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【读片】产科疑难超声病例（334）：先天性肺气肿

wangjiankang120

常驻站友

106楼

1. 异位心（左移心），心脏右侧为均匀的实质回声，似肝回声。考虑膈疝（胸腔肝？）
2.未见胃泡
3.右下腹见一圆形低回声实质团块（畸胎瘤？）

2013-01-04 20:02

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• 首套【肺石医生】表情上架啦，一起斗图吧！

阿拉丁cs

超声科

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胸壁部分缺失

2013-01-04 20:10

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xihuansushi

超声科

丁香园荣誉版主

108楼

Case report

A 32-year-old G2P0 woman conceived by IVF-ICSI (intracytoplasmic sperm injection) presented to our facility at 16 weeks of pregnancy. Her previous pregnancy was terminated at 16 weeks due to hydrocephalus and abnormal cerebellar vermis of the fetus. No other risk factors of congenital anomalies were noted.
患者32岁，G2P0，经试管受精妊娠，孕16周来我处就诊。其前次妊娠因脑积水和小脑蚓部异常在孕16周时终止。患者未发现其他先天异常的危险因素。

Our ultrasound examination revealed noticeable dextroposition of the fetal heart, with no conspicuous changes of the lung parenchyma. The fetus was examined several times between 16 and 33 weeks and the initial striking cardiac dextroposition had resolved between 30 and 33 weeks. The lung parenchyma did not exhibit any remarkable changes in ultrasound imaging (maybe lightly more echogenic left lung).
我们超声检查发现胎儿心脏右移，而肺组织并未有明显异常。孕16-33间多次进行超声复查，孕30和33周检查时发现原先显著右移位的心脏恢复原位了。超声检查时肺组织并未见任何异常（左肺回声稍有增强）。

The patient underwent MRI scan at 33 weeks of pregnancy revealing a "hyperinflation" or, put it more correctly, a "hyperhydration" of the left lung making the final diagnosis of congenital lung emphysema and differentiating the finding from microcystic congenital adenomatoid malformation or lung sequestration.
孕33周时进行了胎儿MRI检查发现左肺“充气过度”或者说“水分过多”，最终诊断为先天性肺气肿，鉴别诊断包括先天性肺囊腺瘤以及隔离肺。

The newborn was delivered at term and was asymptomatic. Now, several months after delivery, the child is doing well.
新生儿足月分娩，无明显症状。数月后检查婴儿良好。

This case shows an interesting cause of fetal cardiac malposition that should be taken into consideration in differential diagnostic process of such cases. It also emphasizes the need of MRI examination enabling differentiation of congenital lobar emphysema from other possible cases of cardiac malposition such as congenital adenomatoid malformation or lung sequestration.
本例报道了导致心脏移位的一种可能的病因，我们人为MRI检查对于鉴别心脏移位病因、排除肺囊腺瘤和隔离肺是有价值的。

Images 1, 2 and videos 1, 2: 16 weeks of pregnancy; the images and videos show transabdominal (image 1 and video 1) and transvaginal (image 2 and video 2) transverse scans of the fetal thorax with marked dextroposition of the heart. The lung parenchyma looks normal.
孕16周。图像和视频均为胎儿胸腔水平横切面，心脏右移，肺组织正常。其中图1和视频1为经腹部超声，图2和视频2为经阴道超声。

Images 3, 4 and videos 3, 4: 24 weeks of pregnancy; the images and videos show transverse (image 3 and video 3) and longitudinal (image 4 and video 4) scans of the fetal thorax with marked dextroposition of the heart and no conspicuous findings at lung parenchyma (maybe lightly hyperechoic left lung).
孕24周。图3和视频3为横切面，图4和视频4为矢状面，均可发现心脏明显右移，肺脏未见明显异常（左肺回声稍有增加）。

Image 5 and video 5: 30 weeks of pregnancy; the image and video shows transverse scan of the fetal thorax with still presented marked dextroposition of the heart and no conspicuous findings at lung parenchyma.
孕30周。胎儿胸腔横切面显示心脏依然明显右移，肺脏正常。

Image 6 and video 6: 33 weeks of pregnancy; the image and video shows transverse scan of the fetal thorax revealing resolution of previously seen malposition of the heart. The lung parenchyma looks normal.
孕33周。图像视频显示胎儿心脏位置正常，肺组织正常。

Images 7, 8, 9: 33 weeks - MRI images showing hyperhydration within the left lung consistent with congenital lobar emphysema and differing the finding from congenital adenomatoid malformation or lung sequestration.
孕33周胎儿MRI肺组织内水分过多，符合先天性肺叶气肿的表现，与先天性肺囊腺瘤或隔离肺不同。