| 摘要: |
| 胎儿期间，因胎儿心脏较小，心率较快，产前常规超声对TAPVC的诊断非常困难，只有在左房后方形成较为明显的肺总静脉，产前超声才较容易发现[3]，所以一般产前常规超声容易漏诊。特别是最为重要的中孕大畸形筛查期间，假如超声检查图像不规范，也比较容易漏诊。
总结分析漏诊TAPVC原因可能有以下几种：1.胎儿期间因特殊的血流动力学影响，左右心房及心室基本对称，没有出现明显的右心房扩大，左心房缩小等较为明显的间接心脏改变。2.左房后方肺静脉与左心房存在空间的重叠，容易误认为肺静脉角存在，而认为肺静脉血流引流至左房，导致对TAPVC的漏诊。3.彩色多普勒技术应用不规范，通常情况下，将彩色血流速度标尺下降至 20 cm/s 左右，以便能更好地观察肺静脉血流。假如标尺过高，容易屏蔽低速肺静脉血流，而导致漏诊的发生。4.超声筛查时，技术不规范，切面不标准，左心房后方明显光滑，未仔寻找其明确原因，而导致漏诊的发生[4]。本例胎儿中孕期筛查图像，心脏图像较小，未进行充分放大，彩色标尺过高，未显示明显肺静脉血流，也未明显看到明显的肺静脉角，所得导致漏诊，误诊的发生。随着产前超声图像的标准化管理，完全性肺静脉异位引流得到了越来越多的关注，检出率也有了明显的提高。 |
| 关键词: 完全性肺静脉异位引流 大畸形筛查 漏诊 |
| DOI： |
| 投稿时间：2020-02-19修订日期：2021-03-05 |
| 基金项目:复旦大学附属浦东医院院级课题（项目编号：YJ2020-02） |
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| A case of complete pulmonary venous ectopic drainage in the screening of large malformation during pregnancy |
| dengyanming,WanjIanfang |
| () |
| Abstract: |
| During the fetal period, because the fetal heart is smaller and the heart rate is faster, the diagnosis of TAPVC by prenatal routine ultrasound is very difficult. Only when a more obvious total pulmonary vein is formed behind the left atrium, prenatal ultrasound is easier to find [3], so the general prenatal routine ultrasound is easy to miss diagnosis. Especially during the most important screening period, if the ultrasound image is not standard, it is easier to miss diagnosis.
Conclusion and analysis of the causes TAPVC missed diagnosis may be as follows :1. During the fetus due to special hemodynamic effects, the left and right atrium and ventricle are basically symmetrical, there is no obvious right atrium enlargement, left atrium narrowing and other more obvious indirect cardiac changes. 2. there is space overlap between the left posterior pulmonary vein and the left atrium, it is easy to mistake for the presence of the pulmonary venous angle, while it is believed that the pulmonary venous blood flow drains to the left atrium, resulting in missed diagnosis of TAPVC. 3. the application of color doppler technique is not standard, usually, the color blood flow velocity scale is dropped to about 20 cm/s so that the pulmonary venous blood flow can be better observed. If the scale is too high, it is easy to block the low-speed pulmonary venous blood flow, and lead to missed diagnosis. 4. ultrasound screening, the technique is not standard, the cut surface is not standard, the rear of the left atrium is obviously smooth, and the uncai search for its clear cause leads to the occurrence of missed diagnosis [4]. In this case, the image of pregnancy screening in the fetus, the heart image is small, not fully magnified, the color scale is too high, no obvious pulmonary venous blood flow is shown, and no obvious pulmonary venous angle is seen, resulting in missed diagnosis and the occurrence of misdiagnosis. With the standardized management of prenatal ultrasound images, complete ectopic pulmonary vein drainage has received more and more attention, and the detection rate has been significantly improved. |
| Key words: Keywords complete pulmonary vein ectopic drainage screening for major malformation missed diagnosis |
