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【读片】产科疑难超声病例（399）：致命小三已经公布答案

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【病史特点】---找出所提供病史中的有价值之处（如无有价值信息，此项可空缺。但以下三项缺一不可）
【图像特征】---重点分析所给图像的特点
【超声诊断】---根据图像特点提出自己的诊断意见
【鉴别诊断】---根据图像表现对其他可能的诊断予以鉴别
Case report
22 years old woman G2, P1 was referred to us at the 37th week of gestation due to abnormal four chamber view of the heart. No history of medical diseases or familial conditions. Ultrasound examination revealed the following findings:
患者22岁，G2P1，妊娠37周因四腔心切面异常就诊，无既往病史和家族史。超声检查所见如下：
Images 1, 2, and video 1:

Image 3, videos 2. 3:

Images 4, 5, 6:

Videos 4, 5:

Image 7, video 6:

Image 8:

Image 9:

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2015-07-16 19:51 浏览 : 8941 回复 : 58

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xihuansushi 编辑于 2015-07-30 23:01

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Case report
22 years old woman G2, P1 was referred to us at the 37th week of gestation due to abnormal four chamber view of the heart. No history of medical diseases or familial conditions. Ultrasound examination revealed the following findings:
- huge aneurismal dilatation of the main pulmonary trunk and its major branches with consequent severe compression on fetal lungs causing marked pulmonary hypoplasia;
- arterial duct could not be traced due to its probable agenesis;
- pulmonary valve was seen dysplastic with rudimentary leaflets and small pulmonary annulus showing severe stenosis and regurgitation on Doppler study (Yin Yang flow);
- ascending aorta was seen overriding a large outlet subaortic ventricular septal defect arising from both ventricles through the defect;
- normal arrangement of the great vessels in mediastinum with slight anterior displacement of the ascending aorta in relation to the aneurysmatic dilatation of the main pulmonary trunk;
- evidence of marked right ventricular myocardial hypertrophy with multiple deep myocardial crypts.
Our final diagnosis was Tetralogy of Fallot with absent pulmonary valve syndrome.
The baby was delivered at term but died after one hour despite of intensive care probably due to bronchomalacia.
患者22岁，G2P1，妊娠37周因四腔心切面异常就诊，无既往病史和家族史。超声检查所见如下：
-主肺动脉干呈瘤样明显扩张，肺动脉干及其分支严重挤压胎儿肺脏导致肺脏发育不良。
-动脉导管显示不清，可能是存在发育不全
-彩色多普勒检查发现肺动脉瓣发育不良，瓣叶不发育，瓣环过小，导致重度狭窄和反流（阴阳波）
-升主动脉经室间隔缺损处起源于双侧心室，并骑跨室间隔
-大动脉位置关系正常，升主动脉略向前移位。
-右心室心肌明显肥厚，可见多发心肌深部隐窝。
我们最终诊断为法洛四联症合并肺动脉瓣缺如综合征。
患者足妊分娩，尽管新生儿随即送入重症监护病房，但一小时后因气管软化死亡。
Images 1, 2, 3, and video 1: Diastolic and systolic frames show cardiomegaly, aortic overriding and hypertrophy of myocardium. Video 1: shows cardiomegaly with hypertrophy of the myocardium, aortic overriding with huge aneurismal dilatation of the main pulmonary trunk, the pulmonary valve annulus is hypoplastic with rudimentary valve. The great vessels are normally related with anterior displacement of the aorta.
图1-3和视频1：舒张期和收缩期图像显示心脏扩大、主动脉骑跨和心肌肥大。视频显示心脏扩大和心肌肥大、主动脉骑跨，主肺动脉瘤样扩张，肺动脉瓣环发育不良，肺动脉瓣未发育。大动脉位置关系正常。

Images 4, 5: the images shows pulmonary artery (Pulm) arising from the right ventricle (RV); stenotic pulmonary valve anulus (PV) with huge aneurismal dilatation of the pulmonary artery (Pulm).
图4、5：图像显示肺动脉（Pulm）起源于右心室（RV），肺动脉瓣环狭窄（PV），肺动脉呈瘤样扩张。

Videos 2, 3: shows aortic overriding with normal relation and crossing of the great vessels with anterior displacement of the aorta.
视频2、3显示主动脉骑跨，大动脉关系正常，主动脉向前移位。

Image 6, 7, 8, 9, 10, 11: the images show huge dilatation of the main pulmonary trunk and the pulmonary branches
图6-图11：图像显示主肺动脉干瘤样扩张和肺动脉分支。

Videos 4, 5: the video 4 shows normally related great vessels with dilatation of the main pulmonary trunk and the pulmonary branches; the video 5 shows pulmonary artery arising from the right ventricle - hypoplastic pulmonary valve annulus and the aneurismal dilatation is evident.
视频4显示大动脉关系正常以及主肺动脉干扩张和肺动脉分支；视频5显示肺动脉起源于右心室，肺动脉瓣环发育不良，肺动脉干明显瘤样扩张。

Images 12, 13, and video 6: right parasagittal section showing relation between the aorta and the hugely dilated right pulmonary artery. The anterior displacement of the aorta is evident too.
图12、13和视频6：右侧旁矢状切面显示主动脉和明显扩张的肺动脉的关系，主动脉明显向前移位。

Image 14: Color Doppler showing overriding of the aorta.
图14：彩色多普勒图像显示主动脉骑跨。

Image 15: Pulsed wave Doppler showing both stenosis and regurgitation across the pulmonary valve (Yin Yang flow).
图15：脉冲多普勒图像显示肺动脉瓣既有狭窄又有反流（阴阳波）。

2015-07-30 21:43

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xihuansushi 编辑于 2015-07-30 21:53

• 2021.02+中医药单用／联合抗生素治疗社区获得性肺炎临床实践指南

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【读片】产科疑难超声病例（399）：致命小三已经公布答案