心源性栓塞患者的超声检查

1、目 录n栓子的分类及来源n心源性栓塞的超声表现n容易被误诊为血栓的心腔内正常结构心源性栓塞的栓子分类心源性栓塞的栓子来源室壁瘤内血栓自体瓣膜赘生物人工瓣膜赘生物粘液瘤自体瓣膜肿瘤左心耳血栓主动脉内血栓-斑块PFO的逆行血栓高风险中风险低风险心房颤动室壁瘤卵圆孔未闭近期前壁心肌梗死人工生物瓣房间隔膨胀瘤人工机械瓣充血性心力衰竭左房自发显影风湿性二尖瓣狭窄扩张型/限制型心肌病感染性心内膜炎二尖瓣脱垂心源性栓塞的疾病风险分层目 录n心源性栓塞患者的分类及来源n心源性栓塞的超声表现n容易被误诊为血栓的心腔内正常结构栓子超声表现左心房血栓/肿瘤风心病血栓乒乓球样血栓房颤合并心房内血栓左心房粘液瘤栓子超声

2、表现左心房血栓/肿瘤左心房粘液瘤栓子超声表现自发显影左心房重度自发显影左心房重度自发显影+左心耳血栓栓子超声表现左心室血栓/肿瘤栓子超声表现自体瓣膜疾病二尖瓣感染性心内膜炎赘生物二尖瓣抗磷脂抗体综合征赘生物Lambls excrescence-线状赘生物栓子超声表现自体瓣膜疾病Marantic endocarditis：又翻译为消耗性心内膜炎、恶病质性心内膜炎主要见于肿瘤、HIV患者终末期。二尖瓣及主动脉瓣均可以受累超声表现为非感染性赘生物形成，可脱落导致周围动脉栓塞 栓子超声表现自体瓣膜疾病Aortic valve calcified debris. Pre-TAVR midesophage

3、al long-axis transesophageal echocardiographic diastolic still frame of the aortic valve and proximal aorta reveals a 1.3-cm elongated, echogenic mass (arrow) attached to the aortic side of the calcified aortic valve. This likely represents calcific debris. 栓子超声表现自体瓣膜疾病乳头状弹力纤维瘤： PFE is the second mo

4、st common pri- mary cardiac tumor in adults. They are predominantly located on the cardiac valves (80%), with the highest prevalence on the aortic valve, followed by the MV. However, they may be seen on any endo- cardial surface. When located to the valves, they are typically on the aortic side of t

5、he aortic valve and on the ventricular side of the MV (downstream); this is exactly the opposite of the typical location of IE lesions. PFEs rarely cause significant valvular dysfunction. 栓子超声表现自体瓣膜疾病n Native aortic valve endocarditis. (A)Midesophageal long-axis shows a large posterior root cavity (

6、arrow), compatible with root abscess/pseudoaneurysm complicating native aortic valve endocarditis.(B)Color Doppler on midesophageal long-axis TEE view in systole demonstrates communication between the left ventricle and abscess cavity in systole.(C)Video corresponds to (B) and depicts the pulsatile

7、quality of this root abscess/pseudoaneurysm, as it fills with blood in systole and empties into the left ventricle in diastole.栓子超声表现自体瓣膜疾病栓子超声表现人工瓣膜异常机械瓣心内膜炎：赘生物形成（A）、瓣周瘘（B）栓子超声表现人工瓣膜异常栓子超声表现人工瓣膜异常栓子超声表现人工瓣膜异常栓子超声表现人工瓣膜异常栓子超声表现人工瓣膜异常栓子超声表现人工瓣膜异常栓子超声表现血管异常矛盾栓塞的解剖基础卵圆孔未闭矛盾栓塞的血栓来源深静脉血栓矛盾栓塞的血栓来源右心房血栓矛盾栓塞的血栓来源右心室血栓栓子超声表现骑跨血栓警惕同时合并的肺栓塞右心声学造影目 录n心源性栓塞患者的分类及来源n心源性栓塞的超声表现n容易被误诊为血栓的心腔内正常结构正常超声征象超声微泡化效应正常超声征象欧式瓣正常超声征象右心房界嵴正常超声征象华法林嵴正常超声征象房间隔脂肪瘤样肥厚正常超声征象调节束小结