脐尿管占位性病变的CT诊断及鉴别诊断

目的 探讨CT检查在诊断和鉴别诊断脐尿管占位性病变方面的价值。方法根据临床病理证实的24例脐尿管占位性病变患者的CT影像学特征，分析其大小、部位、形态、性质、Retzius间隙影像学变化及增强后的影像学特征。结果 24例均明确诊断。4例为脐疝，其中3例疝囊内容物为网膜组织，另1例为肠管。20例为脐尿管占位性病变，均位于Retzius间隙内的脐尿管行走区，其中单纯性脐尿管囊肿6例，CT表现为长条椭圆形完整囊状包块，囊壁薄、光滑，囊内容物呈均匀低密度回声，增强后无强化；感染性脐尿管囊肿7例，CT表现为内部回声不均，灶周Retzius间隙内可见絮状或条索状密度增高影，其中4例囊壁明显增厚，3例囊壁不完整，2例呈多房性囊肿；脐尿管憩室伴结石3例，CT表现为中线处膀胱壁内可见高密度结石影；脐尿管肿瘤性病变4例，均于膀胱顶壁区中线处发现不规则软组织肿块影，增强后明显强化。结论 脐尿管占位性病变并不常见，多为感染性囊肿，结合临床术前确诊并不困难。CT是脐尿管占位性病变术前明确诊断和鉴别诊断的重要措施之一。

CT diagnosis and differential diagnosis of urachus tumor

Objective To analyze the value of CT scanning on the diagnosis of urachus tumor. Methods CT images of 24 cases of urachus tumor proved by pathological examination were reviewed, focusing on size, location, shape, character and the imageological feature of Retzius space. Results In the 24 cases, 4 cases were urachal herniation and the other 20 cases were urachal neoplasm located in Retzius space. In the neoplasm group, 6 cases were simple uracheal cyst reflected as home gemeous fluid-filled cavity with thin wall in CT scanning and no enhancement in the contrasting imaging. 7 cases were infected urachal cyst manifested as cysts with thickened and enhanced wall, with patch and strip in Retzius space. 3 cases were urachal diverticulum accompanied with caculi showing high-density imaging in bladder. The other 4 cases were urachal tumor showing irregular soft-tissue mass over the apex of bladder with apparente enhancement in contrast imaging. Conclusion CT scan can demonstrate the location, shape, extent and density of lesions as well as their relation with adjacent structures, thereby providing a valuable method for diagnosis and differential diagnosis of urachus tumor.