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目的 探讨原发性肝癌伴下腔静脉及右心房转移的超声特征、发生机制及病理过程 ,为临床提供诊断和治疗依据。方法 应用彩色多普勒超声 (CDFI)及 DSA等对 11例原发性肝癌伴下腔静脉及右心房转移患者进行检查。结果 11例原发性肝癌伴下腔静脉及右心房转移患者超声均可见肝原发病灶伴肝静脉癌栓阻塞 ,下腔静脉腔内见中等回声团块 ,其远端扩张 ,生理性搏动消失。心脏超声见右心房内大小不等呈椭圆形或不规则的稍高回声团块 ,其中 9例位于右房后壁、2例位于右房侧壁 ,CDFI见红色血流环绕肿块从三尖瓣流入右室 ,同时肿块内显示较丰富的动脉血流信号。DSA造影提示癌栓由肝动脉供血。结论 超声能显示肝内肿瘤、静脉内癌栓和右心房转移灶的声像图特点以及血流动力学的改变 ,对后续的检查、手术、介入治疗等追踪观察具有重大的价值。
Objective To investigate the ultrasonographic features, mechanism and pathological process of primary hepatocellular carcinoma with inferior vena cava and right atrium metastasis and provide the basis for diagnosis and treatment. Methods Eleven cases of primary hepatocellular carcinoma with inferior vena cava and right atrial metastasis were examined by color Doppler ultrasonography (CDFI) and DSA. Results In 11 cases of primary hepatocellular carcinoma with inferior vena cava and right atrium metastasis, the primary liver lesion with hepatic vein tumor thrombus occlusion could be seen by ultrasonography. The middle echo mass in the inferior vena cava was seen, the distal expansion and physiological pulse disappeared . Echocardiography see the right atrium ranging in size from oval or irregular slightly hyperechoic mass, of which 9 cases located in the right atrial posterior wall, 2 cases located in the right atrial wall, CDFI see red blood flow around the tumor from the tricuspid valve Into the right ventricle, while the mass showed relatively abundant arterial blood flow signal. DSA angiography suggests that the thrombus is supplied by the hepatic artery. Conclusion Ultrasound can show the characteristics of intrahepatic tumor, thrombus in the vein and metastasis of the right atrium, as well as the changes of hemodynamics. It is of great value to follow-up examination, surgery and interventional therapy.