双侧先天性第一鳃裂瘘一例报告

目的总结双侧先天性第一鳃裂瘘的诊治经验,提高手术切除第一鳃裂瘘的安全性和治愈率。方法回顾性分析双侧先天性第一鳃裂瘘1例的临床诊治资料。结果本例间隔半年均以耳部疼痛流脓并耳垂后肿痛就诊,专科检查结合耳后B超确诊为第一鳃裂瘘,子切除术。本例双侧先天性第一鳃裂瘘均一次手术治愈。右侧随访18个月、左侧随访12个月,双侧均无复发。结论第一鳃裂瘘临床比较少见,症状、体征不典型,病理检查是确诊的重要依据,手术彻底切除病变组织是治愈本病的唯一方法。     

First branchial cleft anomaly, a case for misdiagnosis

First branchial cleft anomaly is a rare condition that is often misdiagnosed and falsely mistreated before complete and definitive surgical treatment. Its origin is uncertain and the presence of ectodermal and sometimes also mesodermal elements has led some authors to the conclusion that it represents buried nests of cells forming the first branchial cleft and the underlying mesoderm. First branchial cleft anomaly can be presented as a cystic lesion, fistula or sinus extending towards the membranous external ear canal. The sinus tract runs through the parotid gland in close association with the facial nerve. There is no imaging method capable of identifying a first branchial cleft anomaly with certainty. The danger of facial nerve injury during surgery and the failure to identify the sinus tract running to the external ear canal are the main reasons for incomplete excision. The facial nerve must be identified and preserved and the lesion completely excised. Facial nerve injury is more common in attempts to remove recurrent branchial cleft lesions.     

高频超声对鳃裂囊肿的诊断价值

目的探讨高频超声在诊断鳃裂囊肿中的应用价值。方法回顾分析12例经手术病理证实为鳃裂囊肿的高频超声声像图表现。结果本组患者中11例位于胸锁乳突肌上1/3的前缘,相当于舌骨平面、颈动脉鞘的外侧,1例位于耳前腮腺区。超声表现囊肿大部分外形尚规则,边界清晰或尚清且包膜回声较强,内部回声的多样性与内壁衬里上皮有关。结论高频超声可直接显示鳃裂囊肿的内部结构、大小、形态、回声及血供情况,可作为鳃裂囊肿的首选影像学检查方法。     

鳃裂囊肿的高频超声诊断与鉴别诊断价值

目的 探讨鳃裂囊肿的超声诊断与鉴别诊断价值.方法 回顾性分析与总结56例经手术和病理证实的鳃裂囊肿的高频彩色多普勒超声表现.结果 第一鳃裂7例,第二鳃裂48例,第三鳃裂1例,7例可显示瘘口.囊肿均为椭圆形或类圆形,囊壁多清晰规则,囊内多布有稀疏、密集不等的点状回声,其后方具有声增强效应;彩色多普勒超声显示囊内无血流信号,囊壁显示血流信号者仅9例.超声诊断符合率90.11%(完全符合42例,基本符合9例).结论 高频彩色多普勒超声能较准确地诊断与鉴别鳃裂囊肿,具有重要的临床价值.     

超声诊断儿童鳃裂畸形

目的 探讨儿童鳃裂畸形的超声诊断价值.方法 回顾15例鳃裂畸形患儿的声像图表现,并与手术、病理结果对照分析.结果 6例为鳃裂囊肿,超声表现为囊性团块,内回声均匀;6例为鳃裂囊肿并瘘管形成,超声表现为囊性团块,并有条状低回声与体表或咽内相通;3例为鳃裂窦道形成.全部鳃裂畸形患儿中13例病灶位于颈前,1例位于锁骨下缘前胸壁,1例位于耳前腮腺区.超声诊断与手术病理符合率为86.70%.结论 超声诊断鳃裂畸形较准确、可靠,可明确其位置及毗邻关系,对临床手术有重要意义.     

