摘要
目的分析超声漏诊、误诊无顶冠状静脉窦综合征(UCSS)病例,提高术前诊断准确性。方法回顾性分析2013年1月至2021年1月华中科技大学同济医学院附属协和医院心外科手术患者中术前超声漏诊和误诊的UCSS病例13例,观察超声图像及图像描述,包括成像质量、重要切面显示情况、图像关键特征等,并与手术结果对照。结果13例病例中,漏诊4例,包括3例Ⅰa型和1例Ⅱa型。误诊9例,包括将UCSS误诊为原发孔型房间隔缺损(ASD)2例、继发孔型ASD 2例、下腔静脉型ASD 1例,另将1例下腔静脉型ASD、2例右肺静脉异位引流心内型、1例永存左上腔静脉(PLSVC)所致的冠状静脉窦(CS)增宽误诊为UCSS。漏诊病例中2例未扫查CS及PLSVC相关切面,1例留存部分相关切面但不能识别UCSS,1例因声窗差不能显示PLSVC。5例将UCSS误诊为其他疾病者,均未专门扫查CS及PLSVC,仅无意中留存部分切面,且对切面中连续中断、异常血流所处的位置、分流束的走行及形态解读错误。4例将其他疾病误诊为UCSS者,术前均针对CS及PLSVC进行专门扫查,但因CS扩张、移位而忽视其存在,从而误判为CS完全缺失,或因窦壁迂曲、薄弱而回声失落,在附近血流信号干扰下错误解读为窦壁缺损及其分流。结论UCSS漏诊和误诊与检查者认识不足、扫查手法不熟练、对窦壁与房间隔连续中断及其异常血流解读错误等因素有关。提高UCSS诊断警惕性,加强其与ASD、心内型肺静脉异位引流等的鉴别意识,可提高术前超声诊断准确性。
Objective To analyze the cases of missed and misdiagnosis of unroofed coronary sinus syndrome(UCSS)by ultrasound to improve the accuracy of preoperative diagnosis.Methods Thirteen cases of UCSS examined by preoperative echocardiography and undergoing cardiac surgery at Union Hospital,Tongji Medical College,Huazhong University of Science and Technology were retrospectively analyzed from January 2013 to January 2021.The ultrasound images and image description,including imaging quality,the display of important sections of the coronary sinus(CS)and persistent left superior vena cava(PLSVC),and the key image features,were reviewed and compared with the surgical results.Results Four UCSS cases were missed,including 3 type Ia and 1 type IIa.Nine cases were misdiagnosed,among which UCSS was misdiagnosed as primary foramen atrial septal defect(ASD)in 2 cases,as secondary foramen ASD in 2,and as inferior vena cava ASD in 1.In addition,4 cases,including 1 case of inferior vena cava ASD,2 cases of intracardiac anomalous right pulmonary venous drainage,and 1 case of CS widening caused by PLSVC,were misdiagnosed as UCSS.In patients with a missed diagnosis,the relevant sections of the CS and PLSVC were not scanned completely in two cases,1 case stored partial sections were stored and the septal defect of the CS was not identified in 1,and PLSVC was missed due to poor acoustic window in 1.In 5 cases with UCSS misdiagnosed as other malformations,special CS and PLSVC sections were not closely observed but only some sections were stored unintentionally.What's more,the position of defect,abnormal blood flow,and the course and shape of shunt bundle were misinterpreted.In 4 cases with other cardiovascular malformations misdiagnosed as UCSS,the CS and PLSVC were scanned before operation.However,the CS was ignored and misjudged as complete absence due to its expansion and displacement,or misinterpreted as sinus wall defect with its shunt under the influence of echo loss due to its tortuous and weak sinus wall and nearby blood flow signals.Conclusion Missed diagnosis and misdiagnosis of UCSS by ultrasound are mainly related to the lack of vigilance or unskilled scanning of the examiners,and wrong interpretation of the defect on the sinus wall or atrial septum and relevant abnormal blood flow.The accuracy of preoperative ultrasound diagnosis can be significantly improved by more vigilance of UCSS and more differential diagnostic knowledge between UCSS and ASD or intracardiac anomalous pulmonary venous drainage.
作者
许春燕
谢明星
方凌云
贺林
纪莉
吴文谦
彭源
杨亚利
Xu Chunyan;Xie Mingxing;Fang Lingyun;He Lin;Ji Li;Wu Wenqian;Peng Yuan;Yang Yali(Department of Ultrasound Medicine,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Hubei Province Key Laboratory of Molecular Imaging,Wuhan 430022,China)
出处
《中华医学超声杂志（电子版）》
CSCD
北大核心
2022年第10期1083-1090,共8页
Chinese Journal of Medical Ultrasound(Electronic Edition)
基金
科技部数字诊疗研发装备(2018YFC0114602)
国家自然科学基金(81000615)
华中科技大学同济医学院研究型临床医师项目(5001530051)。
关键词
无顶冠状静脉窦综合征
漏诊
误诊
房间隔缺损
肺静脉异位引流
Unroofed coronary sinus syndrome
Missed diagnosis
Misdiagnosis
Atrial septal defect
Anomalous pulmonary venous drainage
