目的

分析超声心动图漏诊的缩窄性心包炎患者的临床及影像学特征。

方法

回顾性纳入2020 年1 月至2024 年12 月于成都市第三人民医院就诊的缩窄性心包炎患者共92 例。所有患者均最终经手术及术后病理证实，诊断明确。所有患者均行超声心动图及CT 检查，其中82 例首次超声心动图检查确诊缩窄性心包炎（超声诊断组），10 例首次检查漏诊（超声漏诊组）。对比分析2 组的临床及影像学特征。

结果

与超声诊断组比较，漏诊组患者病程较短［9.00（11.00）个月 vs 2.50（7.90）个月，P＜0.05］。超声诊断组中有更高比例的患者合并肝静脉扩张（31.7%，26/82）、腹腔积液（54.9%，45/82）及胸腔积液（73.2%，60/82），2 组比较差异有统计学意义（P均＜0.05）。与超声诊断组比较，漏诊组心脏形态改变较不明显。超声诊断组与漏诊组的左心房前后径［41.00（8.30）mm vs 37.50（4.30）mm，P＜0.05］、左心室舒张末期内径［40.50（4.00）mm vs 45.50（4.30）mm，P＜0.05］、右心房横径［41.00（7.00）mm vs 36.50（9.00）mm，P＜0.05］、右房室角［（80.71±30.55）°vs（106.50±35.87）°，P＜0.05］、心尖球形指数［69.00（29.00） vs 84.00（25.00），P＜0.05］及左心室质量指数 ［（69.79±15.91）g/m²vs（84.51±13.53）g/m²，P＜0.05］比较，差异均有统计学意义。2 组患者心包均增厚，但漏诊组不合并心包钙化。超声诊断组与漏诊组行心包剥脱术后围术期死亡率［（3.7%，3/82）vs （0，0/10），P＞0.05］及不良事件发生率差异无统计学意义。

结论

缩窄性心包炎的超声心动图表现具有一定特征性，但临床实践中存在漏诊。漏诊病例多为病程早期患者，这部分患者虽有心包增厚，但无心包钙化，同时心脏形态改变不明显，临床症状相对较轻。结合患者病史特征进行多模态影像学评估比单一依赖超声心动图更有利于做出正确诊断。

Objective

To analyze the causes of missed diagnosis of constrictive pericarditis by echocardiography， and investigate the safety of pericardiectomy in patients with atypical constrictive pericarditis.

Methods

A total of 92 patients with constrictive pericarditis who visited the Third People's Hospital of Chengdu from January 2020 to December 2024 were retrospectively included.All patients underwent echocardiography and CT examination.Based on the first echocardiographic examination， the patients were divided into an accurate diagnosis group（n=82）and a missed diagnosis group（n=10），and the clinical and imaging characteristics of the two groups were compared and analyzed.

Results

Compared to the accurate diagnosis group， the missed diagnosis group had a shorter disease course ［9.00（11.00）months vs 2.50（7.90）months， P＜0.05］ and milder liver function impairment.The accurate diagnosis group exhibited higher proportions of hepatic vein dilation， ascites， and pleural effusion （all P＜0.05）.The missed diagnosis group demonstrated milder cardiac morphological changes， including the changes of left atrial size ［41.00（8.30）mm vs 37.50（4.30）mm， P＜0.05］， left ventricular size ［40.50（4.00）mm vs 45.50（4.30）mm， P＜0.05］， right atrial size ［41.00（7.00）mm vs 36.50（9.00）mm，P＜0.05］， right atrioventricular angle ［（80.71±30.55）° vs（106.50±35.87）°， P＜0.05］， apical sphericity index ［69.00（29.00） vs 84.00（25.00）， P＜0.05］， and left ventricular mass index ［（69.79±15.91）g/m² vs（84.51±13.53）g/m²， P＜0.05］.Both groups had thickened pericardium， but the missed diagnosis group did not have calcifled pericardium.Postoperative mortality ［3.7% （3/82） vs 0 （0/10）］ and adverse event rates showed no signiflcant difference between the two groups （P＞0.05）.

Conclusion

Echocardiography exhibits characteristic flndings for constrictive pericarditis， but misdiagnosis occurs in clinical practice.Missed cases are often early-stage patients with pericardial thickening but no calciflcation， subtle cardiac morphological changes， and milder symptoms.Multimodal imaging evaluation combined with clinical history can improve diagnostic accuracy compared with reliance on echocardiography alone.