肝脏钝性伤的CT表现

目的探讨肝脏钝性外伤所造成肝脏损伤的螺旋CT表现征象。方法收集17例肝脏钝性外伤病例的临床与CT资料。所有病例均行标准化的上腹部螺旋CT平扫及双期增强扫描．着重观察肝脏实质、肝内血管及胆管的形态、密度和完整性，同时也观察肝门结构、肝周及腹膜腔、腹膜后等区域。结果本组12例发现肝实质裂伤(70．6％)；9例发现血肿(52．9％)，其中5例为肝实质内血肿，4例为肝包膜下血肿；1例(5．9％)发现血肿内的活动性出血；2例(11．8％)发现肝静脉的损伤(撕裂)；7例(41．2％)显示肝内门静脉分支周围的“晕环”征。本组有13例合并腹腔内积液(血)．3例合并右侧肾上腺血肿．8例合并胸水．3例合并肋骨骨折。结论肝脏钝性损伤可出现肝实质的裂伤、血肿、活动性出血以及肝内静脉的撕裂等表现。CT平扫和双期增强扫描具有重要的诊断价值。     

双层螺旋CT增强扫描在闭合性肝损伤诊断中的价值

目的评价双层螺旋CT增强扫描对闭合性肝脏损伤的诊断价值及临床意义。方法回顾性分析2006年9月至2009年8月间收治的75例急性闭合性肝脏损伤的CT征象,患者临床资料完整。结果 75例CT平扫发现肝脏明确损伤61例(81.33%),显示肝包膜破口9例(12.00%),肝脏可疑损伤14例(18.67%)。增强扫描:门静脉期清晰显示肝包膜破口17例,14例可疑损伤均明确显示为相对低密度挫伤灶,显示率为100%。结论双层螺旋CT增强扫描门静脉期能够更准确地判断肝脏损伤的存在并予以CT分级,特别是对肝包膜破裂及肝实质内小的不明显损伤灶的显示更具有价值。     

CT检查在腹腔实质器官损伤中的临床价值

目的 探讨腹腔实质器官损伤中CT影像学表现的临床价值.方法 对外伤所致腹部脏器损伤的159例患者行平扫和(或)增强扫描,增强扫描采用动脉期、实质期,肾脏加做延迟期,与行增强扫描复查病例进行对比分析.结果 159例病例中,98例CT诊断为腹腔实质脏器挫裂伤,经手术与临床追踪得到证实,22例为单纯空腔脏器损伤或脊柱、骨盆骨折,39例为阴性,检查阳性率为75.5%(120/159),诊断符合率为98.1%(156/159).结论 CT检查能清楚显示实质脏器内损伤情况、包膜下血肿、腹膜后血肿、腹腔积液量,能对损伤的程度进行分级,正确选择扫描技术在腹部损伤诊断中有重要的临床价值.     

CT增强扫描在闭合性腹部外伤中的诊断价值研究

目的观察CT增强扫描在闭合性腹部外伤中的诊断价值研究。方法选取本院收治的闭合性腹部外伤患者100例患者,分别采用CT平扫和CT增强扫描进行检测,观察其诊断准确率和检出损伤结果。结果 CT增强扫描各项指标效果显著优于CT平扫,差异显著(P0.05)。结论 CT增强扫描能够增加闭合性腹部外伤诊断的准确性,能够更好的观察患者病变部位的病程变化以及范围程度,极大的避免了临床上出现漏诊和误诊的情况。     

采用填塞缝扎法和肝静脉缝扎法治疗近第二肝门肝损伤的临床疗效分析

肝损伤特别是近第二肝门肝静脉附近的损伤 ,由于位置较高 ,手术操作困难 ,其死亡率高达 4 0 %～70 % 〔1〕。作者自 1990年 1月至 2 0 0 1年 12月期间 ,依据是否合并肝静脉损伤 ,采用填塞缝扎和肝静脉缝扎等方法对 6 2例单纯近第二肝门肝实质破裂大出血的病人进行了手术治疗。现将治疗结果分析报告如下。1.临床资料和方法 :(1)一般情况 :本组 6 2例 ,就肝脏而言仅存在近第二肝门肝损伤 ,其中男性 4 3例 ,女性 19例 ,年龄 10～ 6 5岁 ,平均年龄 37岁 ,占同期肝外伤病人总数 5 7 94 % (10 7) ,4 5例同时合并有一处或多处严重外伤。受伤的原因…     

肝周大静脉损伤救治策略的探讨

目的 探讨肝周大静脉损伤救治策略.方法 2001年6月至2011年6月,急诊收治肝外伤病人152例,根据术前CT检查和术中探查,18例诊断为肝周大静脉损伤.入院时行创伤严重度评分(ISS)和肝损伤严重度评分.按照损伤控制性外科的原则,分别采用肝脏缝合、损毁肝切除、血管直接修补、纱布填塞等治疗,分析手术并发症和临床疗效....     

