pericardial tumor
Introduction
Introduction to pericardial tumor Pericardial tumors are very rare. Primary benign pericardial tumors include lipoma, lobulated fibrous polyps, hemangiomas, and teratomas. Primary malignant tumors are mesothelioma and sarcoma, widely distributed, often infiltrating tissues. Secondary tumors, which spread directly from the chest, involve the pericardium, the most common being bronchial lung cancer and breast cancer. basic knowledge The proportion of illness: 0.0002% Susceptible people: no specific population Mode of infection: non-infectious Complications: pleural effusion, atelectasis, pericardial effusion, hypotension
Cause
Pericardial tumor cause
Primary factor (45%):
Primary pericardial tumors may develop from embryonic remnants, including benign tumors (most common), pericardial cysts, lipomas, hemangioma, and smooth muscle fibroids.
Secondary factors (55%):
Pericardial secondary tumors are more common than primary tumors. Among them, malignant tumors of various organs in the body are transferred to the pericardium, such as breast cancer, AJ-German's disease, leukemia and malignant melanoma; malignant tumors directly spread to the pericardium, usually bronchial lung cancer, breast cancer, mediastinal malignant tumor (fine Source cell tumor, embryogenic carcinoma, pheochromocytoma, etc.).
Prevention
Pericardial tumor prevention
1. Pericardial tumor prevention must first maintain an optimistic mood and establish a strong confidence to overcome.
2, proper exercise can make the blood flow smooth, enhance the body's resistance. Avoid being affected by the cold, "every disease from the cold", when the body is affected by the cold, the resistance is reduced, easy to induce disease.
3, diet should be light and rich in nutrition. Eat more vegetables, vitamins, protein and digestible nourishing foods.
4. Eat less greasy food; eat less warm meat such as dog meat and lamb; eat less seafood without shells.
Complication
Pericardial tumor complications Complications, pleural effusion, pulmonary insufficiency, pericardial effusion, hypotension
Tumor treatment itself can cause a series of complications, which are also found in cases of pericardial tumors, including:
(1) Complications caused by pericardial tumor itself: pleural effusion;
Pleural effusion: patients often present with difficulty breathing, cough and chest pain, and some are asymptomatic at onset. Due to mechanical limitations of lung expansion, lung volume is reduced and lung atelectasis and recurrent infection are prone to occur. Typical signs may have percussion dullness. The respiratory sound is reduced and the vocal tremor is reduced. The chest X-ray examination can confirm the presence or absence of effusion, and should be carefully examined for the presence of concurrent mediastinal lymphadenopathy.
Pericardial effusion: some of the pericardial effusion can be asymptomatic, especially those with slower development; some may have anterior region, rib arch and upper abdominal pain or venous engorgement, hypotension, typical symptoms of pericardial tamponade Heart sound is low and odd pulse, physical examination can appear heart expansion, jugular vein congestion, hepatomegaly, venous pressure and Ewart disease, chest X-ray and chest X-ray are helpful for diagnosis, low voltage and extensive on ECG Changes, cardiac ultrasound mapping and 2 echoes can be diagnosed.
(2) Complications caused by treatment of pericardial tumors: complications caused by anti-tumor drugs, complications caused by radiotherapy, complications of immunotherapy, complications of surgical treatment;
(3) Complications in the treatment of pericardial tumors: infection.
With the development of tumor therapy, infection has become the most common complication and major cause of death in cancer patients. This is related to the existence of a series of infection susceptibility factors in cancer patients: immune deficiency, barrier defense destruction, neutropenia and Tumor itself causes edema, erosion, ulceration, necrosis, compression and obstruction are beneficial to the occurrence of infection.
Symptom
Pericardial tumor symptoms Common symptoms Bloody exudate fatigue chest pain end breathing intra-breathing hypertension nodules pericardial tamponade pulse pressure small dry cough
First, primary cardiac tumor
Many pericardial tumors have no characteristic symptoms and signs, or early asymptomatic and physical signs, or appear late, or occasionally found, or found at autopsy. The symptoms and signs of pericardial primary tumors can be roughly divided into two categories.
