膈疝的影像学特征及检查方法评价

目的：分析膈疝的影像学特征,并对检查方法进行比较。材料与方法：本组１６例包括滑动性食管裂孔疝４例,不可复性食管裂孔疝２例,胸腹膜裂孔疝３例,胸骨旁裂孔疝３例,创作性膈疝４例,１４例摄胸片,１２例作钡餐,２便作钡灌肠,４便作胸部ＣＴ,４例作Ｂ超结果：１２便膈疝钡餐清楚显示胃、小肠或结肠疝入胸腔内,２例膈疝钡灌肠清晰显示结肠肝曲疝入胸腔,２例膈疝ＣＴ显示部门胃腔疝入胸腔。结论：当膈疝内容物为消化道腔脏     

食管裂孔疝胸部正位片诊断价值

目的 探讨X线胸部正位片对食管裂孔疝诊断价值.方法 分析、总结11例经上消化道钡餐检查确诊的食管裂孔疝患者胸部正位片影像表现.结果 11例于左膈上心影重叠区见密度增高类圆形肿块影,外上缘清晰,上部有低密度区,部分有液平面,其中2例首诊误诊为左下肺部病变.11例均行上消化道钡餐检查确诊为不可恢复型食管裂孔疝.结论 胸部正位片能发现食管裂孔疝,辅助上消化道钡餐检查确诊,对避免误、漏诊有重要价值.     

胸腹通连病变的影像诊断及其解剖基础

目的 探讨胸腹通连病变的ＣＴ、ＭＲＩ诊断及其解剖基础。材料与方法 回顾性分析５４例穿越膈孔的膈肌的胸腹通连病变,并以４０例正常人ＣＴ、ＭＲＩ表现作对照。结果 ５４例病变经食管裂孔１８例,病变主要系贲门癌侵犯食管下段、食管静脉曲张及食管旁疝;经主动脉裂孔２１例,病变有淋巴瘤、淋巴转移、其他肿瘤及上腔静脉塞后厅静脉扩张;经下腔静脉裂了孔７例;经膈肌直接穿通８例,见于肺癌、肝癌、感染性疾病、先天性膈发育     

小儿食管裂孔疝的X线诊断

目的：分析与复习小儿食管裂孔疝的X线诊断。方法：回顾分析我院60例X线钡餐造影发现食管裂孔疝后经手术证实的病例，结合相关文献复习其影像学特征。结果：60例患儿中有32例胸片可见膈上出现疝囊，吞钡后呈囊状、漏斗状或葫芦状，膈上可见胃粘膜及食管一胃环。当腹压增高时疝囊明显，减小时可消失，并多伴有食管持续反流；14例胸片心影后方可见软组织包块影，有时有气液面。吞钡后胃的部分突入胸腔，贲门位置有11例位于膈下，3例位于膈上；4例食管短而直，贲门位置在胸7—8水平。60例患儿中有1例合并食道狭窄，2例合并有贲门失弛缓症。结论：食管裂孔疝有典型的X线征象，X线检查可以明确不同类型的诊断，为临床提供手术依据。     

数字连续摄片对食管裂孔疝的动态观察

目的:探讨数字连续性点片对食管裂孔疝早期诊断的价值。方法:使用数字连续点片,以2-4幅/s的速度,对42例食管裂孔疝患者进行胃肠造影检查。结果:42例中不可复性食管裂孔疝14例,可复性食管裂孔疝28例。X线显示疝囊17例,膈上胃黏膜38例,B环24例,HIS角变钝37例,贲门口增宽上移13例,食管炎28例等。结论:通过这种方法可以动态地观察食管的运动过程,明显提高食管裂孔疝的检出率。     

婴幼儿巨大型食管裂孔疝的X线诊断(附5例分析)

婴幼儿食管裂孔疝并非少见 ,笔者从 17例婴幼儿食管裂孔疝中发现 5例巨大型食管裂孔疝 ,鉴于此型食管裂孔疝容易误诊 ,本文重点对巨大型食管裂孔疝的胸片和钡餐造影表现作一分析。1　材料与方法1.1　临床资料　男 4例 ,女 1例 ,年龄 :45ｄ～ 18个月 ,其中 4例就诊时小于 6个月。主要临床表现为呕吐、营养不良、肺部感染等。1.2　方法　 5例均行胸片或胸透检查 ,3例是以呕吐症状就诊 ,经钡餐检查后摄胸片 ,1例是为查找营养不良原因、1例因肺部感染而摄胸片 ;5例均口服或经胃管向胃内注入稀钡后取立、卧位 ,多轴位透视观察并及时点片。 2例复…     

