腔积液,在某市医院抽出黄色混浊积液约1800m l(双侧)。胸水常规:李凡他实验( )白细胞     

HBV致右侧胸腔积液1例报告

病史 患者男,56岁。因咳嗽、气促伴乏力、食欲减退2月余,于1993年1月4日入院。患者于1992年10月20日起出现咳嗽、气促、尤以平卧时明显。无胸痛、无畏寒发热、无盗汗。胃纳欠佳、乏力。曾在当地医院住院治疗,诊断为“肝硬化失代偿期”及“右侧胸腔积液原因待查”,予护肝、抗炎、抗结核治疗,先后抽胸水8次,共7000ml。但病人症     

左心房黏液瘤伴颅内多发动脉瘤一例

患者 女,54岁。因“突发左侧肢体无力”于2008年10月20日就诊于南方医科大学珠江医院神经内科。该患者2年前因心悸、胸闷于广东省中医院诊断为左心房黏液瘤及房间隔缺损,当时未伴肢体乏力及不适,遂行黏液瘤切除术并修补房间隔缺损。术后病理证实为左心房黏液瘤,术后3个月及1年复查心脏彩超均未见黏液瘤复发。2d前患者感头部轻度胀痛,以右侧头部为主,头痛持续存在,程度无加重。伴恶心,不伴呕吐。伴发作性左侧肢体乏力,每次发作持续约30min,而后自行缓解。无头晕及肢体抽搐。     

全胸腔镜下左心房黏液瘤切除15例

目的 总结15 例全胸腔镜左房黏液瘤切除术的初步经验,探讨全胸腔镜下心内手术的安全性和适应证.方法 2012年1 月至2013 年10 月,收治15例左房黏液瘤患者,女性10 例,男性5 例,其中5例合并二尖瓣关闭不全行二尖瓣成型术.全身麻醉下,双腔气管插管,采用股动静脉插管、右侧颈内静脉引流进行体外循环.右侧胸壁3个1～2 cm切口,在全胸腔镜下行左房黏液瘤切除术.结果 15 例手术均顺利进行.1例因瘤蒂位于左房底,瘤体大暴露困难,正中切口开胸手术,其余均全腔镜下完成手术.体外循环（40±15）min,升主动脉阻断（30±12）min,术后呼吸机辅助（4.5±1.4）h,术后住院（5.6±1.3）d.无大出血、术后再次开胸止血、脑栓塞等并发症.术后病理检查,1例为左房肉瘤,其余均为左房黏液瘤.结论 全胸腔镜左房黏液瘤切除技术可行、安全,既减少了常规正中开胸的手术创伤,又没有过度延长体外循环时间造成的进一步全身器官损害,有利于患者的术后早日康复,手术切口小、美观.     

左心房黏液瘤误诊为肺栓塞一例

患者女性 ,5 5岁 ,因“胸闷、憋气进行性加重 10个月余”于 2 0 0 3年 2月 10日入院。患者自 2 0 0 2年 4月 ,无明显诱因出现胸闷、憋气 ,开始为平卧时感胸闷、气短 ,坐起后好转 ,活动后无明显症状 ,之后逐渐加重 ,夜间时常憋醒 ,干重活、平地快走及登楼时感胸闷、呼吸困难 ;3个月前发展至不能平卧 ,稍活动即出现呼吸困难。曾于外院诊断为“肺栓塞”给于溶栓、抗凝治疗后 ,症状稍有缓解 ,但溶栓前后的放射性核素扫描检查 ,均未发现下肢血栓及典型肺栓塞的证据 ,未做心脏彩色超声波检查。出院后患者继续口服“华法林” ,于半个月前停药。患者…     

脑栓塞为首发症状左心房黏液瘤合并早孕1例

正脑栓塞最常见于中老年患者,若年轻患者出现脑栓塞症状,应积极考虑其心脏疾病存在,左心房黏液瘤是最常见心脏良性肿瘤,约占心脏肿瘤75%,之前报道男女发病比例约1∶3[1-2],近年来报道约1∶2[3],虽属良性,但肿瘤表面附着血栓或瘤体破裂易导致周围血管栓塞,出现严重并发症,降低患者生存质量,大约20%~45%的患者首发症状为栓塞,其中50%为脑栓塞。现将本院收治的以脑栓塞为首发症状,早孕为诱因致心力衰竭的左心房黏液瘤1例,报道如下。患者女性,28岁,主因"活动后心慌、气短1个月,伴咳     

左心房黏液瘤致右下肢动脉栓塞伴阵发性室上性心动过速1例

心房黏液瘤为最多见的良性心脏肿瘤,约占心脏原发肿瘤的75%,占心外科患者的0.3%,常因肿瘤碎片或瘤表面血栓形成脱落导致体循环和肺循环栓塞,发生率约为40%[1].肿瘤堵塞房室瓣口可导致昏厥、阿一斯综合征,严重猝死威胁患者生命安全,故早期诊断、早期手术是很重要的.     

