外伤性脾破裂的CT诊断

目的探讨外伤性脾破裂的CT表现及诊断价值. 资料与方法对48例成人闭合性钝性脾破裂的CT、B超表现与外科手术所见进行回顾性分析. 结果 48例中完全性脾破裂39例,中心破裂6例,3例包膜下破裂.48例均行CT检查, 46例确诊, 诊断符合率98.5%; 其中19例同时行B超检查, B超确诊17例, 诊断符合率89.4%.其CT表现为脾内血肿、脾撕裂伤、包膜下血肿、脾周血肿及腹腔积血,同时发现25例合并肝、肾、肋骨、脊柱等损伤. 结论 CT作为一种非损伤性检查手段,能迅速、准确评估脾损伤程度及出血的部位、大小以及腹腔伴随性损伤.肋骨及运动性伪影是CT诊断脾破裂过程中的主要误、漏诊原因,结合彩色多普勒超声检查,可减少运动性伪影造成的误漏诊;CT能为临床选择非手术病例提供重要帮助.

CT Diagnosis of Spleen Rupture with Trauma

Objective To evaluate CT features of traumatic spleen rupture (SR) and its diagnostic value. Materials and Methods 48 adult patients with closed blunt SR were performed CT , and 19 added to ultrasound. The imaging findings were compared with surgical findings. Results 48 cases had entire SR in 39, central SR in 6, subcapsular SR in 3. 46 of 48 cases were detected on CT scans, and the concordant rate was 95.8%. 17 of 19 cases were detected by ultrasound, and the concordant rate was 89.4%. CT demonstrated hematoma in spleen, lacerated injury of spleen, subcapsular hematoma, hematoma surrounding spleen and hematoperitoneum. In addition, CT showed 25 cases with concomitant liver, renal, rib or spine damage. Conclusion As a non invasive imaging method, CT can rapidly demonstrate the extent of SR, position and size of the bleeding, and the concomitant damage of other organs in abdomen. Rib and motion artificial shadows are the main cause for the misdiagnosis and missing diagnosis of SR. Together with color ultrasound, the rate of the misdiagnosis and missing diagnosis caused by motion artefict on CT can be improved. CT is helpful for management planning.