BMJ:呼吸困难和不寻常的胸片-案例报道

2017-03-18 xing.T MedSci原创

心包钙化认为是由于心包炎症和纤维化所导致的。该病与缩窄性心包炎相关,但不能予以诊断。将近30%的心包钙化患者有缩窄性心包炎的体征或症状。缩窄性心包炎患者中,27%-50%的患者发生心包钙化。

患者为一名70岁的男性,因呼吸短促几个月而就诊。他的胸片显示什么(如图1所示),这种情况最常见的原因是什么?


图1 胸片

回答
胸片显示心包钙化。鉴于他的症状,考虑进行超声心动图检查,由于心包钙化与缩窄性心包炎有关。尽管该病的原因通常是特发性的,缩窄性心包炎公认的原因包括感染、既往放疗或手术、胶原血管疾病。

讨论
心包钙化认为是由于心包炎症和纤维化所导致的。该病与缩窄性心包炎相关,但不能予以诊断。将近30%的心包钙化患者有缩窄性心包炎的体征或症状。缩窄性心包炎患者中,27%-50%的患者发生心包钙化。

尽管这通常是特发性的,缩窄性心包炎公认的病因包括感染、胶原血管疾病、尿毒症,以及之前的放疗、外伤性心包积血、心脏手术。从历史上看,结核感染也是心包钙化的重要原因。


图2 胸片,黑白箭头显示左、右心室外的心包钙化

平片可区别心包钙化与心肌钙化。心包钙化常发生在右心室。当广泛的心包钙化可以延伸到左心腔,正如这个病人(图2所示)。相反,心肌钙化往往是更深层次的,常发生在心尖或左心室后壁,并可能与动脉瘤隆起相关。

学习点

对于心包钙化患者,临床医师应考虑缩窄性心包炎的可能性。

原始出处:

James SB Kho. et al. Dyspnoea and an unusual chest radiograph. BMJ2017;356:j986 doi: 10.1136/bmj.j986 

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    2017-05-28 一叶知秋
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    2017-03-20 喜婷