超声诊断鳃裂畸形

目的 探讨高频彩色多普勒超声诊断鳃裂囊肿及鳃裂瘘的价值。 方法 回顾13例鳃裂畸形患者的声像图表现,结合手术所见及病理结果进行对照分析。 结果 3例为鳃裂囊肿,超声表现为囊性团块伴或不伴长短不一的瘘管残迹;4例为鳃裂囊肿并瘘管,超声表现为囊性团块伴细管状通道;4例为鳃裂囊肿并感染,超声表现为囊性团块,内回声细密,壁厚,边不清;2例为鳃裂瘘。13例患者中,10例病灶位于颈前区,2例位于锁骨下前胸壁,1例位于右下颌后角后。超声诊断与术中所见符合率为84.62%(11/13),与病理结果符合率92.31%(12/13)。 结论 高频彩色多普勒超诊断鳃裂畸形准确、可靠,可作为首选影像学检查方法。     

Ultrasound Evaluation of Dermal Sinuses/Fistulas in Pediatric Patients

A dermal sinus/fistula is a common condition; the relevant department should be consulted for appropriate treatment. It is important for radiologists to have adequate knowledge of these conditions to provide the correct diagnosis and recommend subsequent management. This review describes the following lesions: preauricular sinus, midline sinus of the upper lip, nasal dermoid sinus cyst, cheek fistula, first branchial cleft anomaly/sublingual branchial cleft anomaly, thyroglossal duct cyst/fistula, lateral cervical sinus/fistula, congenital dermal sinus/fistula of the anterior chest region, congenital skin sinus/fistula with a sternal cleft, and congenital prepubic sinus. On the basis of the skin orifice location and ultrasound images, radiologists can provide useful information to physicians.     

高频超声诊断鳃裂囊肿

目的 探讨鳃裂囊肿的高频超声特点及鉴别诊断.方法 回顾性分析经手术及病理证实的14例鳃裂囊肿的高频超声表现.结果 14例鳃裂囊肿中,第一鳃裂7例,第二鳃裂5例,第三鳃裂2例;3例合并瘘管.囊肿均边界清晰,呈椭圆形或类圆形.超声表现分为3型:无回声或伴稀疏点状回声型4例;均匀或不均匀低回声内部密集回声型9例;混合回声型1例.6例后方回声增强.3例囊壁和1例囊壁及囊内结节可见彩色血流信号.超声诊断符合率为57.14％ (8/14).结论 鳃裂囊肿有经典发生部位,超声表现多样,需与颈部其他囊性肿物相鉴别.     

鳃裂囊肿和瘘管彩色多普勒超声检查误诊原因探讨

目的总结鳃裂囊肿和瘘管的彩色多普勒超声声像图特征,以减少误诊。方法回顾性分析我院经手术病理检查证实为鳃裂囊肿和瘘管17例的彩色多普勒超声声像图表现,并与手术病理检查结果进行对比分析。结果本组17例,12例以外耳道下方或颈侧肿块就诊,5例体检发现腮腺和甲状腺内结节就诊。我院和外院术前彩色多普勒超声检查,7例确诊鳃裂囊肿或瘘管,10例误诊,误诊率58.8%,误诊为腮腺实性肿物及颈部淋巴结炎伴液化各3例,甲状腺结节2例,腮腺囊肿及甲状舌管囊肿各1例。17例均行手术治疗,术后病理检查证实为鳃裂囊肿11例,鳃裂瘘管6例。术前彩色多普勒超声检查结果与术后病理诊断结果符合率41.2%(7/17)。结论临床虽然可根据彩色多普勒超声声像图特点及临床表现对鳃裂囊肿和瘘管做出诊断,但由于受各种因素影响易误诊,应注意与其他颈部囊性占位性病变相鉴别。     

Recurrent parathyroid cystic disease

Cystic masses of the neck may represent thyroid, parathyroid, thyroglossal duct or branchial cleft cysts. Analysis of the cyst fluid may establish the etiology. Elevated levels of parathyroid hormone can be found in parathyroid cysts without concomitant hyperparathyroidism. A high concentration of cholesterol without the finding of thyroglobulin or parathyroid hormone in the fluid aspirated from a lateral neck mass suggests a branchial cleft cyst.     