食管裂孔疝的螺旋CT诊断价值

目的：探讨螺旋CT扫描对食管裂孔疝（EHH）的诊断价值。方法：回顾性分析经上消化道钡餐造影或胃镜检查证实的25例食管裂孔疝的CT表现。结果：25例EHH螺旋CT扫描均清楚显示膈上疝囊,表现为食管裂孔上方层面后纵隔内大小不等的软组织密度结节或肿块影,通过食管裂孔与膈下胃腔相连续。其中结节型（〈3．0cm）13例,假肿块型（≥3．0cm）12例,增强扫描结节影或疝囊壁与膈下胃壁呈均匀一致强化。4例同时伴有网膜食管裂孔疝,18例（72％）EHH的膈肌脚间距增大。结论：螺旋CT对EHH检出率高,可以显示食管裂孔有无增大、疝囊的全貌以及合并症等,对发现NEHH以外的原因作胸部或上腹部CT检查的EHH病例有重要的价值,可作为上消化道钡餐造影和胃镜检查较好的补充检查方法。     

传统钡餐造影对老年性食管裂孔疝的诊断价值

目的 探讨传统钡餐造影对老年性食管裂孔疝的诊断价值,增强大家对食管裂孔疝的认识,提高对本病的诊断水平.方法 总结我院自2009年6月～2012年6月诊治的32例食管裂孔疝病例,进行X线分析,并结合CT及内镜诊断予以比较.结果 X线表现具有特征明显,分型准确.32例食管裂孔疝患者,其中可复性23例,不可复性9例（后者又分为短食管型2例、食管旁型3例、混合型4例）,16例行CT检查,21例行内镜检查.结论 通过对本组病例的分析,对食管裂孔疝有了进一步的认识,通过与CT及内镜的对比,传统钡餐造影对诊断食管裂孔疝具有独特优势.     

小儿食管裂孔疝的CT诊断

食管裂孔疝(esophagealhiatushernia)并不罕见,因其临床X线表现复杂多样,有时与胸部病变难以鉴别,文献报道诊断延误严重者可造成死亡[1],尤其是小儿。关于小儿食管裂孔疝的CT诊断尚未见报道,现将我院经手术证实的3例婴幼儿食管裂孔疝介绍如下,并探讨其CT诊断价值。1　病历报告例1　男,8月。发热4d,咳嗽2d入院。病人无呕吐,查体,两肺呼吸音粗,余未见异常。胸片示右心膈角处一小片密度增高影,边缘不清。7d后复查示片状阴影消失,并可见一约2cm的孤形影。CT胸部平扫示右下心后缘肋脊角处见一囊性病灶,内含气体,内壁不规则,外缘清,见病灶向前…     

心包膈静脉扩张致左心旁肿块：4例报告

心包膈静脉扩张致左心旁肿块：４例报告左心包隔静脉是左头臂静脉的一分支，有与膈下静脉吻合的横膈支，在腔静脉阻塞时可以起侧支旁路作用。作者报告了４例心包膈静脉扩张在胸片上表现为心旁肿块的病人，均经下腔静脉造影，ＣＴ和ＭＲ证实有下腔静脉之肝上部分的膜性阻塞...     

The differential retrocardiac air-fluid level: a sign of intrathoracic gastric volvulus

A single retrocardiac air-fluid level on a chest radiograph typically implies the presence of a sliding hiatal hernia. A differential retrocardiac fluid level (two air-fluid interfaces at different heights) suggests not a simple sliding hiatal hernia but rather an intrathoracic gastric volvulus. Simultaneous fluid levels above and below the diaphragm are not required to make the diagnosis. We have seen four patients with chronic gastric volvulus confirmed by upper gastrointestinal barium examination. Each case was diagnosable on the basis of the chest radiographs obtained on admission, using the radiographic sign described above. We draw attention to this sign because chronic gastric volvulus has the potential to progress to acute volvulus and gastric ischemia or infarction.     

CT of fundoplication

To determine the CT findings postfundoplication, we retrospectively compared CT in 22 postfundoplication patients with CT in 22 patients with unrepaired hiatal hernias and gastroesophageal (GE) junction abnormalities and 24 patients with gastric or esophageal carcinoma involving the GE junction. Seventeen of the 22 postfundoplication patients had undergone a Nissen procedure. Of the 22 patients, 11 had esophageal dilatation, 14 had GE junction masses, 4 had esophageal wall thickening, 7 had surgical clips, and none had hepatic metastases or upper abdominal lymphadenopathy. Statistically, on CT, postfundoplication patients are more likely to have a GE junction mass (p = 0.023) and least likely to have wall thickening (p = 0.021). Nonetheless, because the findings occur frequently in each group, they are not diagnostic in the individual patient. However, 11 of 12 post-Nissen masses had the unique finding of an oval or linear central fat density within the mass. This finding was absent in the other postfundoplication masses and in those patients with repaired hiatal hernia or tumor. We conclude that pseudomasses occur on CT postfundoplication and can be indistinguishable from hiatal hernias and GE junction neoplasms unless a central fat density is present.     