外伤性肝破裂146例临床治疗分析

肝脏是人体最大的实质性脏器,且质脆而易受损伤,在各种腹部外伤中发生率约占15%~20%,右肝破裂较左肝为多[1],一般都是伤情较复杂,病情较凶险,死亡率较高。总结我院1992年至2007年的146例创伤性肝破裂的治疗体会,报告如下。1临床资料1.1一般资料:146例外伤患者,男84例,女62例。年龄4~70岁,平均40.1岁。腹部闭合性外伤138例,其中车祸伤128例(87.6%),坠落伤8例(5.5%),砸伤2例(1.4%),锐器穿刺伤8例(5.5%)。单纯性肝损伤64例。合并其他脏器损伤82例,其中颅脑挫伤10例,胸部外伤、创伤性湿肺26例,肋骨骨折14例,血气胸10例,右肾挫伤12例,后腹膜血肿8例,脾破裂2例。按照国际通用的1994年美国创伤学会制订的肝脏损伤标准,Ⅰ级损伤22例,Ⅱ级损伤38例,Ⅲ级损伤42例,Ⅳ级损伤8例,Ⅴ级损伤24例,Ⅵ级损伤12例。1.2临床表现及诊断:146例患者均有外伤史及不同程度的休克体征,神志清,有腹痛表现。134患者有腹膜炎,行腹腔穿刺,126例抽出不凝固血液,术前B超检查94例诊断肝脏破裂,CT检查62例提示肝破裂。1.3治疗:非手术治疗12例。手术治疗134例,...     

肝外伤124例诊治分析

目的　探讨肝外伤早期诊断与治疗的方法。方法　回顾性分析采用不同手段治疗的各种肝外伤的临床资料 ,包括非手术治疗 2 7例 (中转手术 3例 ) ,手术治疗 99例。结果　非手术治疗组治愈 2 4例 ,中转手术 3例 ;手术治疗 10 2例 (包括中转手术 3例 )治愈 95例 ,死亡 7例。总治愈率 94.4% ( 117/12 4) ,病死率 5 .6% ( 7/12 4)。 5例死于肝内血管损伤大出血 ,2例死于多器官衰竭。术后并发症有 :膈下感染 3例、肝内脓肿 6例、腹腔积液 8例、切口感染 7例和腹腔脓肿 2例 ,均治愈。结论　对I型肝外伤可采取非手术治疗 ;II～IV型肝钝性损伤 ,血液动力学稳定可行非手术治疗 ;II～VI型肝损伤、伴腹腔大出血或其他脏器损伤者 ,一经诊断应立即手术     

CT在评价慢性肾病经皮肾穿刺活检术后并发症中的应用

目的:通过与超声(US)的对比研究,评价CT对慢性肾病经皮肾穿刺活检术后不同血肿类型及相关肾损伤的显示能力,探讨CT三期动态增强扫描在评价经皮肾穿刺活检术后并发症中的应用价值.方法:6 000例慢性肾病经皮肾穿刺活检术后的患者,其中156例术后临床症状比较重者行CT平扫,75例同时行三期动态增强扫描,并对发现血肿的病例通过Volume软件测量血肿体积大小.所有患者在穿刺前、后均行肾脏US检查.结果:CT检测发现72例(46.2%,72/156)血肿,根据CT表现将血肿分为3种类型:肾包膜下血肿55例(76.4%,55/72),合并轻度肾撕裂伤3例(5.4%,3/55);吉氏筋膜下血肿12例(16.7%,12/72),合并轻度肾撕裂伤5例(41.7%,5/12);腹腔血肿5例(6.9%,5/72),合并肾重度撕裂伤4例(80.0%,4/5);2例吉氏筋膜下血肿和3例腹腔血肿并发肾内假性动脉瘤.US检测发现72例血肿,其中发现肾撕裂伤1例.3种类型血肿体积大小分别为(9.55±10.21)ml、(209.85±126.21)ml、(1 638.72±291.76)ml;经方差分析两两比较,三组相互之间均差异有统计学意义(P<0.01).结论:CT对慢性肾病经皮肾穿刺活检术后轻度并发症的评价与US有同等价值,对严重并发症的评价较US有明显优势.CT对病变既能做出定位诊断,又能得出定性诊断,对指导临床治疗方案有很重要的实用价值.     

