CT结肠成像的临床应用

CT结肠成像(CTC),也叫仿真结肠镜,是一种安全、非侵入性的结肠检查方法.临床主要应用于结、直肠癌筛查,结肠镜未完成之后的补充检查,结肠镜检查禁忌或不愿接受结肠镜检查以及结、直肠癌的诊断与分期等.本文对CTC的临床应用予以综述.     

Kartagener综合征1例并文献复习

病例男,32岁,因“反复咳嗽、咳痰10+年,再发加重1周”就诊于我院呼吸科,患者自诉自幼体质较弱,反复出现咳嗽、咳浓痰、间断咯血等症状,病程中反复发作性头痛、头昏,伴鼻塞、流脓性鼻涕,嗅觉差,未婚未育。曾于外院多次诊断“支气管扩张并感染”。体格检查:双侧鼻腔黏膜充血,可见少许分泌物,鼻窦区压痛。胸部对称,外形正常,肋间隙正常,双侧乳头正常对称。双侧呼吸运动对称,双下肺呼吸音减低,可闻及散在哮鸣音及下肺湿罗音。触诊未触及胸膜摩擦感,语音震颤对称。心前区无隆起,心界不大。心尖搏动位于第5肋间右锁骨中线内侧缘约0.5 cm处,心率75次/分,律齐。腹平软,肝肋缘下未触及,脾未触及,肠鸣音正常。     

腹部嗜血细胞综合征1例

患者女,54岁.10个月前无明显诱因出现发热,经药物治疗后症状无明显改善,并出现皮肤瘙痒,在当地医院应用激素治疗后好转;近2个月再次出现发热,伴上腹部不适、恶心、呕吐等.入院查体未见异常.实验室检查;血清铁蛋白897.00μg/L;RBC 3.48×1012/L;WBC 3.28×109/L;PLT 62.00×109/L.骨髓穿刺细胞涂片;组织细胞比例增高,可见巨噬细胞及吞噬血细胞现象.     

十二指肠脂肪瘤1例

十二指肠脂肪瘤属罕见的疾病，笔者在工作中遇到1例，现报告如下。     

指甲-髌骨综合征1例

<正>指甲-髌骨综合征(Nail-patella syndrome,NPS)是一种常染色体显性遗传病，又称Fong氏病、遗传性指甲骨发育不全或发育异常、Turner-Kieser综合征，常对称性地累及来源于外胚层和中胚层的器官^[1-2]，具有不同的外显率和表达，指甲、骨、眼、肾脏是常见的受累系统。这种疾病比较罕见，但其临床和影像学表现具有一定特征。本文回顾性分析1例我院收治的NPS患儿的典型临床及影像资料，总结该病的影像表现及鉴别诊断，以助于进一步认知NPS，避免漏诊或误诊。     

石胎1例

病例女,58岁.腹痛3天,加重半天人院.体检可见腹部膨隆.B超提示腹腔包块.CT检查:中下腹子宫上方见一巨大类圆形包块,上缘平脐,下至耻骨联合稍上方,大小约16.5cm×12.3cm,边缘不规则,股骨长约6.7cm,相当于孕36周左右.包膜呈蛋壳样钙化,其内骨样组织清晰,可见脊柱、颅骨、肋骨及四肢等骨样组织,考虑"石胎".     

Cockayne综合征1例并文献复习

<正>Cockayne综合征(Cockayne syndrome,CS)是1936年由英国儿科医生Cockayne最先报告的一种罕见的常染色体隐性遗传性儿童严重致残致死的早衰性疾病,全球仅报告200余例,发病率为2.5/100万^[1]。现分析总结我院诊疗的1例CS患儿的临床表现、影像特征及基因检测,提高影像科医生对该病的认识。     

Marchiafava-Bignami综合征1例

1病历摘要 患者，男，44岁，下岗职工。冈步态不稳、记忆力减退1月余就诊。饮劣质白酒20余年，每日200～300g左右。查体：BP 110／75mmHg，T36．5℃，消瘦，生命体征平稳，意识清，言语含糊，回答有时不切题，步态不稳，记忆力差，定向力正常。颅神经检查未见异常，肌力正常，病理反射未引出。     

Joubert综合征1例

病例 男,6岁。因智力运动发育落后,肌张力减低,间断出现双眼发直,喘息样呼吸就诊。体检：四肢肌张力减低,肌力Ⅳ-,步态不稳,巴宾斯基征阳性。影像学检查：CT及MR平扫均显示小脑蚓部发育不良,两侧小脑半球间裂增宽，脑干发育异常．脚间窝加深,小脑上脚延长并加厚．呈“臼齿征”,第四脑室形态异常,上部扩大，呈“蝙蝠翼”状（图1，2）。大脑未见明显异常。结合临床诊断为Joubert综合征。     

Kartagener’s综合征1例

病例 男,26岁,已婚2年,不育.以长期反复咳嗽、咳痰、咳血,久治不愈,近期加重.经系统抗炎治疗,疗效不显著来我院检查.患者自出生开始反复发生肺部感染,伴长期咳脓性痰.于10余年前开始出现间歇性痰中带血、胸闷、胸痛等症状,无呼吸困难.本次发病于入院前9d,因受凉后出现高热、寒战.咳嗽、咳痰症状加重.痰为黄脓样,经抗炎治疗后症状减轻,外院X线胸片显示肺内病变未见减小.     