Giant right atrial myxoma leading to cardiac arrest in an infant

We present the case of a three-month-old infant with a giant right atrial myxoma obstructing the tricuspid valve, who following haemodynamic deterioration and cardiac arrest, was operated upon as an emergency. On echocardiogram, there was a mass attached to the tricuspid annulus, in close proximity to the septal leaflet, with dimensions of 16.6 × 12.5 mm. The mass was prolapsing through the tricuspid valve into the right ventricle and obstructing the inflow. While preparing for surgery, cardiac arrest occurred, so the patient underwent an emergency operation under cardiopulmonary resuscitation. The mass was excised without damaging the tricuspid valve and the conduction system. Histologically, the mass consisted of a myxoid matrix with scatted globoid and star-shaped myxoma cells. The patient stayed 15 days in the intensive care unit and was discharged home on the 20th day postoperatively. Although accepted as a benign tumour, a myxoma can display an aggressive clinical course in infants. In centres where cardiac operations cannot be performed, these patients need to be transferred to cardiac centres as soon as possible. Whatever the clinical presentation, we advocate immediate surgical extirpation of the tumour in order to avoid any unpredictable consequences in its clinical course.     

Pergolide-induced dyspnea, bilateral pleural effusion and peripheral edema

A patient with severe Parkinson's disease presented with increasing dyspnea, bilateral pleural effusion and peripheral edema that were refractory to diuretic therapy and were first misdiagnosed as signs of right-sided heart failure. Pergolide was the only culprit for this devastating condition and on its discontinuation all signs of fluid retention resolved. In this report, drug reactions to ergots and dopamine agonists are discussed.     

Spontaneous course of myxoma of the left atrium

Little is known about the natural history of left intra-atrial myxomas. We report 3 cases of that disease where successive echocardiographic examinations provided figures of 11, 12 and 14 months respectively for the formation of the tumour in the left atrium. Echocardiography is perfectly reliable for the diagnosis of myxoma. False-negative results are rare and usually due to very small myxomas being beyond the resolution potential of the instrument; this seems to have been the case in 2 of our 3 patients. Two data, however, remain unknown: the beginning of formation and the rapidity of tumoral growth. These 3 cases raise the problem of repeat echocardiography some time after a cerebral accident of suspected embolic origin, when the initial examination is negative.     

Constrictive pericarditis localized to left ventricle presented with left pleural effusion: a case report

An 18-year old woman presented with progressive dyspnea and cough. Physical examination revealed decreased breath sounds at the left hemithorax and distant heart sounds with no murmurs or rub. Electrocardiogram revealed low voltage. Chest X-ray showed unilateral left-sided pleural effusion with no cardiomegaly. Transthoracic echocardiogram showed thickened pericardium localized throughout the left ventricle impairing the diastolic filling. Doppler waveforms were suggestive of localized constrictive pericarditis. A computerized tomographic scan of the chest confirmed the presence of unilateral pleural effusion with thickened pericardium surrounding the left ventricle. The patient's symptoms and signs were related to localized constrictive pericarditis and improved following surgery.     

Secondary carcinoma of left atrium simulating myxoma.

Three cases are presented in which secondary carcinoma in the left atrium mimicked atrial myxoma or infective endocarditis. Constitutional features of weight loss, fever, anaemia, leucocytosis, raised erythrocyte sedimentation rate, and systemic emboli were prominent clinical features. The association of these systemic manifestations with both secondary deposits in the atrium and atrial myxomata may be the result of an immune response to circulating tumour antigens. Mitral stenosis was present in two of the three patients suggesting that left atrial thrombus may provide a site for the seeding of malignant cells.     

Pulsed Doppler transmitral flow in a case of myxoma of the left atrium

This work deals with transmitral flow studied with Range Gate Pulsed Doppler Echocardiography in a 73 year old man affected by left atrial myxoma. The dominant clinical picture was pleural effusion and dyspnoea. Neither syncope nor systemic emboli were reported. Echocardiography (TM and 2D) and surgical inspection showed a large moving tumor connected to the interatrial septum with a short stalk. The histological examination gave evidence of myxoma. Range Gate Pulsed Doppler Echocardiography, using the apical four chamber view, was performed with the sample volume between the mitral leaflets and tumor. Peak velocities were normal, indicating no diastolic a-v gradient, probably the size of the tumor interfered with left atrial filling. The flow between the anterior leaflet and tumor was only protodiastolic: the myxoma leaning on the leaflet just after the opening stopped the blood stream. The flow between the posterior leaflet and tumor was variable, with single or multiple velocity peaks (early, middle and end diastole): this was probably caused by the intermittent obstruction of the a-v ostium. These data agree with the variability of the auscultation in the left atrial myxoma and show that the flow pattern is different from that of mitral stenosis.