糖尿病高渗状态并发横纹肌溶解超声表现

目的 分析糖尿病高渗状态并发横纹肌溶解超声声像图特征,以探讨超声诊断糖尿病高渗状态并发横纹肌溶解的价值.方法 我院2005年1月至2011年9月27例糖尿病高渗状态伴肌肉肿胀、疼痛患者,经临床、病理及实验室检查证实糖尿病高渗状态并发横纹肌溶解19例.27例患者中超声诊断为糖尿病高渗状态并发横纹肌溶解18例,其中17例与临床、病理及实验室检查结果相符,漏误诊3例.回顾性分析超声诊断正确的17例糖尿病高渗状态并发横纹肌溶解患者超声表现,观察病变肌肉的连续性、肌肉纹理回声、病变部位、形态、边界、范围、有无液性无回声区和范围、彩色多普勒超声血流成像探测病变肌组织内有无血流信号显示.结果 超声诊断正确的17例糖尿病高渗状态并发横纹肌溶解患者,二维超声显示病变区横纹肌均明显肿胀,分别位于骨盆附件肌肉(6例)、下肢肌肉(8例)、上肢肌肉(1例)和后背肌肉(2例),病变范围17 mm×13 mm×9 mm至62 mm×39 mm×19 mm.其中6例肌肉弥漫性肿胀,11例肌肉内出现界限清晰的肿块样结构;病变区横纹肌肌纹理模糊不清,内部出现不均匀的强回声及低回声,呈现云雾状或毛玻璃样回声,其中7例病变中心出现强回声斑,6例于肌束间出现液性无回声区及强回声,4例肌肉与骨表面出现液性无回声区.彩色多普勒血流成像示病变肌肉内均无血流信号.结论 糖尿病高渗状态并发横纹肌溶解症超声表现有特征性,结合临床及实验室检查,可为临床诊断和治疗提供重要依据.

Ultrasonic manifestations of hyperosmolar diabetic patients with rhabdomyolysis

Objective To discuss the ultrasound manifestations of hyperosmolar diabetic patients with rhabdomyolysis and evaluate the diagnostic value of ultrasound.Methods Ultrasound was performed in 27 hyperosmolar diabetic patients with skeletal muscle lesions.Nineteen cases of rhabdomyolysis were diagnosed clinically.Ultrasonographic diagnosis was in accord with clinical diagnosis in 17 cases（17/19）,three cases were misdiagnosed.The ultrasound imaging features of 17 cases which were confirmed clinically were retrospectively analyzed.The size,shape,border and the blood flow of the lesions were observed.ResultsThe ultrasound features were as followed：17 lesions were swelling with unclear margin.Ultrasound showed 6 lesions in pelvic attachment of muscle,8 cases in lower limb muscles,1 case in upper limb muscles,and 2 cases in back muscles,the lesion size ranged from 17 mm×13 mm×9 mm to 62 mm×39 mm×19 mm.Six lesions of striated muscle accompanied with obvious swelling.Strong echoes were found in seven lesions.Echo free areas were found intramuscular（6 cases） or in the bone surfaces（4 cases）.Color Doppler flow imaging：no color Doppler signal was found in the 17 lesions.Conclusions Ultrasound plays an important role in the diagnosis of rhabdomyolysis.In combination with the clinical laboratory tests,ultrasound can provide an important basis for clinical diagnosis and treatment.