不典型咽旁胸锁乳突肌肉内血管瘤一例

患者 女,69岁.偶然发现颈部包块20余天.体检:左胸锁乳突肌中段前缘触及一大小约3 cm×3 cm肿物,呈类圆形,活动度可,质稍韧,边界欠清,与周围组织粘连,轻压痛,无周围淋巴结肿大.     

桡动脉在全动脉化非体外循环冠脉搭桥术中的临床应用

目的 探讨桡动脉(RA)在全动脉化非体外循环下冠脉搭桥术(OPCABG)中的早期临床效果.方法 32例患者采用乳内动脉和桡动脉行全动脉化非体外循环冠脉搭桥手术,桡动脉的获取标准采用改良Allen's实验、量化Allen's实验、术前超声检查和术中Allen's实验判定桡动脉功能及尺动脉代偿功能;采用不接触血管技术获取桡动脉,与冠状动脉对角支、钝缘支、前降支、右冠状动脉等单独、序贯及"Y桥"吻合,共搭桥63支.术后应用钙通道阻滞剂及硝酸甘油防止桡动脉痉挛.结果 32例手术均顺利完成,痊愈出院,无围术期心肌梗塞,术后心肌缺血改善,无手部缺血并发症.随访3月～1 a,手部运动及感觉功能正常,无心绞痛复发.结论 桡动脉作为血管桥材料在全动脉化冠脉搭桥术中应用效果良好,作为第2选动脉桥血管具有明显优势.     

分次团注技术对迷走血管所致肾盂输尿管连接部梗阻诊断价值的探讨

目的 探讨分次团注技术对迷走血管压迫所致肾盂输尿管连接部梗阻(UPJO)的诊断价值. 方法 52例UPJO患者采用分次团注技术扫描,观察有无迷走血管、迷走血管的起源及其与UPJO之间的关系,并与手术病理相对照. 结果 52例患者中,CT怀疑14例为迷走血管压迫所致,其中10例为左侧副肾动脉,1例为起源于左肾动脉的卵巢动脉,1例为右侧副肾动脉,2例为左侧性腺静脉,均与手术病理相吻合,敏感性和特异性均为100%. 结论采用分次团注技术能准确对迷走血管压迫所致的UPJO患者做出病因诊断,以指导手术,并且减低了患者所接受的放射剂量.     

重症甲型H1N1流感的临床分析及CT表现

目的 探讨重症甲型H1N1流感患者的临床特点及CT表现.方法 回顾性分析24例重症甲型H1N1流感患者的临床和CT资料.结果 83.3%(20/24)的重症甲型H1N1流感患者为男性.最常见(66.7%,16/24)的首发症状为咳嗽,而非发热(58.3%,14/24).胸部CT扫描24例患者均有不同程度的肺部异常表现.24例中位于双侧肺野19例(79.2%),单侧肺者5例(20.8%),病变累及5个肺叶者15例(62.5%).病变形态表现为斑片状实变影16例(66.7%)、局灶性渗出影13例(54.2%)、磨玻璃影13例(54.2%)、大片状实变影9例(37.5%)及间质性改变4例(16.7%).4例(16.7%)患者伴有胸水.所有患者均无纵隔淋巴结肿大.结论 肺部异常是重症甲型H1N1流感患者诊断的重要指标,重症甲型H1N1流感患者的临床和CT表现有一定的特征.     

不典型细支气管肺泡癌误诊为肺炎一例

病例资料患者,女,40岁,咳嗽,咳黄色粘痰1个月,无发热、盗汗、消瘦、乏力、痰中带血等。体检:呼吸16次/分,脉搏80次/分,血压100/70mmHg,体温36.6℃。实验室检查:WBC5.8×109/l,NEU0.6933,Hb134.9g/l。CT检查:肺窗示右肺上叶前段一大小约4.0cm×4.5cm边缘清晰的云絮状高密度影,中央可见纤细肺纹理(图1);纵隔窗仅显示病灶前缘条状间质增生(图2a),增强扫描示中度强化(图2b),纵隔内未见肿大淋巴结和肿块影像,首诊为感染。经近2个月抗生素治疗后复查,病灶变化不大。手术所见:肺裂完整,未见确切肿块。在右肺上叶水平裂面可观察到一大小约1.1cm…     

