结核性心包积液（Tuberculous Pericarditis）是胸部结核病较常见的并发症，结核性心包积液的感染途径包括：
Tuberculous pericardial effusion (Tuberculous Pericarditis) is the chest tuberculosis (TB) is one of the more common complications of Tuberculous pericardial effusion infection include:
1、气管、支气管结核，纵隔或肺门淋巴结结核，经淋巴管逆行至心包所致
1, tracheal and bronchial tuberculosis, mediastinal lymph nodes or the lung tuberculosis, via lymphatics retrograde to pericardium
2、肺结核的干酪样坏死病变直接蔓延所致
2, tuberculosis of caseous necrosis lesions caused by direct spread
3、结核分枝杆菌经血性播散所致
3, caused by mycobacterium tuberculosis by hemorrhagic spread
其中最为常见的感染方式为纵隔淋巴结结核经淋巴管播散，机体对结核分枝杆菌及代谢产物产生过敏反应形成的心包积液。
One of the most common way of infection for mediastinal lymph node tuberculosis by lymphatic spread, the body of mycobacterium tuberculosis and pericardial effusion metabolites produce allergic reaction.
心包积液在胸部X线平片上可以呈阴性；大量积液时，心影扩大呈‘烧瓶状’或‘球形’改变；有时在慢性期或粘连期可显示心包弧形或条索状钙化。
Pericardial effusion on the chest X-ray plain film can be negative; A large number of effusion, heart shadow expand 'flask shaped' or 'ball' change; Sometimes in the chronic phase or adhesion period pericardium arc can be shown or funicular calcification.
CT扫描示诊断心包积液有效的检查方法，少量积液即可以敏感显示，但在定性诊断方法存在一定的局限性。心包积液在CT上的表现：
CT scan in diagnosis of pericardial effusion effective inspection method, a small amount of effusion is sensitive, but in the qualitative diagnosis method has certain limitation. The expression of pericardial effusion in CT:
1、少量积液：出现在左心室背侧与左心房外侧，呈条带状液体密度影，边界清晰，边缘光滑。
1, a small amount of effusion appeared on the back and sides of the left ventricle and left atrium lateral, liquid density with a bar belt in the boundary clear, smooth edges.
2、中量积液：可见带状或弧形液体密度影，自心脏左侧跨过中线至右心室、右心房周围，伴心包粘连与肥厚，但液体未完全包绕心脏。
2, the amount of effusion: visible band or arc liquid density, since the heart around the left across the center line to the right ventricle, right atrium, with pericardial adhesion and hypertrophy, but not completely liquid has heart.
3、大量心包积液：液体充满整个心包腔，呈环状影包绕心脏和大血管根部，并可向上延伸至心包上隐窝，向下充填心包底部。
3, a large number of pericardial effusion: liquid fills the pericardial cavity, show cricoid shadow package around the root of the heart and great vessels, and can be extended upward to the pericardium fossae, pack down at the bottom of the pericardium.
↑本例为结核性心包炎（积液）
CT扫描显示心脏周围半弧形水样密度影，以右侧心包积液较多，心包增厚粘连；另外，双侧胸腔亦可见积液征象
CT对结核性心包炎难以做到定性诊断，心包粘连增厚、厚度小于10mm和心包钙化对诊断具有提示作用，如合并纵隔、肺门淋巴结结核或显示肺结核病灶则基本可确立结核性心包炎的诊断。
CT qualitative diagnosis of tuberculous pericarditis hard, thickening of pericardium adhesion and thickness of less than 10 mm and pericardial calcification has implications for diagnosis, such as combination of mediastinal lymph nodes, lung door tuberculosis or display tuberculosis lesions are basic to establish the diagnosis of tuberculous pericarditis.
↑本例为结核性心包炎（钙化）
CT扫描显示心脏增大，局部心包略增厚，两侧各见钙化
MRI检查亦有助于心包积液的诊断，尤其是对少量心包积液的显示十分敏感，但对显示心包钙化不敏感，亦难以判断心包积液的性质。
结核性心包积液系临床上常见的病因之一。少量积液多无临床症状，积液量逐渐增加或短期快速积液时，可表现为心前区疼痛、胸闷；大量心包积液可产生心脏压塞症状。多种影像学方法均在心包积液的显示与诊断中具有重要作用，超声检查无创，且有助于定量；CT有助于显示心包钙化及肺结核与纵隔淋巴结结核等病变；MRI有助于发现少量心包积液及观察心脏的功能。但有时心包增厚与少量心包积液在CT上难以鉴别，如增强扫描心包呈均匀中等以上强化，应考虑为心包增厚。结核性心包积液有时需与恶性肿瘤心包转移等鉴别，后者多有原发性肿瘤病史，心包积液进展较快，有时可伴有心包结节。与心源性、肾源性心包积液的鉴别需要密切结合临床及其他检查结果综合考虑。
Tuberculous pericardial effusion is one of clinical common cause. More than a small amount of effusion no clinical symptoms, effusion quantity gradually increase or short-term rapid fluid, can be shown as the area before the heart pain, chest tightness; A large amount of pericardial effusion can produce symptoms of cardiac tamponade. A variety of imaging methods are demonstrated in the pericardial effusion and plays an important role in diagnosis, noninvasive ultrasound, and helpful to the quantitative. CT is helpful to show pericardial calcification and mediastinal lymph node tuberculosis and tuberculosis lesions; MRI is helpful to find a small amount of pericardial effusion and observe the function of the heart. But sometimes thickening of pericardium with a small amount of pericardial effusion in CT is difficult to identify, such as enhanced scanning reinforcement, the pericardium homogeneously medium above should be considered for thickening of pericardium. Tuberculous pericardial effusion is sometimes with the malignant pericardial transfer such as identification, the latter is more a history of primary tumor, pericardial effusion progress faster, sometimes may be accompanied by pericardium nodules. Pericardial effusion and cardiac, renal origin for the identification of needs closely combined with clinical and other test results into account.
如果觉得《第226课—结核性心包积液（TuberculousPericarditis）》对你有帮助，请点赞、收藏，并留下你的观点哦！