高分辨率食管测压与X线钡餐造影对食管裂孔疝诊断价值的评价

目的探究X线钡餐造影与高分辨率食管测压对食管裂孔疝的诊断价值。方法选取50例经手术确诊为食管裂孔疝患者的高分辨率食管测压与X线钡餐造影资料,对比这两种方法对食管裂孔疝的诊断价值。结果X线钡剂造影检查出食管裂孔疝48例(阳性率96%),未发现食管裂孔疝2例(阴性率4%);高分辨率食管测压检查出食管裂孔疝46例(阳性92%),未发现食管裂孔疝4例(阴性率8%);两种方法同时检查出食管裂孔疝47例,符合率94%,两种检查诊断食管裂孔疝差异无统计学意义(P>0.05)。疝囊小于3 cm时,上消化道造影诊断准确率优于高分辨率食管测压,其差异有统计学意义。高分辨测压诊断食管体部运动功能障碍21例,X线钡餐造影无特异性表现。结论X线钡餐造影与高分辨率食管测压对诊断食管裂孔疝均有较高价值,食管高分辨测压诊断食道裂孔疝合并食管体部运动功能障碍有明显优势;当疝囊较小时,上消化道造影诊断准确率优于高分辨率食管测压。     

膈疝的临床及影像学分析

目的：加深对膈疝的临床及影像征象的认识并对检查方法进行比较。方法：回顾性分析14例经手术证实的膈疝的影像表现。结果：膈疝具有下列征象：①膈面异常：膈面轮廓部分或全部不清与缺如;假膈面升高;膈上半圆形块状阴影;②胸腔积气积液阴影或块状影：中下肺野囊状或蜂窝状透光阴影;胸腔宽大气液平面;心膈角区肿块影;③胸腔阴影形态的可变性：不同时间、不同体位阴影形态、数量或密度发生改变;④邻近脏器的异常：纵隔向健侧移位;腹部正常脏器的向上移位;⑤钡餐及钡灌肠检查胸腔内见胃肠道影;⑥CT扫描胸腔内见胃肠道、网膜及肠系膜、肝脾肾。结论：影像学检查对膈疝的术前诊断有重要价值。胸腹部平片及透视对膈疝有提示作用,钡餐（钡灌肠）能直接显示胸腔内胃肠道,胸腹部CT扫描能显示疝入胸腔的空腔脏器或实质性脏器。     

胸部脂肪瘤的影像学诊断(附14例报告)

目的探讨胸部脂肪瘤的影像学表现及检查方法优选. 资料与方法搜集胸部脂肪瘤14例资料,包括肺脂肪瘤2例,胸壁脂肪瘤4例,纵隔脂肪瘤3例,胸腺脂肪瘤3例,横膈脂肪瘤1例,右心房脂肪瘤1例,全部病例均有胸部正侧位片,12例进行了CT检查,1例进行了MRI检查,对全部患者的影像学表现进行分析. 结果胸部正侧位片病灶发现率78.6%,漏诊原因与肿瘤密度过低,肿瘤沿胸壁深部肌间隙浸润生长或肿瘤位于平片上较隐蔽的部位有关.CT检查不仅可进行精确的定位诊断和分类诊断,而且能作出定性诊断,但应常规摄脂肪窗片.MRI对这类肿瘤最敏感,它对病变的发现、定位、分类诊断及定性诊断有决定性意义. 结论胸部正侧位片是胸部脂肪瘤的首选检查方法,但病变的分类诊断与定性诊断需依赖胸部CT与MRI,其中MRI是该类疾病的最佳检查方法.     

Communicating intrathoracic hydrocele

Tense ascites may cause herniation of parietal peritoneal reflection into the mediastinum at the gastroesophageal junction. This may produce a mass visible on chest radiograph and computed tomography (CT). This communicating intrathoracic hydrocele may occur in the absence of hiatal hernia and may be confused with other middle mediastinal fluid collections including necrotic tumor, abscess, cyst of foregut origin, or pancreatic pseudocyst. Recognition of this entity in patients with ascites should prevent diagnostic confusion and unnecessary further evaluation.     

Chest CT scanning for clinical suspected thoracic aortic dissection: beware the alternate diagnosis

The aim of the study was retrospectively to evaluate the spectrum of chest diseases in patients presenting with clinical suspicion of thoracic aortic dissection in the emergency department. We performed a retrospective medical records review of 86 men and 44 women (ages ranging between 23 and 106 years) with clinically suspected aortic dissection, for CT scan findings and final clinical diagnoses dating between January 1996 and September 2001. All images were obtained by using a standard protocol for aortic dissection. We found aortic dissection in 32 patients (24.6%), 22 of which were Stanford classification type A and 10 Stanford type B. In 70 patients (53.9%), chest pain could not be explained by the CT scan findings. However, in 28 patients (21.5%), CT scanning did reveal an alternate diagnosis that, along with the clinical impression, probably explained the patients' presenting symptoms, including: hiatal hernia (7), pneumonia (5), intrathoracic mass (4), pericardial effusion/hemopericardium (3), esophageal mass/rupture (2), aortic aneurysm without dissection (2), pulmonary embolism (2), pleural effusion (1), aortic rupture (1), and pancreatitis (1). In cases where there is clinical suspicion of aortic dissection, CT scan findings of an alternate diagnosis for the presenting symptoms are only slightly less common than the finding of aortic dissection itself. Although the spectrum of findings will vary depending upon your patient population, beware the alternate diagnosis. Electronic Publication