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例1 女性,42岁。因胸闷、心慌、腰背痛就诊。发现心脏扩大、心包摩擦音,以急性心包炎收入院。查体:颈静脉轻度充盈,心尖搏动不明显,未扪及震颤,心界向两侧扩大,心率106bpm,律齐,心前区、心底部均可听到心包摩擦音。余无异常发现。骨髓穿刺涂片未见有肿瘤细胞。X线胸片示心影呈烧瓶状,锁骨、颅骨、骨盆、四肢骨均有不同程度的破坏,分别呈“穿凿”样改变。心包积液涂片见少许骨髓瘤样细胞。骨髓病理检查发现大量骨髓瘤细胞,大部分形态分化差,胞浆少、核质染色深,呈弥漫浸润。病理诊断:多发性骨髓瘤合并心包转移。例2 男性,36岁。因咽痛、心慌、胸闷、乏力、气短,X线胸片发现心包积液,按“结核性心包炎”治疗不见好转入院。查体:咽后壁稍充血,颈静脉轻度怒张,心尖搏动不明显,心界明显向两侧扩大,未扪及震颤,心率90bpm、律齐、心音弱,心尖部可闻及心包摩擦音。余无异常。反复多次查痰抗酸杆菌、痰培养
Example 1 Female, 42 years old. Due to chest tightness, palpitation, back pain treatment. Found heart enlargement, pericardial fricative, with acute pericarditis income hospital. Physical examination: mild jugular filling, apex beat is not obvious, not palpable tremor, the heart to both sides of the expansion, heart rate 106bpm, law Qi, precordial, heart palpable pericardial frictional sound. I found no abnormalities. Bone marrow smear no tumor cells. X-ray showed heart shadow was flask-shaped, clavicle, skull, pelvis, limbs have different degrees of bone damage, were “to wear chisel” like change. Pericardial effusion smear see a few myeloma-like cells. A large number of myeloma cells were found by pathological examination in bone marrow, most of them were poorly differentiated, less cytoplasm, darker nucleoplasm and diffuse infiltration. Pathological diagnosis: multiple myeloma with pericardial metastasis. Example 2 male, 36 years old. Due to sore throat, palpitation, chest tightness, fatigue, shortness of breath, chest X-ray found pericardial effusion, according to “tuberculous pericarditis” treatment did not improve admitted to hospital. Physical examination: posterior pharyngeal wall slightly hyperemic, mild jugular jerk, apical beating is not obvious, the heart bound to both sides of the expansion, no palpable tremor, heart rate 90bpm, Qi Qi, weak heart, apex can be heard and pericardial frictional sound . I no exception. Repeatedly sputum acid-fast bacilli, sputum culture