儿童胸壁横纹肌肉瘤的CT诊断

发布时间：2018-06-07 02:35

本文选题：胸部肿瘤 + 横纹肌肉瘤　；参考：《中国医学影像学杂志》2015年12期

【摘要】：目的原发于胸壁的横纹肌肉瘤(RMS)少见,关于儿童胸壁RMS影像学表现的研究较少,本文分析了儿童胸壁RMS的CT影像学表现,以提高儿童胸壁RMS的诊断准确率。资料与方法回顾性分析经手术病理证实为胸壁RMS的5例患儿的CT影像资料,总结患儿RMS的CT影像特点。结果 5例患儿中,病灶位于前胸壁1例,后胸壁2例,侧胸壁(腋下)2例。病灶形态呈类圆形或梭形,部分肿块呈浅分叶。平扫病灶密度不均匀、可见斑片状低密度坏死区2例,密度较均匀3例;5例病灶均未见钙化及脂肪组织。肿块侵犯邻近椎管1例;肿块突入胸腔压迫肺组织1例,压迫心脏及肝脏1例;肿块包绕血管生长2例。5例病灶均紧邻肋骨、肱骨、肩胛骨及脊柱骨等,有骨质破坏1例。增强扫描5例病灶呈不均匀轻-中强化,以周边强化明显,病灶内可见较多增粗、扭曲的供血动脉影,其内坏死区不强化。2例出现肺转移灶,1例出现胸腔积液及腹腔积液,1例出现淋巴结转移。结论儿童胸壁RMS的CT表现为胸壁较大或巨大软组织肿物,密度均匀或欠均匀,内无钙化及脂肪组织,部分有坏死区,邻近组织受推压甚至侵犯,可出现淋巴结及远处转移;增强扫描后病灶呈不均匀轻-中度强化,以周边强化明显。结合临床表现,综合分析增强CT影像表现可提高诊断准确率。
[Abstract]:Objective RMS (rhabdomyosarcoma of the primary chest wall) is rare, but there are few studies on the RMS imaging findings of the chest wall in children. The CT imaging findings of the chest wall RMS in children were analyzed in order to improve the diagnostic accuracy of the chest wall RMS in children. Materials and methods CT images of 5 children with chest wall RMS proved by operation and pathology were analyzed retrospectively and the CT features of RMS were summarized. Results in 5 cases, the lesions were located in the anterior chest wall in 1 case, the posterior chest wall in 2 cases, and the lateral chest wall in 2 cases. The shape of the lesion was round or fusiform, and part of the mass was shallowly lobulated. The density of the lesions on plain scan was not even, and there were 2 cases of low density necrotic areas in plaque shape, and 3 cases were more homogeneous in density. No calcification and adipose tissue were found in 5 cases. One case involved the adjacent spinal canal, one case was the mass protruding into the thoracic cavity, one case was pressing the lung tissue, one case was pressing the heart and liver, and two cases (5 cases) with the tumor around the blood vessel grew close to the ribs, humerus, scapular and spinal bones, and 1 case had bone destruction. Enhanced scanning showed uneven light and moderate enhancement in 5 cases, with obvious peripheral enhancement, with more thickening and distorted arterial shadows in the lesions. Pulmonary metastasis was found in 1 case with pleural effusion and 1 case with lymph node metastasis. Conclusion the CT findings of RMS in children's chest wall are large or large soft tissue masses with uniform or uneven density, no calcification and adipose tissue, some necrotic areas, the adjacent tissues may be pushed or even invaded, lymph nodes and distant metastasis can occur. The lesions showed uneven mild to moderate enhancement, especially peripheral enhancement. Combined with clinical manifestations, comprehensive analysis of enhanced CT images can improve the diagnostic accuracy.
【作者单位】：南方医科大学;南方医科大学第五附属医院影像科;广州市妇女儿童医疗中心放射科;南方医科大学南方医院影像诊断中心;
【分类号】：R738.6;R730.44

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