巨大特发性肺动脉瘤1例

延东娥，陈新云，张 俊

(成都市第一人民医院心功能科，四川 成都 610041)

巨大特发性肺动脉瘤1例

延东娥，陈新云*，张 俊

(成都市第一人民医院心功能科，四川 成都 610041)

图1 肺动脉主干及左肺动脉瘤声像图 (RPA：右肺动脉；LPA：左肺动脉) 图2 肺动脉内涡流声像图

患者女，77岁，因“活动后心累气促3年”入院。超声心动图检查：各房室腔大小及室壁厚度测值正常，肺动脉主干(近心端61 mm，近分叉处84 mm)及左肺动脉(57 mm)呈瘤样扩张，右肺动脉稍增宽(27 mm)，内未见确切夹层、血栓及其他异常回声(图1)；双侧心室收缩功能正常；CDFI：三尖瓣微量反流，肺动脉瓣前向血流通畅，肺动脉内血流呈低速涡流(图2)，心内及大血管水平未见分流；超声诊断：肺动脉主干及左肺动脉瘤。胸部CT平扫：肺动脉主干及左肺动脉增宽，提示肺动脉高压。冠状动脉造影、心电图、颈动脉超声检查未见异常；血常规、免疫学全套、肿瘤标志物、血沉、C-反应蛋白、甲状腺功能、肝肾功能、血糖、血脂、血清酶学等实验室检查结果均正常。

讨论 肺动脉瘤诊断标准为：肺动脉主干内径超过40 mm或正常值的1.5倍；或肺动脉内径/主动脉瓣环内径>2。明显超过上述标准称为巨大肺动脉瘤。巨大肺动脉瘤分为特发性和继发性两大类，无明确病因者为特发性肺动脉瘤，常无明显

症状却有潜在无法预测的生命危险；多数肺动脉瘤是其他疾病的继发性改变，包括导致肺动脉高压的疾病(如先天性心脏病和肺源性心脏病)、高速血流冲击肺动脉壁致扩张(如肺动脉瓣狭窄)、免疫系统疾病血管炎性损伤(如白塞病)、肿瘤、动脉粥样硬化、感染和外伤等。巨大特发性肺动脉瘤病理改变可能为肺动脉中层节段性缺如、中层囊性变性、肌纤维发育不良或动脉壁纤维化钙化等；其临床表现无特异性，多为原发疾病和肺动脉高压及瘤体压迫周围组织而出现的相应症状，如呼吸困难、活动耐量降低、心悸和胸闷等，致命性并发症包括破裂、夹层和肺动脉栓塞。超声确诊肺动脉瘤容易，但有时需与邻近肺动脉的心包囊肿相鉴别：肺动脉瘤的多切面正向和逆向追踪扫查均可见瘤样扩张的肺动脉与右心室流出道及肺动脉瓣连接，并随后分为左、右肺动脉，而心包囊肿为一独立的囊性结构，不与心内任何结构相通。肺动脉瘤的治疗应针对原发疾病并密切随访，高危患者推荐外科治疗以缓解症状和减少发生致命性并发症。

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

DOI：10.13929/j.1003-3289.201608130

Echocardiography; Pulmonary; Aneurysm [关键词] 超声心动描记术；肺；动脉瘤

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.

成都市卫生局青年基金课题(2013079)。

延东娥(1980—)，女，山西临县人，硕士，主治医师。

E-mail: 545095524@qq.com

陈新云，成都市第一人民医院心功能科，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