Precordial bulge

Introduction The enlargement of the heart causes signs of local uplift in the precordial region. Normal people are roughly symmetrical on both sides of the chest. The anterior region of the heart is more common in children with heart disease and a significant increase in the heart (often right ventricular hypertrophy), such as congenital heart disease or rheumatic heart disease. At this time, the chest wall bone is still in the developmental stage, and the heart area can be raised by the influence of the enlarged heart. When the adult has a large amount of pericardial effusion, the precordial area can be full.

Cause

1 heart enlargement, with organic heart disease, especially when the heart is significantly enlarged in childhood, because the chest bone is still developing, it can be raised outward due to the compression of the front chest wall; For congenital heart disease, rheumatic valvular heart disease and myocarditis after cardiomyopathy.

2 chicken chest (keeled chest) and funnel chest deformity with pre-cardiac bulge, often associated with congenital heart disease. When a large amount of pericardial effusion occurs, the appearance of the precordial area is full. The depressed chest refers to the posterior displacement of the sternum, which can be seen in patients with Ma Fang syndrome and partial mitral valve prolapse.

an examination

Related inspection

Electrocardiogram dynamic electrocardiogram (Holter monitoring) blood analyzer examination

The lower sternum and the left sternal border and rib space are raised. When the heart chambers are enlarged, the shape of the heart also changes, and there are three heart types on the posterior anterior chest radiograph.

1. Mitral valve type: Common in mitral valve disease, chronic pulmonary heart disease, cardiac septal defect, pulmonary artery stenosis, etc., manifested as right heart bulging, the left lower edge of the heart is blunt, the heart is full or curved The aortic node is small and the heart shadow is pear-shaped.

2. Aortic type: Common in hypertension and aortic valve disease, the left apex extends to the left and left, the heart and waist are depressed, the aortic node is prominent, and the heart shadow is boot-type.

3. General: Common in myocarditis, heart failure, pericardial effusion. It appears that the heart shadow increases toward both sides and is more symmetrical.

Differential diagnosis

Pain in the precordial area: a fibrin exudation stage mainly found in the inflammatory changes of acute pericarditis. The visceral layer of the pericardium and the inner surface of the parietal layer are painless, and the outer surface of the parietal layer below the fifth or sixth intercostal level has a distribution of pain fibers of the phrenic nerve, so when the lesion spreads to this part of the pericardium or nearby pleura, mediastinum Pain occurs only when you are sick. Pain in the precordial area is often caused by changes in body position, deep breathing, coughing, swallowing, and lying position, especially when lifting the leg or the left lateral position, and reducing it when sitting or leaning forward. Pain is usually limited to the substernal or anterior region of the chest, often radiating to the left shoulder, back, neck or upper abdomen, even to the lower jaw, left forearm and hand radiation.

A peanut-sized mass at the lateral margin of the pectoralis major: one of the clinical manifestations of breast cancer. Mammary of accessory mamma refers to a cancer that occurs in the accessory breast, which occurs mostly in the temporal region. The rare sites are the subclavian region, the abdomen, and the vulva region. Wang Faheng (1993) reported 4 cases of paraneoplastic breast cancer, including nipples, areola, and mammary glands. There are also only nipples, and some have lactation.

Barrel chest: When the left and right diameter of the thorax is 1:1, it is like a "barrel", so it is called "barrel chest". Also known as "emphysema chest." barrel chest" is generally caused by excessive gas content in the lungs, such as emphysema, acute asthma attacks and long-term heavy smoking can lead to such performance, individual normal people can sometimes A "barrel chest" appears.

Thoracic bulge: The chicken breast, also known as the sternal protuberance or the pigeon chest, is the sternum protruding prominently, while the ribs on both sides are inclined downwards and inward, causing the chest to become the same shape as the chicken, pigeon, and bird sternum. "Chicken breast". Chicken breast can be divided into two types: sternal stem cartilage type, sternum cartilage type.

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