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Constrictive Pericarditis Presenting As Massive Ascites in Children: Report of One Case

以大量腹水表現之小兒緊縮性心包膜炎:一病例報告

摘要


小兒患有緊縮性心包膜炎通常以腹脹為最常見之症狀。本文報告一位13歲男童一開始以腹脹伴隨腹水及肝脾胳腫大表現。身體理學檢查發現頸靜脈擴張及心音奔馬節律,同時放射腺攝影顯示心包膜鈣化引導我們診斷緊縮性心包膜炎。在快速斷層掃瞄及心導管確定靜診斷後,病童經心包膜切開術後症狀快速的改善。心包膜的病理報告顯示有纖維鈣化但沒有耐酸性桿菌及肉芽組織病變。小兒緊縮性心包膜炎伴隨明顯心包膜鈣化的發生率是相當低。對於緊縮性心包膜炎我們提出胸部放射腺攝影及身體檢查發現為重要之診斷輔助。

並列摘要


Abdominal distension has been described as the most common presenting symptom in children with constrictive pericarditis. This report describes a 13-year-old boy who had abdominal distension with massive ascite and hepatosplenomegaly as an initial presentation. The physical signs of jugular vein engorgement and gallop rhythm as well as the pericardial calcification on the chest roentgeno gram lead to the diagnosis of constrictive pericarditis. After ultrafast computed tomography and cardiac catheterization confirmation, the patient received a pericardiectomy with excellent relief of symptoms. Pathology of the pericardium reveals fibrocalcified change, but no acid fast stained bacillus nor granulomatous lesion was observed. The incidence of constrictive pericarditis with evident pericardial calcification in children is extremely low. The diagnostic value of the chest roentgeno gram and physical findings for the constrictive pericarditis are addressed.

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