1. Pericardial tumor itself causes symptoms and signs:
(1) Hypertensive symptoms caused by pheochromocytoma itself;
(2) Pericardial hemorrhage caused by mesothelioma or sarcoma;
(3) fever, fatigue and chest pain and bloating discomfort caused by malignant pericardial tumors.
2. Pericardial tamponade caused by pericardial tumors and signs:
(1) dry cough, shortness of breath, sitting breathing;
(2) A few cases can hear pericardial friction sounds, resulting in symptoms and signs similar to "constrictive pericarditis" when pericardial tamponade, such as hepatomegaly, jugular vein engorgement, elevated venous pressure, small pulse pressure, odd pulse Wait.
Second, secondary cardiac tumors
Most of the symptoms and signs of pericardial effusion and pericardial tamponade, and the symptoms of primary organ malignant tumors, often more important than the symptoms and signs of pericardial tumors, so no characteristics, sometimes found in pericardial metastatic tumors.
When diagnosing primary cancerous lesions (such as lung cancer), if pericardial and cardiac morphological abnormalities are found, accompanied by pericardial effusion and pericardial tamponade, the possibility of secondary pericardial tumor should be considered, and pericardial puncture should be taken out. In the case of bloody fluids, the diagnosis is established.
Examine
Pericardial tumor examination
X-ray inspection
Heart shape changes, heart shadow enlargement, pericardial effusion, a small amount of pleural effusion, teratoma can be seen in the pericardial calcification area.
2. Color Doppler supercardiogram check
A lump and pericardial effusion protruding from the pericardium can be displayed.
3. CT examination
Can suggest the location and nature of some tumors
Such as pericardial cyst:
12/3 is located in the right anterior palpebral angle and is located on the diaphragm;
2 typical teardrops are placed next to the pericardium, and the edges are smooth and sharp;
3 The wall of the capsule is thin, most of which contains pure liquid, CT value 0-20HU.
Another example is pericardial mesothelioma:
1 The pericardium is irregularly thickened, and the leading edge can be seen as a nodular tissue-like lung;
2 a large amount of fluid in the pericardium, bilateral pleural effusion, right coronary artery calcification.
4. Cardioangiography
When the diagnosis is very difficult, the extracardiac compression zone can be displayed.
Diagnosis
Diagnosis and diagnosis of pericardial tumor
diagnosis
The diagnosis of pericardial tumors is difficult, and in the diagnosis of other diseases, pericardial tumors are considered after careful analysis.
1. The outline of the heart shadow is abnormal, the local protrusion is irregular, or it is nodular, and the localized calcification area on the pericardium is found by X-ray examination.
2. Repeated episodes of pericardial effusion, especially bloody exudate, but lack of history and symptoms of inflammatory lesions (such as tuberculosis).
3. For obvious reasons, difficult to control heart failure, especially those with significant venous pressure, liver enlargement, ascites or persistent edema, should be highly suspected of pericardial tumors.
4. Unexplained chest pain, small pulse pressure, odd pulse and obstruction of superior vena cava.
5. CT and MRI examination can confirm the diagnosis of pericardial tumors.
Differential diagnosisPericardial tumors are easily misdiagnosed as tuberculous pericarditis and need to be strictly identified. The main reasons for misdiagnosis of this disease are as follows:
(1) Both can be more insidious, and the symptoms of pericardial effusion can be light or heavy.
(2) Both can gradually lose weight and have low fever.
(3) Both of them may have bloody pericardial effusion.
(4) Tuberculous pericarditis is the most common pericardial disease in the past.
(5) Lack of awareness and vigilance of pericardial metastases.
In addition, the disease needs to be differentiated from viral myocarditis, pericarditis, myocardial infarction and pericarditis.