成人第二鳃裂囊肿的CT与MRI表现及鉴别诊断

目的:探讨成人第二鳃裂囊肿的CT与MRI表现,以提高对该病的认识及鉴别诊断。材料与方法:回顾性总结18例经手术病理证实的第二鳃裂囊肿,分析其CT和MRI表现并结合文献进行讨论。结果:全部病例均为第二鳃裂囊肿,其中BaileyⅠ型5例,Ⅱ型13例。鳃裂囊肿位于颈前三角区、胸锁乳突肌前内侧,圆形或椭圆形,壁薄、均质,胸锁乳突肌受压向后或后外移位,颌下腺向前移位,颈动脉鞘内大血管向内或内后移位,CT表现为密度均匀、边界清晰的囊性肿块。MRI表现为T1WI呈低至高信号,T2WI呈高信号,囊壁强化或不强化,合并感染时,边界模糊,囊壁及周围软组织强化,囊壁强化的厚度取决于感染的程度。结论:CT与MRI可以清楚显示鳃裂囊肿的解剖部位、大小、形态、范围、强化特点及其与周围结构的关系,结合临床特点能做出准确诊断及鉴别诊断。     

Branchial cleft cyst

Branchial cleft cysts are benign lesions caused by anomalous development of the brachial cleft. This report describes a 20-year-old girl with swelling on the right lateral aspect of the neck, which expanded slowly but progressively. The clinical suspicion was that of a branchial cleft cyst. Sonography revealed a homogeneously hypo- to anechoic mass with well-defined margins and no intralesional septa. Color Doppler reviewed no internal vascularization. The ultrasound examination confirmed the clinical diagnosis of a second branchial cleft cyst, demonstrating the cystic nature of the mass and excluding the presence of complications. For superficial lesions like these, ultrasound is the first-level imaging study of choice because it is non-invasive, rapid, low-cost, and does not involve exposure to ionizing radiation.     

Ultrasound diagnosis of fourth branchial arch sinus at 22 weeks' gestation.

Fourth branchial arch sinus is the rarest of the branchial cleft anomalies and its prenatal detection has not previously been reported in the English literature. We describe a case of fourth branchial arch sinus identified in a fetus during a routine ultrasound evaluation at 22 weeks' gestation. Survey of the fetal anatomy revealed a small 'nipple-like' structure on the neck, arising anteriorly to the sternocleidomastoid muscle, midway between the chin and the left shoulder. The structure persisted unchanged throughout the pregnancy. The prenatal diagnosis of fourth branchial arch sinus was confirmed at delivery at term.     

小儿颈部囊性病变的高频超声诊断与鉴别诊断

目的：探讨小儿颈部囊性病变的高频超声表现特征。方法：搜集42例经手术病理证实的颈部囊性病变，均行超声检查，回顾性分析其超声特点。结果：甲状舌管囊肿19例（45．24％），颈淋巴管瘤15例（35．71％），鳃裂囊肿8例（19．05％）。颈部囊性病变各有其好发部位，且病变具有一定的超声特征。甲状舌管囊肿多见于颈中线附近、舌骨上下；淋巴管瘤多见于颈侧部、锁骨上，范围较广；腮裂囊肿多见于中上侧颈部。甲状舌管囊肿及鳃裂囊肿呈单房性，淋巴管瘤多为多房性。结论：超声检查可清晰显示病变的大小、形态和延伸范围，多数能定性诊断，对颈部囊性病变具有重要的诊断和鉴别诊断价值。     

颈部囊性病变的CT、MRI诊断

目的：分析颈部囊性病变的CT、MRI表现,提高对颈部囊性病变的诊断和鉴别诊断能力。资料与方法：回顾分析经手术病理证实的颈部囊性病变16例,其中鳃裂囊肿9例（男8例,女1例,年龄13－62岁,平均28．1岁）,甲状舌管囊肿3例（男2例,女1例,年龄4－41岁,平均16．7岁）,淋巴管囊肿4例（均为男性,年龄9－56岁,平均33．3岁）。全部均行层厚、间隔5mm的CT薄层平扫,其中6例行增强扫描,5例行MRI轴位、矢状位及冠状位扫描,T1WI用SE序列,T2WI用FSE序列。结果：9例鳃裂囊肿和4例淋巴管囊肿均位于颈侧,前者与胸锁乳突肌紧邻,有的甚至造成了胸锁乳突肌的肥大。3例甲状舌管囊肿位于颈正中线舌骨上下区。形态多呈圆形、卵圆形或梭形,淋巴管囊肿呈分叶状不规则形。以低密度和长T1、长T2信号为主,合并感染、手术或穿刺可使病变密度或信号变得复杂。结论：CT、MRI检查可提高颈部囊性病变的诊断准确性,尤其是MRI可多轴位显示病变的形态及周围关系。     

First branchial cleft anomaly presenting as a recurrent post-auricular abscess

Failure to recognise these unusual cases may result in misdiagnosis, inadequate treatment, and subsequent recurrence. Further definitive surgery may thus be complicated. A case is reported of a patient who attended accident and emergency on three occasions with an infected post-auricular cyst, which was treated by incision and drainage. It was subsequently found to be a first branchial cleft anomaly.     

