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最易转移到心脏的肿瘤是黑色素瘤。图示转移性黑色素瘤浸润到心肌。箭头所示黑色素是黑色素瘤的特征。

The neoplasm with the greatest propensity to metastasize to heart is melanoma. The metastatic melanoma is seen here to be infiltrating into the myocardium. At the arrow can be seen some brown-black pigment characteristic of melanoma.

右为成年人卵圆孔未闭的探查。 一根金属探针将房间隔掀起以显示未闭开放。正常情况下,左心房压力较高使得卵圆孔闭合。但如果肺动脉高压(如肺栓塞)引起右心房压力上升,卵圆孔就可能开放甚至血栓可以从右心房通过卵圆孔到达左心房。这是一个十分罕见的“反常栓子”(请看本图左边),之所以这样称呼是因为这种在静脉循环中出现的血栓会栓塞于体循环。

At the right is a probe patent foramen ovale in an adult. A metal probe lifts the septum secundum and reveals the opening. Normally, the left atrial pressure keeps the foramen closed, but if right atrial pressures rise with pulmonary hypertension (as with pulmonary embolus), the foramen may open and even allow a thrombus to go from right to left. This is a "paradoxical embolus", rare (seen on the left here), and so called because a thromboembolus arising from the venous circulation can end in the systemic circulation.

右侧可见开放心脏的房间隔卵圆孔附近有一小块房间隔缺损。房间隔并未使得这块缺损关闭,因此形成了一条从左到右的旁路。

In the region of the foramen ovale on the interatrial septum is a small atrial septal defect, as seen in this heart opened on the right side. Here the defect is not closed by the septum secundum, so a shunt exists across from left to right.

大的房间隔缺损以及左向右分流导致肺动脉高压。随着肺动脉压的增加,右心室明显肥大,最终导致血液倒流和右向左分流。这种由房间隔缺损引起的疾病称为艾森曼格复合病(Eisenmenger's complex)。左边手指提着的是明显变厚的位于三尖瓣下的游离心室壁,而右边手指提着的是室间隔。

This large atrial septal defect with left-to-right shunt resulted in pulmonary hypertension with increased pulmonary arterial pressures that eventually led to reversal and right-to-left shunt, resulting in marked right ventricular hypertrophy. This result from a cardiac septal defect is known as Eisenmenger's complex. The finger at the left is holding a markedly thickened right ventricular free wall below the tricuspid valve, and the finger at the right is holding the interventricular septum.

这是一例因13三体综合征而流产的早产儿心脏。可见室间隔缺损。大约90%的室间隔缺损发生在膜部,10%的发生在肌部。

This is the heart of a premature stillborn with Trisomy 13 in which a ventricular septal defect is visible in the membranous septum. About 90% of VSD's are in the membranous septum and 10% in the muscular septum.

既有房间隔缺损(ASD)又有肌性室间隔缺损(VSD)。心脏的左边被剖开。虽然这种小缺损不足以导致从左到右的分流,但增大了感染性心内膜炎的危险性。

Here is a heart with both an atrial septal defect (ASD) and a muscular ventricular septal defect (VSD). The heart is opened on the left side. Such small defects do not produce significant left-to-right shunting, but they do increase the risk for infective endocarditis.

主动脉的一部分,通过切除一例主动脉狭窄病人的主动脉而得来。主动脉后部狭窄,仅有3毫米左右通畅。

This portion of aorta was resected from a patient with a coarctation. The aorta narrows postductally here to about a 3 mm opening.

主动脉纵向切开后,可以清楚地看见狭窄。在狭窄区域,湍流增加将导致动脉粥样硬化的危险性增加。

The aorta is opened longitudinally here to reveal a coarctation. In the region of the narrowing, there was increased turbulence that led to increased atherosclerosis.

这是一例少见的畸形。这足以考验你的观察能力和对解剖学知识的运用。在医学上许多疾病仅仅通过描述你所见的就能得到诊断。你认为这个肺动脉瓣有多少个瓣叶?这是一个有四个瓣叶的瓣膜。

This is an unusual anomaly (and not too significant for the patient).This demonstrates the power of simple observation and use of your knowledge of anatomy. Many conditions in medicine can be diagnosed by just describing what you see. How many cusps are there supposed to be on this pulmonic valve. This is a quadricuspid valve.

这是一个先天性的两瓣叶主动脉瓣。大部分瓣叶容易钙化。病人无明显症状,这种状况可持续至狭窄发展到充血性心力衰竭的时候。在瓣膜的表面可见密集的白色钙化灶。这里的瓣膜已经通过主动脉流出道之上和左心室以下切开了。

Here is a congenital bicuspid aortic valve. Most bicuspid valves are prone to calcification. Patients can remain relatively asymptomatic until the stenosis reaches a critical point when congestive heart failure rapidly ensues. The dense white nodules of calcification are present on either valve surface. The valve here has been opened with the aortic outflow above and the left ventricular myocardium below.


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