    学习了

    0

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content=对于心包钙化患者,临床医师应考虑缩窄性心包炎的可能性,事实上,影像医师基本都会提示这个。, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM6DGOvNrRdcib3UmzMgpEQplCaQGBmjHytXQqvsuocO2uV2lOAaJibzDafJudKToVfU12LzwArHDb4TSrmU2hk5Qxzc6icoicBK3Dg/0, createdBy=a7901968505, createdName=明心见性, createdTime=Sat Mar 18 19:28:03 CST 2017, time=2017-03-18, status=1, ipAttribution=)]
  4. 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createdTime=Mon Mar 20 21:22:49 CST 2017, time=2017-03-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1281848, encodeId=e578128184885, content=<a href='/topic/show?id=21753963364' target=_blank style='color:#2F92EE;'>#呼吸困难#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=39633, encryptionId=21753963364, topicName=呼吸困难)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=365d170, createdName=chenwq08, createdTime=Mon Mar 20 08:29:00 CST 2017, time=2017-03-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1446865, encodeId=75bf144686588, content=<a href='/topic/show?id=293484132b0' target=_blank style='color:#2F92EE;'>#胸片#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84132, encryptionId=293484132b0, topicName=胸片)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/PiajxSqBRaEKLKvGibqOiaS8aNUxicnauicTrMjGzKpNxGK8emxaZH22OeU4sEOujftNY904T6neAvAbLXOKONlZziaQ/132, createdBy=3c605291750, createdName=hukaixun, createdTime=Mon Mar 20 08:29:00 CST 2017, time=2017-03-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=181205, encodeId=bec7181205bb, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKfcA3xZnott5TnvcnGrdO58uy0RP4NgPa0Qz8FibHlolypPLEmmcGicSPMJVWQKbRkAY8UVZlFRtGw/132, createdBy=c67f2030047, createdName=喜婷, createdTime=Sun Mar 19 18:57:06 CST 2017, time=2017-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=181122, encodeId=011718112222, content=学习中,谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/PiajxSqBRaEJicFGXtYqfjGiaibNdjOiaRgkexnXiciaDeXaLiaKicovcicDugdYwRPSnQj3FlfXBwVLB5ANB9PGFyB0kraQ/0, createdBy=35b01663265, createdName=1ddf3e1dm99(暂无匿称), createdTime=Sun Mar 19 12:39:10 CST 2017, time=2017-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=180989, encodeId=212418098911, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5K4PNicOvbHfgIficrsEKztlD5yv1UnCFhnFmFU9yv1RHLflMRibWrppbsiccfMB8tT9HCkAr3zL2zVml/0, createdBy=89da1604922, createdName=䖝二, createdTime=Sat Mar 18 23:33:54 CST 2017, time=2017-03-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=180981, encodeId=886f180981dd, content=心包钙化临床医师应该考虑缩窄性心包炎的可能, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7cJ6ejWUr2nIia8qOvAKNdLHr32Df6G8iaoaOx6pHaoiacwp26DaslxZHCGbibZhhCGven4rvmWP60GahtzgFjgCjR/0, createdBy=6b111703011, createdName=有备才能无患, createdTime=Sat Mar 18 22:40:20 CST 2017, time=2017-03-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=180960, encodeId=63fa180960d4, content=谢谢分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=18741984753, createdName=smartxiuxiu, createdTime=Sat Mar 18 20:21:25 CST 2017, time=2017-03-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=180950, encodeId=ab491809500f, content=对于心包钙化患者,临床医师应考虑缩窄性心包炎的可能性,事实上,影像医师基本都会提示这个。, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM6DGOvNrRdcib3UmzMgpEQplCaQGBmjHytXQqvsuocO2uV2lOAaJibzDafJudKToVfU12LzwArHDb4TSrmU2hk5Qxzc6icoicBK3Dg/0, createdBy=a7901968505, createdName=明心见性, createdTime=Sat Mar 18 19:28:03 CST 2017, time=2017-03-18, status=1, ipAttribution=)]
    2017-03-20 hukaixun
  5. 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level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/PiajxSqBRaEJicFGXtYqfjGiaibNdjOiaRgkexnXiciaDeXaLiaKicovcicDugdYwRPSnQj3FlfXBwVLB5ANB9PGFyB0kraQ/0, createdBy=35b01663265, createdName=1ddf3e1dm99(暂无匿称), createdTime=Sun Mar 19 12:39:10 CST 2017, time=2017-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=180989, encodeId=212418098911, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5K4PNicOvbHfgIficrsEKztlD5yv1UnCFhnFmFU9yv1RHLflMRibWrppbsiccfMB8tT9HCkAr3zL2zVml/0, createdBy=89da1604922, createdName=䖝二, createdTime=Sat Mar 18 23:33:54 CST 2017, time=2017-03-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=180981, encodeId=886f180981dd, content=心包钙化临床医师应该考虑缩窄性心包炎的可能, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7cJ6ejWUr2nIia8qOvAKNdLHr32Df6G8iaoaOx6pHaoiacwp26DaslxZHCGbibZhhCGven4rvmWP60GahtzgFjgCjR/0, createdBy=6b111703011, createdName=有备才能无患, createdTime=Sat Mar 18 22:40:20 CST 2017, time=2017-03-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=180960, encodeId=63fa180960d4, content=谢谢分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=18741984753, createdName=smartxiuxiu, createdTime=Sat Mar 18 20:21:25 CST 2017, time=2017-03-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=180950, encodeId=ab491809500f, content=对于心包钙化患者,临床医师应考虑缩窄性心包炎的可能性,事实上,影像医师基本都会提示这个。, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM6DGOvNrRdcib3UmzMgpEQplCaQGBmjHytXQqvsuocO2uV2lOAaJibzDafJudKToVfU12LzwArHDb4TSrmU2hk5Qxzc6icoicBK3Dg/0, createdBy=a7901968505, createdName=明心见性, createdTime=Sat Mar 18 19:28:03 CST 2017, time=2017-03-18, status=1, ipAttribution=)]
    2017-03-19 喜婷