原发性肝脏透明细胞癌的CT影像表现

目的探讨原发性肝脏透明细胞癌(primary clear cell of liver,PCCCI,)的CT影像学表现及特征,为术前诊断提供参考。方法回顾性分析经手术证实的6例PCCCL的CT表现及临床资料,3例行平扫及动态增强扫描,3例行动态增强扫描。结果 男性2人,女性4人,5人有乙肝病史,AFP阳性2例。病灶数6个,83%(5/6)位于肝右叶,17%(1/6)位于左内叶。50%(3/6)病灶边界不清,动脉期增强扫描病变均呈轻度不均匀强化,门静脉期及延迟期多呈轻度持续性强化,1例等一低混杂密度病变呈持续性渐进性强化,并见假包膜。结论 PCCCL的CT动态增强呈持续性不均匀强化,三期扫描均低于正常肝实质,具有较特征性影像学表现,能够为术前诊断提供重要诊断价值。     

Rapid resolution of acute subdural hematoma; report of two cases]

We reported two cases of rapid resolution of acute subdural hematoma. Case 1, a 21-year-old female, sustained head trauma and became unconscious for about 15 min. Probably she was suffering from posttraumatic amnesia for about 1 day. On admission J.C.S and G.C.S were 20 and 9 (2 + 2 + 5) points, respectively. Neurological examination showed no abnormalities. An initial computed tomography (CT) scan taken 2 hours after the injury showed a high dense subdural hematoma on the left cerebral hemisphere and hemispheric swelling. She was conservatively treated. A follow up CT scan taken 8 hours after the injury disclosed rapid disappearance of the hematoma and cerebral swelling. Case 2a 23-year-old male, sustained head trauma and became unconscious for about 30 min. On admission J.C.S and G.C.S were 1 and 14 (4 + 4 + 6) points, respectively, and slight right hemiparesis was noted. An initial CT scan taken 2 hours after the injury showed subdural hematoma of the left cerebral hemisphere and hemispheric swelling. He was conservatively treated. A follow up CT scan taken 24 hours after the injury revealed almost complete disappearance of the subdural hematoma and cerebral swelling. It was suggested that the rapid resolution of acute subdural hematoma was attributable to redistribution due to decrease of ICP, and washing out by cerebrospinal fluid.     

Diagnostic accuracy of CT scan in abdominal blunt trauma

Obiective: To evaluate the sensitivity and specificity of CT scan findings in Patients ith blunt abdominal trauma admitted to the university hospital.Methods: All the atients ith blunt abdominal trauma admitted at a tertiary teaching trauma center in Iran between 2005 and 2007 were enrolled in this study.In the absence of any clinical anifestations,he patients underwent a diagnostic CT scan.Laparatomy was performed in those with positive CT results.Others were observed for 48 hours and discharged in case no problem as reported;otherwise they underwent laparatomy.Information on patients'demographic ata,mechanism of trauma,indication for CT scan,CT scan findings,results of laparotomy ere gathered.The sensitivity,specificity and accuracy of the CT-scan images in regard ith the organ injured were calculated.The sensitivity,specificity and accuracy of the T scan were calculated in each case.Results: CT Scan had the highest sensitivity for etecting the injuries to liver (100%) and spleen (86.6%).The specificity of the method or detecting retroperitoneal hematoma (100%) and injuries to kidney (93.5%) was higher han other organs.The accuracy of CT images to detect the injuries to spleen,liver,idney and retroperitoneal hematoma was reported to be 96.1%,94.4%,91.6% and 91.6% espectively.Conclusion: The findings of the present study reveal that CT scan could econsidered as a good choice,especially for patients with blunt abdominal trauma in eaching hospitals where the radiologic academic staff is not present in the hospital in the night shifts.     

A case report of spontaneous rupture of renal cell carcinoma difficult to be distinguished from angiomyolipoma

A 56-year-old woman was admitted with right flank pain as the chief complaint without any trauma. Abdominal and chest computed tomography (CT scan) demonstrated with low-density area in a retroperitoneal hematoma suspected of spontaneous rupture of angiomyolipoma and hematothorax. Superselective transarterial embolization and drainage of the thoracic cavity were performed. Three months later a right renal tumor in perirenal hematoma was revealed by abdominal CT scan and suspected renal cell carcinoma. Right nephrectomy was performed. Histopathology revealed renal cell carcinoma. Including this case, 31 cases of spontaneous rupture of renal cell carcinoma have been reported in the Japanese literature.     

