Recently, an interesting patient, a 45-year-old female patient, came to see a doctor because of [intermittent palpitation, chest tightness for 4 years, recurrence and aggravation for 3 months].
It looks like an ordinary rheumatic heart disease patient, but-
A weird smiling face
The patient brought color Doppler ultrasound of the heart of the local hospital, [rheumatic heart disease: aortic insufficiency, mitral insufficiency], and chest radiograph [mediastinal space occupying lesion].
Chest radiograph is not easy to judge whether the space occupying is what, so do an enhanced CT.
Oh, my God! Seems to see a creepy smiling face!
Is this the situation in what?
In order to make a clear diagnosis, we also performed cardiac color Doppler ultrasound, coronary angiography and coronary CT.
Considering the medical history and examination results, the possible diagnosis of thoracic space occupying lesions is as follows:
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Coronary artery aneurysm is more likely.
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Ventricular aneurysm with no history of myocardial infarction was basically excluded.
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Mediastinal teratoma (mediastinal? Anterior interventricular sulcus? ), closely related to the heart, unlike ordinary mediastinal tumors, and teratoma on the heart is very rare;
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Pericardial cyst, not completely excluded.
Whether to cut or not is a question.
After thoracotomy, it was found that the space occupying lesion was located at the apex of the left ventricle and had no obvious boundary with the ventricle. It was about the size of goose eggs and had a hard texture.
We began to hesitate slightly between cutting and not cutting: if not cutting, left ventricular activity would be obviously affected, and cardiac function estimation would be difficult to completely return to normal; However, the risk of resection is also very high. The lesion is closely related to the left ventricle. The operation is easy to damage the left ventricular myocardium. Patients with double valve replacement already have the risk of left ventricular rupture.
Considering that the patient was relatively young, it was finally decided to take the risk of surgery to remove the apical space occupying lesion.
After cardiac arrest and incision of the calcified adventitia of the apical lesion, a large amount of butter and chocolate sauce can be seen (ladies and gentlemen, how was your lunch? ) the same tissue mixture is basically judged as [teratoma]. Of course, a final pathological report is needed to make a definite diagnosis.
High-energy warning: The picture ahead may cause discomfort, so pull down carefully during lunch time.
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After all the tissues in the calcified adventitia are removed, since there is no obvious boundary between the tumor wall and the left ventricle, it is decided to retain the tumor wall and suture the tumor wall with felt reinforced [sandwich] method to prevent the rupture of the left ventricle.
Later, the combined valve replacement was successfully carried out.
Surgeons are often in a dilemma on the operating table, and each choice has to bear corresponding risks. Space occupying lesions on the heart test not only doctors’ thinking judgment and surgical skills, but also doctors’ willingness and ability to bear risks.
[with a ghost in his heart]
Teratoma is a kind of tumor derived from germ cell variation, which is mostly found in abdominal cavity and occasionally in thoracic cavity. Mature [teratoma] sometimes shows incomplete hair, cartilage, teeth and other tissues. However, [teratoma] on the heart is extremely rare.
Due to the name of [teratoma], there are often stories caused by some misunderstandings, such as: [am I pregnant? Or is it a deformity? ]
However, this patient reminds people of an idiom: having a ghost in mind.
-The idioms in the eyes of doctors are different from those taught by Chinese teachers.