延?xùn)|娥，陳新云，張 俊

(成都市第一人民醫(yī)院心功能科，四川 成都 610041)

巨大特發(fā)性肺動脈瘤1例

延?xùn)|娥，陳新云*，張 俊

(成都市第一人民醫(yī)院心功能科，四川 成都 610041)

圖1 肺動脈主干及左肺動脈瘤聲像圖 (RPA：右肺動脈；LPA：左肺動脈) 圖2 肺動脈內(nèi)渦流聲像圖

患者女，77歲，因“活動后心累氣促3年”入院。超聲心動圖檢查：各房室腔大小及室壁厚度測值正常，肺動脈主干(近心端61 mm，近分叉處84 mm)及左肺動脈(57 mm)呈瘤樣擴張，右肺動脈稍增寬(27 mm)，內(nèi)未見確切夾層、血栓及其他異常回聲(圖1)；雙側(cè)心室收縮功能正常；CDFI：三尖瓣微量反流，肺動脈瓣前向血流通暢，肺動脈內(nèi)血流呈低速渦流(圖2)，心內(nèi)及大血管水平未見分流；超聲診斷：肺動脈主干及左肺動脈瘤。胸部CT平掃：肺動脈主干及左肺動脈增寬，提示肺動脈高壓。冠狀動脈造影、心電圖、頸動脈超聲檢查未見異常；血常規(guī)、免疫學(xué)全套、腫瘤標志物、血沉、C-反應(yīng)蛋白、甲狀腺功能、肝腎功能、血糖、血脂、血清酶學(xué)等實驗室檢查結(jié)果均正常。

討論 肺動脈瘤診斷標準為：肺動脈主干內(nèi)徑超過40 mm或正常值的1.5倍；或肺動脈內(nèi)徑/主動脈瓣環(huán)內(nèi)徑>2。明顯超過上述標準稱為巨大肺動脈瘤。巨大肺動脈瘤分為特發(fā)性和繼發(fā)性兩大類，無明確病因者為特發(fā)性肺動脈瘤，常無明顯

癥狀卻有潛在無法預(yù)測的生命危險；多數(shù)肺動脈瘤是其他疾病的繼發(fā)性改變，包括導(dǎo)致肺動脈高壓的疾病(如先天性心臟病和肺源性心臟病)、高速血流沖擊肺動脈壁致擴張(如肺動脈瓣狹窄)、免疫系統(tǒng)疾病血管炎性損傷(如白塞病)、腫瘤、動脈粥樣硬化、感染和外傷等。巨大特發(fā)性肺動脈瘤病理改變可能為肺動脈中層節(jié)段性缺如、中層囊性變性、肌纖維發(fā)育不良或動脈壁纖維化鈣化等；其臨床表現(xiàn)無特異性，多為原發(fā)疾病和肺動脈高壓及瘤體壓迫周圍組織而出現(xiàn)的相應(yīng)癥狀，如呼吸困難、活動耐量降低、心悸和胸悶等，致命性并發(fā)癥包括破裂、夾層和肺動脈栓塞。超聲確診肺動脈瘤容易，但有時需與鄰近肺動脈的心包囊腫相鑒別：肺動脈瘤的多切面正向和逆向追蹤掃查均可見瘤樣擴張的肺動脈與右心室流出道及肺動脈瓣連接，并隨后分為左、右肺動脈，而心包囊腫為一獨立的囊性結(jié)構(gòu)，不與心內(nèi)任何結(jié)構(gòu)相通。肺動脈瘤的治療應(yīng)針對原發(fā)疾病并密切隨訪，高?；颊咄扑]外科治療以緩解癥狀和減少發(fā)生致命性并發(fā)癥。

[Key words] Thyroid imaging reporting and data system; Contrast-enhanced Ultrasound; Thyroid papillary carcinoma

DOI：10.13929/j.1003-3289.201608130

Echocardiography; Pulmonary; Aneurysm [關(guān)鍵詞] 超聲心動描記術(shù)；肺；動脈瘤

Giant idiopathic pulmonary artery aneurysm: Case report

CEUS in diagnosis of TI-RADS 3, 4 thyroid nodules

WANGYanfang1,NIEFang1*,GENGXiangliang1,SONGAilin2

(1.DepartmentofUltrasound, 2.DepartmentofGeneralSurgery,LanzhouUniversitySecondHospital,Lanzhou730030,China)

Objective To explore the diagnostic value of CEUS for thyroid TI-RADS 3, 4 nodules. Methods The CEUS performence of 95 patients with thyroid TI-RADS 3, 4 nodules (all were confirmed by surgery pathology) diagosed by conventional ultrasound were reviewed retrospectively, and the value of CEUS in the revision and differential diagnosis of thyroid TI-RADS 3, 4 nodules were analyzed. Results Compared with pathological pattern, conventional ultrasound TI-RADS classifications in assessing the property of thyroid nodule had no statistical differences (χ2=3.56,P=0.06). For thyroid TI-RADS 3, 4 nodules, compared with conventional ultrasound TI-RADS classifications, the diagnosis accuracy of CEUS score and revised CEUS TI-RADS classifications showed significant differeces respectively (P=0.03, <0.01) for thyroid papillary carcinoma greater than 1 cm. But no statistical difference were found respectively (P=0.25, 1.00) for thyroid papillary carcinoma smaller than 1 cm. According to the ROC curve analysis, the area under the curve of traditional ultrasound TI-RADS classifications, CEUS score and revised CEUS TI-RADS classifications were 0.64, 0.75, 0.81 respectively, cut-off value was TI-RADS 4a, 1 score, TI-RADS 4a respectively, the sensitivity and specificity of evaluating benign and malignant nodules was 45.3% and 80.0%, 69.3% and 65.0%, 82.7% and 60.0%, respectively. The area under the ROC curve were statistical difference between CEUS score, revised CEUS TI-RADS classifications and conventional ultrasound TI-RADS classifications (bothP<0.05), while CEUS score and revised CEUS TI-RADS classifications without statistical difference. Conclusion CEUS had the revised and improved identification value for thyroid TI-RADS 3, 4 nodules.

成都市衛(wèi)生局青年基金課題(2013079)。

延?xùn)|娥(1980—)，女，山西臨縣人，碩士，主治醫(yī)師。

E-mail: 545095524@qq.com

陳新云，成都市第一人民醫(yī)院心功能科，610041。

E-mail: cissy1002@126.com

2016-10-31

2016-12-20

10.13929/j.1003-3289.201610157

R543.2; R540.45

B

1003-3289(2017)03-0385-01