冠心病三支血管病变伴左心室憩室超声表现1例

2018-02-21 佚名 中华超声影像学杂志

患者男,56岁

【一般资料】

患者男,56岁

【既往史】

既往有高血压糖尿病史多年

【主诉】

本次因“胸椎管狭窄”入院。

【辅助检查】

术前常规心脏超声检查发现左室下壁基底段心肌变薄,向外膨出约40mm×30mm(图1),部分切面可见附壁低回声,且该处心肌似与左室心肌呈同步运动,彩色多普勒未见明显血流出入该膨出的腔室,因受检时无明确的冠状动脉狭窄病史,提示该膨出部分为左室憩室可能。心电图示QT间期延长,T波改变。冠状动脉造影提示冠心病,多支病变,左前降支近段中重度狭窄,左旋支远端全闭,右冠状动脉近段全闭。左室造影可见左室下壁向外膨出部分显影,约39mm×28mm(图2),大小随心动周期无明显变化。





【治疗经过】

因为右冠状动脉全闭,结合临床考虑冠心病心肌梗死,左室下壁窒壁瘤形成,故行室壁瘤切除+左室成形+冠状动脉搭桥术。术中观察左室下壁膨出部与正常心肌分界清晰,无明显收缩运动,质较硬,切开显示膨出心肌较正常稍薄,仅见少许心肌组织,内膜面光滑,可见附壁血栓,术中诊断左室憩室。病理结果提示大量纤维组织及血栓形成,可见少许心肌细胞和滋养血管,结合临床考虑左室憩室。

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    2018-03-21 lofter

    学习了感谢分享

    0

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    2018-03-07 lofter

    学习了感谢分享

    0

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    2018-02-23 zutt
  8. [GetPortalCommentsPageByObjectIdResponse(id=1644650, encodeId=f37916446506e, content=<a href='/topic/show?id=e3eb89e17fb' target=_blank style='color:#2F92EE;'>#血管病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89717, encryptionId=e3eb89e17fb, topicName=血管病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=64bb23195917, createdName=Luyuxie_17, createdTime=Thu Mar 29 02:46:00 CST 2018, time=2018-03-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1632660, encodeId=e9601632660d4, content=<a href='/topic/show?id=676d92821e3' target=_blank style='color:#2F92EE;'>#超声表现#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=92821, encryptionId=676d92821e3, topicName=超声表现)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4dfe21938258, createdName=zhangjingnwpu, createdTime=Wed May 16 17:46:00 CST 2018, time=2018-05-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=298196, encodeId=628e2981966a, content=学习了感谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://q.qlogo.cn/qqapp/1103841572/C20CB8E4EBB36F5B821651C710BCB491/100, createdBy=18de1715848, createdName=lofter, createdTime=Wed Mar 21 06:06:47 CST 2018, time=2018-03-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=293792, encodeId=d7fd293e9247, content=学习了感谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://q.qlogo.cn/qqapp/1103841572/C20CB8E4EBB36F5B821651C710BCB491/100, createdBy=18de1715848, createdName=lofter, createdTime=Wed Mar 07 08:01:21 CST 2018, time=2018-03-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1391076, encodeId=36fe13910e61c, content=<a href='/topic/show?id=6d0689e19f0' target=_blank style='color:#2F92EE;'>#血管病变#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89719, encryptionId=6d0689e19f0, topicName=血管病变)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=85152500072, createdName=124987c6m36暂无昵称, createdTime=Fri Feb 23 07:46:00 CST 2018, time=2018-02-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1413217, encodeId=cac9141321ed2, content=<a href='/topic/show?id=1d7e48033f5' target=_blank style='color:#2F92EE;'>#左心室#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=48033, encryptionId=1d7e48033f5, topicName=左心室)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=15012955474, createdName=wushaoling, createdTime=Fri Feb 23 07:46:00 CST 2018, time=2018-02-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1522723, encodeId=0eb51522e2315, content=<a href='/topic/show?id=14d853e8918' target=_blank style='color:#2F92EE;'>#憩室#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=53789, encryptionId=14d853e8918, topicName=憩室)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=33b211483971, createdName=zutt, createdTime=Fri Feb 23 07:46:00 CST 2018, time=2018-02-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=290061, encodeId=10a429006127, content=学习了.谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7c592194322, createdName=1209e435m98(暂无昵称), createdTime=Fri Feb 23 00:44:32 CST 2018, time=2018-02-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=289878, encodeId=80752898e827, content=厉害了我的哥, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib3IzoRn621JdKCFUI4XvNELcibocrAVU6aUzEVDSaf3rYH08PUYUiagGqxAEhj8g9WqqNvD1CupIpCrmnR2OrqHZh/0, createdBy=7f181365728, createdName=飛歌, createdTime=Thu Feb 22 08:15:16 CST 2018, time=2018-02-22, status=1, ipAttribution=)]
    2018-02-23 1209e435m98(暂无昵称)

    学习了.谢谢分享

    0

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    2018-02-22 飛歌

    厉害了我的哥

    0

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