    学习了

    0

  6. 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attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/PiajxSqBRaEKLKvGibqOiaS8aNUxicnauicTrMjGzKpNxGK8emxaZH22OeU4sEOujftNY904T6neAvAbLXOKONlZziaQ/132, createdBy=3c605291750, createdName=hukaixun, createdTime=Mon Mar 20 08:29:00 CST 2017, time=2017-03-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=181205, encodeId=bec7181205bb, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKfcA3xZnott5TnvcnGrdO58uy0RP4NgPa0Qz8FibHlolypPLEmmcGicSPMJVWQKbRkAY8UVZlFRtGw/132, createdBy=c67f2030047, createdName=喜婷, createdTime=Sun Mar 19 18:57:06 CST 2017, time=2017-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=181122, encodeId=011718112222, content=学习中,谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/PiajxSqBRaEJicFGXtYqfjGiaibNdjOiaRgkexnXiciaDeXaLiaKicovcicDugdYwRPSnQj3FlfXBwVLB5ANB9PGFyB0kraQ/0, createdBy=35b01663265, createdName=1ddf3e1dm99(暂无匿称), createdTime=Sun Mar 19 12:39:10 CST 2017, time=2017-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=180989, encodeId=212418098911, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5K4PNicOvbHfgIficrsEKztlD5yv1UnCFhnFmFU9yv1RHLflMRibWrppbsiccfMB8tT9HCkAr3zL2zVml/0, createdBy=89da1604922, createdName=䖝二, createdTime=Sat Mar 18 23:33:54 CST 2017, time=2017-03-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=180981, encodeId=886f180981dd, content=心包钙化临床医师应该考虑缩窄性心包炎的可能, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7cJ6ejWUr2nIia8qOvAKNdLHr32Df6G8iaoaOx6pHaoiacwp26DaslxZHCGbibZhhCGven4rvmWP60GahtzgFjgCjR/0, createdBy=6b111703011, createdName=有备才能无患, createdTime=Sat Mar 18 22:40:20 CST 2017, time=2017-03-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=180960, encodeId=63fa180960d4, content=谢谢分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=18741984753, createdName=smartxiuxiu, createdTime=Sat Mar 18 20:21:25 CST 2017, time=2017-03-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=180950, encodeId=ab491809500f, content=对于心包钙化患者,临床医师应考虑缩窄性心包炎的可能性,事实上,影像医师基本都会提示这个。, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM6DGOvNrRdcib3UmzMgpEQplCaQGBmjHytXQqvsuocO2uV2lOAaJibzDafJudKToVfU12LzwArHDb4TSrmU2hk5Qxzc6icoicBK3Dg/0, createdBy=a7901968505, createdName=明心见性, createdTime=Sat Mar 18 19:28:03 CST 2017, time=2017-03-18, status=1, ipAttribution=)]
    2017-03-19 1ddf3e1dm99(暂无匿称)