肺平滑肌瘤1例报告

患者　女, 43岁。1年来无明显诱因出现刺激性干咳,偶有咯血,无胸闷、气促,发热、盗汗等。门诊X线提示左肺下叶背段周围型肺癌可能。CT扫描:平扫左下肺门 3. 0cm×2. 5cm×3. 0cm软组织结节,呈浅分叶,边缘光滑,密度均匀,CT值约 44. 4HU,增强扫描强化明显,增强早期CT值增至 89. 4HU,延迟 2min扫描,CT值增至 106. 9HU。右下肺动脉及外基底段分支稍向外后移位,左肺下叶支气管受压稍变形。结节周围肺野清晰,肺门及纵隔无肿大淋巴结(图 1~4)。CT诊断:肺癌可能。手术:肿块位于左肺下叶,约 3. 0cm×2. 5cm×2. 5cm大小,质韧,边界清楚,有…     

原发性喉恶性淋巴瘤CT表现(附4例报告)

喉恶性淋巴瘤较少见,国内1989～2002年共报道80例[1～3],主要为临床病理分析,影像诊断分析报道较少。我院自1989-01～2003-12经病理确诊4例,现报道如下。例1男,22岁。声嘶半年,发现颈部包块4d。查体:左颈部胸锁乳突肌前、后方各触及80mm×100mm、30mm×30mm大小包块,边界不清,质中等,不活动,无压痛。CT表现为左侧声带中份结节向声门突起,大小13mm×10mm,基底较宽,同侧胸锁乳突肌深面见多个肿大淋巴结,部分融合成块,最大层面大小约50mm×25mm,致左侧咽旁间隙消失,左梨状隐窝变形,喉旁间隙变窄,邻近骨质未见破坏,会厌舌面左侧隆起,右侧未见明…     

翻转课堂病例竞赛模式在影像学教学中的应用

目的 探讨翻转课堂结合病例竞赛的教学模式在医学影像专业实践教学中的应用效果.方法 选择昆明医科大学医学影像专业见习学生191名,将其分为教改组(n=96)和对照组(n=95)进行骨骼肌肉系统影像诊断学的翻转课堂教学,在此基础上教改组学生再以3/4名/组以病例竞赛模式进行授课及答疑;课后采用闭卷考试和问卷调查的形式检测影像诊断学的教学效果.结果 教改组学生平均考试成绩(92.50±11.51)分明显高于对照组的(75.15±20.36)分,差异有统计学意义,P<0.05,且两组学生的阅片成绩和教学满意度评价的差异有统计学意义,P<0.05.结论 翻转课堂结合病例竞赛模式能够明显调动学生学习积极性,提高学生学习成绩和教学评价效果,是一种有效的实践教学方法.     

Application of spiral CT image 3D reconstruction in severe talar neck fracture

Objective： To explore the application of the spiral computerized tomography （CT） image three-dimensional （ 3D ） reconstruction technique associated with the conventional radiography in the diagnosis and treatment of severe talar neck fracture. Methods： Using the multi-slice spiral CT image 3D reconstruction technique, we analysed Ⅱ cases of talar neck fracture. The fractures were reduced and fixed through a minimal incision and internal fixation with titanium cannulated lag screws. Results. In the Ⅱ cases, the results of CT image 3D reconstruction were in concordance with plain radiograph in 6 case of Hawkins type Ⅱ. And the remaining 5 cases of Hawkins types Ⅲ and Ⅳ could not be classified exactly only by radiographs, one of whom was misdiagnosed. After using the CT image 3D reconstruction, the 5 cases were classified exactly before osteosynthesis. The classifications of these Ⅱ cases were confirmed finally by surgical findings. The duration of operation were 45-Ⅰ40 min, averaging 8Ⅰ min （including the duration of C-arm fluoroscopy）. X-ray exposure time was 6-58 seconds, averaging 22 seconds. The blood loss was less than Ⅰ00 ml. The fracture union was achieved in 3 months. No nonunion, talus avascular necrosis or joint surface collapse occurred. Postoperative follow-up was from Ⅰ to 25 months. According to Hawkins score, excellent result was found in 6 type Ⅱ cases and Ⅰ type Ⅲ case; good result in I type Ⅲ case with both medial and lateral malleolar fracture, Ⅰ type Ⅲ with medial malleolus fractures and Ⅰ open type Ⅲ; fair result in Ⅰ open type Ⅳ with lateral malleolus fracture. Conclusions ： By using the multl-slice spiral CT image 3D reconstruction associated with radiography to diagnose and treat severe talar neck fractures, the accuracy of diagnosis can be improved obviously. Based on this technique, more consummate operational plan can be designed and performed so as to achieve a better therapeutic effect.