噬血细胞综合征1例

病例女,24岁,孕5月,反复腹胀1年余,腹痛3d入院。入院前3d,病人无明显诱因出现中上腹隐痛伴阵发性绞痛及心前区放射痛,以餐后为甚。不伴黄疸,无排便排气障碍。查体：下腹膨隆,睑结膜苍白,中上腹压痛、无反跳痛,肝区叩痛、无压痛,双下肢无肿胀。     

非典型内脏异位综合征1例

病例 男,30岁,以"活动后胸闷、憋气20余年,伴后背痛1周"入院,20多年来活动后胸闷、憋气,呼吸困难,休息后好转.口唇紫绀、杵状指,心尖搏动位于右第5肋间锁骨中线内1 cm,胸骨右缘3、4肋间闻及3/6级收缩期喷射样杂音.腹软,肝脾未触及.体温36.7℃,心率77 次/分,呼吸17 次/分,血压126/74 mmH...     

Peutz-Jeghers syndrome with mesenteric fibromatosis: A case report and review of literature

BACKGROUND Peutz-Jeghers syndrome(PJS) and mesenteric fibromatosis(MF) are rare diseases,and PJS accompanying MF has not been previously reported. Here, we report a case of a 36-year-old man with both PJS and MF, who underwent total colectomy and MF surgical excision without regular follow-up. Two years later, he sought treatment for recurrent acute abdominal pain. Emergency computed tomography showed multiple soft tissue masses in the abdominal and pelvic cavity, and adhesions in the small bowel and peritoneum. Partial intestinal resection and excision of the recurrent MF were performed to relieve the symptoms.CASE SUMMARY A 36-year-old male patient underwent total colectomy for PJS with MF. No regular reexamination was performed after the operation. Two years later, due to intestinal obstruction caused by MF enveloping part of the small intestine and peritoneum, the patient came to our hospital for treatment. Extensive recurrence was observed in the abdomen and pelvic cavity. The MF had invaded the small intestine and could not be relieved intraoperatively. Finally, partial bowel resection, proximal stoma, and intravenous nutrition were performed to maintain life.CONCLUSION Regular detection is the primary way to prevent deterioration from PJS. Although MF is a benign tumor, it has characteristics of invasive growth and ready recurrence. Therefore, close follow-up of both the history of MF and gastrointestinal surgery are advisable. Early detection and early treatment are the main means of improving patient prognosis.     

超声诊断多脾综合征1例

病例男,22岁。因胆囊结石、胆总管结石入院行术前检查。腹部超声所见：肝脏左右叶大小一致,肝门位于中线。胆囊位于右上腹,内可见二枚1.0cm×0.5cm强回声团伴声影;胆总管上段见1.5cm×1.0cm强回声团伴声影。左季肋区未见     

Rasmussen综合征影像学表现1例

<正>Rasmussen综合征(rasmussen syndrome,RS)是一种少见的、特殊的、主要影响一侧大脑半球的进展性疾病,临床以难治性癫痫伴同侧神经系统进行性功能障碍为主要表现。近年来证实早期手术可以有效减少癫痫发作提高预后,因此早诊断、早治疗显得尤为重要。本文依据其临床及影像学表现并回顾相关文献,报道如下。患儿,女,11个月,2014年8月9日,以间断抽搐3 h入院,表现为左侧肢体节律性抽动,双眼     

Double intussusception in a teenage child with Peutz-Jeghers syndrome: A case report

BACKGROUNDPeutz-Jeghers syndrome (PJS) is a genetic disorder characterized by the development of gastrointestinal hamartomatous polyps and mucocutaneous melanin pigmentation. Patients with PJS are at risk of complications such as intussusception. Intussusception is a condition where one segment of the intestine invaginates into another, causing intestinal obstruction. We report a PJS patient who was diagnosed with double intussusception in a single setting. CASE SUMMARYA 16-year-old teenage male PJS patient presented with a history of colicky abdominal pain, vomiting, blood in stools, loss of appetite, and weight loss. On abdominal examination, a vague mass was palpable over the right upper quadrant. Contrast-enhanced computed tomography (CT) of the abdomen was performed and an intussusception involving the jejunum and rectosigmoid junction was observed. The patient subsequently underwent a laparotomy and intussusception involving the jejunum and another over the ileum was noted intra-operatively. Bowel resection and an endoscopic polypectomy were performed, followed by a primary anastomosis. The patient was discharged well and reviewed again one month later, and was noted to be well.CONCLUSIONPJS patients have a high risk of intussusception and can be diagnosed accurately by endoscopic surveillance or radiologically with abdominal CT or magnetic resonance imaging. The mainstay of treatment is surgical intervention followed by endoscopic surveillance with periodic polypectomy.     

静脉畸形骨肥大综合征MRI诊断1例

病例男,30岁.主因右下肢增粗、肿胀并静脉瘤样改变及右足肥大30年就诊.查体:患侧下肢较对侧增粗,右大腿外侧可见大片红斑,压之褪色.右足明显肥大,皮肤压之呈海绵状感,患肢皮温高,皮肤粗糙呈皮革样.彩色多普勒超声检查示右侧股静脉走行正常,血流通畅,无明显深静脉返流,小腿浅静脉与肌问静脉呈网格样交通,并有明显迂曲扩张,扩张的管腔内可见密集细点回声,超声诊断:右小腿浅静脉异常曲张.     

硬化性骨髓瘤伴POEMS综合征1例

病例男,34岁。双下肢疼痛、乏力半年,加重1月。体格检查：被动体位。全身皮肤多发红色丘疹,颈胸部为著。腰1、2椎体压痛,腰椎、双下肢活动受限。双足针刺觉减退,双侧直腿抬高试验及加强试验阳性,双侧Babinski征阴性。双侧乳腺发育。实验室检查：血常规、便常规、电解质、肝肾功能、CRP、RF、ESR、PTH、血K及入轻链正常,