摘要
患儿，女，11岁，因“腹部膨隆伴体力下降16个月，发现心包积液5个月”就诊。患儿无明显诱因出现腹部膨隆、体力下降，剧烈运动后较病前感劳累，伴食欲稍减退。在机场安检时发现心影增大、心包钙化。于外院行胸腹CT提示心包积液，右胸腔、腹盆腔积液，予多次心包穿刺、抗感染、抗结核治疗，未见好转。入院后查炎症指标及自身免疫相关检查均无异常，结核菌素（PPD）试验（＋＋），但抗结核治疗无效，诊断不明。后行“心包剥脱术”，心包脏壁两层病理显示纤维结缔组织增生、透明变性、机化，毛细血管扩张充血，少量炎性细胞浸润。诊断特发性缩窄性心包炎，给予强心、利尿、补钾等对症治疗后，患儿症状消失。临床中应注意综合临床表现，排除可能病因，注重早期病理检查。
There was a 11 - year - old school - aged girl complaining of abdomen intumescing and declining physical fitness for 16 months, and hydropericardium for 5 months. The child had a intumescent abdomen and strength diminished strength suddenly. After the strenuous exercise she was more tired than before and lost her appetite. The girl was found cardiac enlargement and calcification of pericardium during security check at the airport. The thoracoabdomi- nal computed tomography（CT） suggested hydropericardium, hydrothorax effusion in the right, and seroperitoneum, pel- vic effusion. The girl had no response to pericardiocentesises, anti - inflammation and antituberculosis therapies. The in- flammatory markers and the findings of autoimmunity were normal after her admission. The purified protein derivatives （PPD） test was （ ＋ ＋ ）, but the antituberculosis therapy was invalid, so the diagnosis was unclear. The she had peri- cardiectomy. The pericardium visceral and parietale＇s pathology showed hyperplasia, hyalinosis and organization of fi- brous connective tissue, congestion of the blood capillaries, infiltration of inflammatory cells. Terminally, she was diag- nosed as constrictive pericarditis. Symptoms disappeared after treatments with cardiotonic, diuretic and potassium sup- ply. The comprehensive analysis is important clinically, the possible causes should be removed gradually, and pathologi- cal examination must be emphasized during the diagnosis of constrictive pericarditis.
出处
《中华实用儿科临床杂志》
CSCD
北大核心
2016年第1期71-73,共3页
Chinese Journal of Applied Clinical Pediatrics
关键词
体力下降
心包积液
心包炎
Diminished strength
I-lydropericardium
Pericarditis