Two cases of acute idiopathic subdural hematoma with delayed intracranial hypertension

Two cases of acute idiopathic subdural hematoma with delayed intracranial hypertension were presented. The first case was a 68-year-old man admitted for vomiting following headache for eight days. There was no history of head trauma. A CT scan revealed a high-density mass that had a concave inner margin in the left temporo-parietal region with a slight midline shift. No vascular lesion was noted on the angiogram. The consciousness of the patient deteriorated suddenly on the 12th day. An operation was performed because of a marked midline shift on the CT. At operation, a subdural clot was removed. The postoperative recovery was good. The patient was discharged 7 days later without any neurological deficit. The second case was a 69-year-old man who was admitted with sudden onset of headache. There was no history of head trauma. A CT scan showed a high density mass in the right temporoparietal subdural space with a slight midline shift. The consciousness of the patient deteriorated suddenly on the 15th day. An operation was performed because of a marked midline shift on the CT. At operation, a subdural hematoma was removed. Two days later, suddenly his consciousness deteriorated. A CT scan showed his severe brain edema with a marked midline shift without increased hematoma. External decompression was performed immediately. The postoperative recovery was very good and 40 days after the second operation, the patient was discharged with no neurological deficit. The delayed intracranial hypertension appeared in these two cases about 10 days after the initial symptom. Two kinds of mechanisms are suspected: 1) swelling of the hematoma because of the adsorption of cerebrospinal fluid, 2) the occurrence of secondary brain edema. From our experience, a repeated CT scan is necessary for 2 to 3 weeks.(ABSTRACT TRUNCATED AT 250 WORDS)     

Three cases of cryptic arteriovenous malformation in basal ganglia manifested by putaminal hemorrhage

Three cases of histologically proven cryptic arteriovenous (AV) malformation of the basal ganglia are reported. Seventeen cases of patients showing putaminal hemorrhage in the CT scan underwent craniotomy for evacuation of a hematoma between January 1986 and December 1988. The preoperative diagnosis was hypertensive putaminal hemorrhage. In all three cases a network of abnormal vessels around the internal capsule was detected at surgery. Case 1: A 62-year-old male was admitted to our hospital with consciousness disturbance (JCS 20), total aphasia and right hemiparesis. The CT scan showed left putaminal hemorrhage. The volume of the hematoma was 45 ml by CT criteria. Left carotid angiography did not demonstrate any abnormal findings. Case 2: 69-year-old male was admitted with consciousness disturbance (JCS 10) and right hemiparesis. Left putaminal hemorrhage (volume 25 ml) was recognized on the CT scan. Two hours after admission, the consciousness level suddenly deteriorated (JCS 100). At that moment, the volume of the putaminal hematoma had increased to 100 ml. AV malformation was not detected by left carotid angiography. Case 3: A 50-year-old male was admitted with consciousness disturbance (JCS 20), total aphasia and right hemiparesis. The CT scan showed left putaminal hemorrhage of 73 ml. Pathohistological examination proved AV malformation in each case. The three cases described here suggest the following; 1) The incidence of the basal ganglia cryptic AV malformation has been considered low, but meticulous examination shows that among the cases diagnosed as hypertensive hemorrhage, AV malformation is not infrequently the hidden cause.(ABSTRACT TRUNCATED AT 250 WORDS)     

Three cases of non-traumatic acute subdural hematoma]

The authors present three cases of non-traumatic acute subdural hematoma showing interesting clinical features and operative findings. Case 1: A-50-year-old male was admitted because of sudden headache and epileptic seizure. Computed tomographic (CT) scan showed a right thin subdural hematoma, but cerebral angiography demonstrated no pathological findings, that might cause acute subdural hematoma on the follow-up CT scans. The hematoma changed to a chronic one within only 15 days, which was proved by the operation. Case 2: A 52-year-old male was hospitalized because of loss of consciousness. CT scan revealed a right subdural hematoma without subarachnoid hemorrhage and cerebral angiography demonstrated a right middle cerebral artery aneurysm. The hematoma was surgically proved to be due to rupture of the aneurysm. Case 3: A 52-year-old male was admitted because of headache, vomiting and left motor weakness. CT scan showed a thick right subdural hematoma and right carotid angiography revealed two internal carotid artery aneurysms. It was surgically certified that the subdural hematoma was caused by a tear in a cortical artery attached to the dura, not by the rupture of the aneurysms. Clinical cause and pathogenesis of so-called "non-traumatic" or "spontaneous" acute subdural hematomas were discussed, and the importance of emergency angiography for this condition is stressed.     