    学习中,谢谢

    0

  7. 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attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/PiajxSqBRaEKLKvGibqOiaS8aNUxicnauicTrMjGzKpNxGK8emxaZH22OeU4sEOujftNY904T6neAvAbLXOKONlZziaQ/132, createdBy=3c605291750, createdName=hukaixun, createdTime=Mon Mar 20 08:29:00 CST 2017, time=2017-03-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=181205, encodeId=bec7181205bb, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKfcA3xZnott5TnvcnGrdO58uy0RP4NgPa0Qz8FibHlolypPLEmmcGicSPMJVWQKbRkAY8UVZlFRtGw/132, createdBy=c67f2030047, createdName=喜婷, createdTime=Sun Mar 19 18:57:06 CST 2017, time=2017-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=181122, encodeId=011718112222, content=学习中,谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/PiajxSqBRaEJicFGXtYqfjGiaibNdjOiaRgkexnXiciaDeXaLiaKicovcicDugdYwRPSnQj3FlfXBwVLB5ANB9PGFyB0kraQ/0, createdBy=35b01663265, createdName=1ddf3e1dm99(暂无匿称), createdTime=Sun Mar 19 12:39:10 CST 2017, time=2017-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=180989, encodeId=212418098911, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5K4PNicOvbHfgIficrsEKztlD5yv1UnCFhnFmFU9yv1RHLflMRibWrppbsiccfMB8tT9HCkAr3zL2zVml/0, createdBy=89da1604922, createdName=䖝二, createdTime=Sat Mar 18 23:33:54 CST 2017, time=2017-03-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=180981, encodeId=886f180981dd, content=心包钙化临床医师应该考虑缩窄性心包炎的可能, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7cJ6ejWUr2nIia8qOvAKNdLHr32Df6G8iaoaOx6pHaoiacwp26DaslxZHCGbibZhhCGven4rvmWP60GahtzgFjgCjR/0, createdBy=6b111703011, createdName=有备才能无患, createdTime=Sat Mar 18 22:40:20 CST 2017, time=2017-03-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=180960, encodeId=63fa180960d4, content=谢谢分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=18741984753, createdName=smartxiuxiu, createdTime=Sat Mar 18 20:21:25 CST 2017, time=2017-03-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=180950, encodeId=ab491809500f, content=对于心包钙化患者,临床医师应考虑缩窄性心包炎的可能性,事实上,影像医师基本都会提示这个。, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM6DGOvNrRdcib3UmzMgpEQplCaQGBmjHytXQqvsuocO2uV2lOAaJibzDafJudKToVfU12LzwArHDb4TSrmU2hk5Qxzc6icoicBK3Dg/0, createdBy=a7901968505, createdName=明心见性, createdTime=Sat Mar 18 19:28:03 CST 2017, time=2017-03-18, status=1, ipAttribution=)]
    2017-03-18 䖝二

    学习了

    0

  8. 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content=对于心包钙化患者,临床医师应考虑缩窄性心包炎的可能性,事实上,影像医师基本都会提示这个。, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM6DGOvNrRdcib3UmzMgpEQplCaQGBmjHytXQqvsuocO2uV2lOAaJibzDafJudKToVfU12LzwArHDb4TSrmU2hk5Qxzc6icoicBK3Dg/0, createdBy=a7901968505, createdName=明心见性, createdTime=Sat Mar 18 19:28:03 CST 2017, time=2017-03-18, status=1, ipAttribution=)]
    2017-03-18 有备才能无患

    心包钙化临床医师应该考虑缩窄性心包炎的可能

    0

  9. 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content=对于心包钙化患者,临床医师应考虑缩窄性心包炎的可能性,事实上,影像医师基本都会提示这个。, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM6DGOvNrRdcib3UmzMgpEQplCaQGBmjHytXQqvsuocO2uV2lOAaJibzDafJudKToVfU12LzwArHDb4TSrmU2hk5Qxzc6icoicBK3Dg/0, createdBy=a7901968505, createdName=明心见性, createdTime=Sat Mar 18 19:28:03 CST 2017, time=2017-03-18, status=1, ipAttribution=)]
    2017-03-18 smartxiuxiu

    谢谢分享!

    0

  10. 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content=对于心包钙化患者,临床医师应考虑缩窄性心包炎的可能性,事实上,影像医师基本都会提示这个。, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM6DGOvNrRdcib3UmzMgpEQplCaQGBmjHytXQqvsuocO2uV2lOAaJibzDafJudKToVfU12LzwArHDb4TSrmU2hk5Qxzc6icoicBK3Dg/0, createdBy=a7901968505, createdName=明心见性, createdTime=Sat Mar 18 19:28:03 CST 2017, time=2017-03-18, status=1, ipAttribution=)]
    2017-03-18 明心见性

    对于心包钙化患者,临床医师应考虑缩窄性心包炎的可能性,事实上,影像医师基本都会提示这个。

    0

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