心脏肿瘤_Cynthia.pptVIP

Cardiac Tumors Cynthia Taub, M.D., F.A.C.C., F.A.S.E. Director, Non-invasive Cardiology Director, Women’s Heart Health Center Einstein Division Montefiore Medical Center October 2009 Dyspnea A 33 year old male presented with dyspnea on exertion for 1 week No angina, palpitations, syncope, fever, night sweats or weight loss Optimal Approach for Biopsy最佳活检方式 1. Right heart cath右心导管 2. Mediastinoscopy纵隔镜 3. Anterior Mediastinotomy前纵隔切开(Chamberlain procedure) 4. Thoracotomy开胸 Biopsy 1 Non-specific fibrous tissue and fibrinoid material 非特异性纤维组织和纤维素样物质 Biopsy 2 PET Scan Hypermetabolic region in the anterosuperior mediastinum前上纵隔高代谢灶 Intense uptake corresponding to prevascular and right paratracheal lymphadenopathy血管前、气管旁淋巴结呈高摄取 No bone marrow involvement无骨髓累及 Treatment Systemic chemotherapy with Ommaya reservior/CNS prophylaxis 全身化疗：Ommaya贮器/CNS 预防 Surgery has limited role手术治疗价值有限 Burkitt’s Lymphoma in HIV(-) adult 1-2% of lymphoma in adults in the US Fast growing Usually involves abdomen May respond to chemotherapy Anterior Mediastinal Masses前纵隔肿块 Thymoma胸腺瘤 Lymphoma淋巴瘤 Germ cell tumor生殖细胞肿瘤 Mediastinal cysts纵隔囊肿 Mediastinal thyroid tissue纵隔异位甲状腺组织 Parathyroid tissue甲状旁腺组织 A 45 year old waitress complains of dyspnea Myxoma粘液瘤 Most common primary cardiac tumor (20-30%) Most common location: LA with attachment to atrial septum左房贴近房间隔 Appear gelatinous and friable胶样、脆弱外观 Embolic events AV valve obstruction房室瓣梗阻 Carney’s complex (autosomal dominant, 7% of all myomas) Recurrent, need follow-up Angiosarcoma血管肉瘤 7.3% of all cardiac tumors Most common malignant primary cardiac tumor最为常见的原发性恶性心脏肿瘤 Occurs most commonly in the RA in conjunction with pericardial effusion最常见于右房伴心包积液 Cardiac Tumors Primary cardiac masses原发性心脏肿瘤 Benign良性 malignant恶性 Metastatic cardiac masses转移性心脏肿瘤 Fake-outs “假性肿瘤” Thrombus血栓 Vegetations赘生物 Artifact伪影 What Are The Cardiac Manifestations? Depend on LOCATION, LOCATION, LOCATION! Cardiac Manifestations LA: most common site for benign tumo