A case of convexity meningioma associated with chronic subdural hematoma

There are 5 reported cases of meningioma complicated by chronic subdural hematoma so far as we reviewed. Considering frequency of occurrence, association of meningioma and chronic subdural hematoma is very rare. Recently, we experienced with a case of convexity menigioma complicated by chronic subdural hematoma. The patient was a 61-year-old woman who complained of headache and numbness of the left hand. She received hysteromyomectomy 28 years before but had no past history of trauma of the head. She suffered from frequent profound pain in both orbits for one year, and she consulted a neighboring practitioner due to occurrence of numbness of the left hand and malaise. Then, CT scan revealed abnormalities, so that she was referred to our center. On admission, neurological oxamination revealed no abnormalities but plain X-ray film of the skull showed a round destruction in the right parieral bone. CT scan showed a round high density area of 3 cm in diameter in the right parietal region, this is markedly enhanced with contrast media. There is a crescent-shaped low density area extending forward from the high density area. The body of the right lateral ventricle is totally collapsed. Selective arteriography of the right external carotid revealed tumor stain in the parietal region. Therefore, under the diagnosis of association of chronic subdural hematoma and convexity meningioma, craniotomy of the right frontal, parietal and temporal regions was carried out and a meningioma of 10 g, and a subdural hematoma with its capsule touching the maningioma were entirely extirpated.(ABSTRACT TRUNCATED AT 250 WORDS)     

Nonoperative management of major blunt renal lacerations with urinary extravasation: report of two cases

Two cases of major blunt renal trauma with urinary extravasation managed by conservative treatment are presented herein. The first case: A 13-year-old girl fell from a bicycle. A computed tomographic (CT) scan showed right renal laceration with retroperitoneal hematoma. Renal arteriography showed evidence of fresh arterial bleeding without visualization of the lower pole. She was treated conservatively with superselective arterial embolization of the lower pole. She developed no urinoma with normal renal function. Renal renin and blood pressures stayed within the normal range in follow up studies. The second case: A 12-year-old boy fell from a tree and hit his right flank. A CT scan showed fragmentation of right renal cortex with retroperitoneal hematoma. He was treated conservatively as his vital signs remained stable, no active arterial bleeding was found no renal arteriography and both renal pelvis and ureters were well visualized by intra venous pyelography. Retroperitoneal hematoma was absorbed without formation of urinoma. Renal function remained within normal limits in follow up studies.     

Posterior fossa subdural hematoma in neonates: report of two cases and review of the literature

Posterior fossa subdural hematoma in neonates caused by birth trauma is rare; only 30 clinical cases can be found in the literature so far. Here we experience two similar cases and review that literature. Case #1 is that of a full-term female born in the pelvic position. At 21 hours after birth she developed convulsions and a CT scan revealed a high-density area, mainly in the right posterior fossa. On the fourth day, a right suboccipital craniectomy was performed and about 15 ml of hematoma was removed. At present her mental and somatic development is appropriate for her age (5 months), despite the fact that moderate brain atrophy was seen in the CT scan taken at 4 months. Case #2 is that of a full-term female also born in the pelvic position. At 38 hours she became convulsive and opisthotonic; a CT scan revealed a high-density area in the posterior fossa. No neurological abnormality was seen thereafter, however, and she was treated conservatively. On the 18th day, the high-density area in the CT scan had almost disappeared. In the CT scan taken at 6 months moderate brain atrophy was seen, but at the present age of two she evidences quite normal development both mentally and somatically. These cases lead us to emphasize the importance of prompt diagnosis followed by removal of hematoma, and the usefulness of CT scan as a diagnostic method in clinical manifestations of this sort.     

Diagnosis of renal trauma

We experienced 25 cases of renal trauma in our hospitals during the past 5 years, 20 cases were male and 5 cases were female, ranging in age 10 to 51 years old with average 26 years old, and the chief complaints were gross-hematuria and pain of renal region. We studied the IVP and CT patterns of these cases. IVP revealed 13 cases of renal contusion, 11 cases of renal lacerated wound and 1 case of renal fragmentation. The CT scan of 14 cases showed that it was useful for the diagnosis of the degree of renal trauma, especially, for hematoma surroundings the kidneys. The hematoma surrounding the kidneys was clearly noted in 7 cases by CT scan, but the unclearness of renal contours and iliopsoas muscle was considered to suggest the existence of hematoma surrounding the kidneys by IVP. All of the hematoma surrounding the kidneys was absorbed by conservative therapy, but 5 of the 7 cases were treated within 3 months.