血管、腹膜及肠系膜源性急腹症的MSCT诊断

发布时间：2018-04-30 21:13

本文选题：急腹症 + 多层螺旋CT　；参考：《临床放射学杂志》2017年09期

【摘要】：目的探讨血管、腹膜及肠系膜源性急腹症的MSCT表现特点及应用价值。方法回顾性分析37例经影像及临床证实的血管、腹膜及肠系膜源性急腹症MSCT平扫、增强及多种后处理技术成像资料。结果动脉瘤破裂并假性动脉瘤6例,发生在腹主动脉4例,腹腔干、左髂总动脉各1例;CT平扫表现为紧贴主动脉壁的软组织肿块影,增强后对比剂自主动脉腔溢出壁外进入动脉瘤外的血肿包块;腹主动脉夹层8例,CT增强7例见真假"双腔",1例见腔内新月形无强化的稍高密度影,提示壁内血肿;血管栓塞16例,包括肠系膜上动、静脉栓塞6例,肾动脉栓塞3例,脾动脉栓塞2例,门静脉血栓形成5例,CT平扫2例表现为相应动脉或静脉内稍高密度影,3例为等密度,增强扫描均呈血管腔内充盈缺损;肠系膜扭转3例,CT增强扫描示肠系膜及其血管呈"旋涡征"改变;肠系膜脂膜炎2例,肠系膜密度增高呈雾状,周边见"假包膜征",病变中可见"脂环征"及多发小结节;原发性化脓性腹膜炎2例,表现为腹腔积液、积气,网膜、肠系膜密度增高、水肿,腹膜多发脓腔形成。结论 MSCT增强及CTA重组是诊断血管源性急腹症重要技术;合适的窗宽、窗位可以增加腹膜、肠系膜源性急腹症疾病诊断信息;肠系膜局部雾状密度增高,其中多发小结节影及纤维条索状密度增高影,边缘有"假包膜征"和"脂环征"是诊断肠系膜脂膜炎依据。
[Abstract]:Objective to investigate the MSCT features and application value of vascular, peritoneal and mesenteric acute abdomen. Methods 37 cases of vascular, peritoneal and mesenteric acute abdomen confirmed by imaging and clinical data were retrospectively analyzed by MSCT plain scan, enhanced imaging and multiple post-processing techniques. Results 6 cases of ruptured aneurysm with pseudoaneurysm occurred in abdominal aorta in 4 cases, celiac trunk in 1 case and left common iliac artery in 1 case on CT plain scan. After contrast enhancement, contrast agents entered the hematoma mass outside the aneurysm from the overflow wall of the aortic cavity, 8 cases of abdominal aortic dissection were enhanced by CT in 7 cases, and 1 case of "double lumen" of true or false "double lumen" was seen, which indicated that the intracavitary hematoma was slightly higher than that of the crescent shape, which indicated that there was no enhancement in the intramural hematoma. Vascular embolization was performed in 16 cases, including superior mesenteric artery, vein embolization in 6 cases, renal artery embolization in 3 cases, splenic artery embolization in 2 cases, and portal vein thrombosis in 5 cases. Contrast enhanced scanning showed endovascular filling defect, mesenteric torsion in 3 cases, mesentery and its vessels as "vortex sign" in 3 cases, mesenteric panniculitis in 2 cases, mesenteric density increased in 2 cases. Peripheral "pseudocapsule sign", "lipid ring sign" and multiple small nodules were found in the lesion, and 2 cases of primary purulent peritonitis were characterized by peritoneal effusion, accumulation of air, omentum, mesentery density, edema, and multiple peritoneal cavity formation. Conclusion Enhancement of MSCT and recombination of CTA are important techniques in the diagnosis of vasogenic acute abdomen, suitable window width and window position can increase the diagnostic information of peritoneal and mesenteric acute abdomen disease, and the mesenteric local fog density is increased. Among them, multiple nodule shadow and fibrous stripe increased density shadow, the margin has "false capsule sign" and "lipid ring sign" are the basis for diagnosis of mesenteric panniculitis.
【作者单位】：广西北海市人民医院放射科;
【分类号】：R656.1;R816.5

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