心脏肿瘤的鉴别诊断.ppt

DIFFERENTIAL DIAGNOSIS OF A CARDIAC MASS Masses in or around the heart are most often incidental findings on echocardiography. Less frequently, a tumor involving the heart causes direct symptoms that lead the clinician to suspect a cardiac abnormality. True intracardiac or extracardiac masses need to be distinguished from the entities in the following section. Eustachian valve Chiari network Bulging of the interatrial septum Annular calcification Fat deposition Pectinate muscles False tendons Aberrant muscle bands Subaortic membranes Moderator band Epicardial fat Pericardial fat 1. Normal Structures/Variants Simulating Tumors 2.Thrombus 4.Artifact 3.Vegetation In the right atrium, the Eustachian valve (also known as the valve of the inferior vena cava [IVC]) is a ridge of tissue that extends from the entry of the IVC to the interatrial septum. In fetal life, this valve directs blood to the fossa ovalis. It can remain prominent in adults, where it appears as a transverse linear echo running approximately parallel to the tricuspid annulus across the posterior right atrium in right ventricular inflow views, or in subcostal views. /bbs/threadFig.1. Subcostal images showing Eustachian valve (left, arrow) with directed flow on color Doppler examination (right). Fig.2.When present, the Eustachian valve (arrow) can be well visualized in the right ventricular inflow view.This patient’s tricuspid valves were thickened and immobile owing to the carcinoid syndrome. The Chiari network is similarly an embryonic remnant of the sinus venosus, which extends from and is continuous with the Eustachian valve. It persists in 2–3% of normal adults (confirmed by autopsy), and appears on ultrasound as a lacy weblike or fenestrated membranous echogenic mass with a characteristic chaotic, undulating motion independent from that of the tricuspid valve and right heart. Fig.3.Chiari’s network usually appears as a highly mobile undulating echogenic mass a