Third branchial cleft cyst as a cause of hoarseness: a case report

Third branchial cleft cyst is a rare congenital disease of the neck. It presents as a painless mass that develops rapidly in the neck following an infection. This is the first case report of recurrent laryngeal nerve palsy caused by a third branchial cleft cyst. A 30-year-old woman presented with a 3-month history of hoarseness as her only symptom; she had no pain, fever, dysphagia, dyspnoea, or palpable neck mass. Laryngoscopy revealed that her right vocal cord was paralyzed. Computed tomography and magnetic resonance imaging revealed a cystic mass in the right tracheoesophageal groove that was closely associated with the trachea. Intraoperatively, the cyst was found not to originate from the thyroid or trachea, but it was compressing the right recurrent laryngeal nerve. The hoarseness resolved the day after the cyst was removed.     

颈部囊性病变的CT检查

分析颈部不同囊性病变的CT表现，进一步提高对颈部各种囊性病变的认识。方法：回顾性分析经手术、病理证实的颈部囊性病变42例，其中鳃裂囊肿19例，淋巴结囊性变8例，淋巴管瘤3例，甲状舌管囊肿2例，神经鞘瘤4例，甲状腺乳头状腺癌6例。全部病例均行层厚、层距为5-10mm的CT平扫；36例作增强扫描。结果：颈部囊性病变形态基本规则、光整，19例鳃裂囊肿大部分位于上颈部．且绝大部分与颈动脉鞘相毗邻：8例囊变淋巴结均与颈动脉鞘相邻；2例甲状舌管囊肿在颈前区与甲状软骨关系密切；4例囊变的神经鞘瘤多数位于椎前间隙的肌肉间隙内；6例甲状腺乳头状腺癌均为下颈部甲状腺区恶性囊性占位。伴感染的鳃裂囊肿、转移性淋巴结，甲状舌管囊肿、甲状腺乳头状腺癌可有囊壁强化改变，甲状腺乳头状腺癌更有较为特征性的囊内乳头样结节改变。囊性病灶增大后会对周围结构产生占位效应，部分恶性及伴有感染的良性病灶与周围组织界限不清。结论：颈部不同囊性病变所处的解剖位置有一定的分布特点，CT表现亦有除囊性外的各自特点，综合分析可提高颈部囊性病变诊断及鉴别诊断的准确性。     

The neck mass. 1. General concepts and congenital causes

A carefully taken history and thorough physical examination are the first steps in establishing the cause of a neck mass. Location, size, consistency, and mobility of the mass provide clues and are useful for comparison during follow-up. Further studies are ordered on the basis of the impressions gathered from this evaluation. Congenital neck masses can be found in patients of any age. Thyroglossal duct and branchial cleft cysts and fistulas are formed by incomplete obliteration of the thyroglossal duct and branchial clefts during embryonic development. Other congenital causes include lymphangiomas, cystic hygromas, dermoid cysts, and hemangiomas. Laryngoceles are acquired cysts that arise from an anatomic remnant, the laryngeal ventricle. Treatment for these neck masses is nearly always surgical removal.     

多排螺旋CT双期扫描对腮腺良性肿瘤的诊断价值

目的探讨腮腺良性肿瘤的CT表现,提高对腮腺肿瘤的诊断水平。方法回顾性分析经手术病理证实的85例腮腺良性肿瘤患者的多排螺旋CT双期增强扫描表现。结果10例腮腺基底细胞腺瘤患者中,2个病灶密度相对均匀,8个病灶密度不均匀。43例腮腺淋巴瘤患者中,43个病灶密度较均匀,18个病灶密度不均匀。31例腮腺多形性腺瘤患者中,16个病灶密度均匀,15个病灶密度欠均匀,CT增强扫描6例明显强化,余25例轻度强化。1例鳃裂囊肿表现为类圆形的低密度结节,CT值19 HU,边缘清楚光滑,密度均匀,增强检查囊内容物不强化,囊壁可轻度增强。增强扫描动脉期,CT值增加幅度由大到小依次为基底细胞腺瘤、腺淋巴瘤、多形性腺瘤、鳃裂囊肿。基底细胞腺瘤双期CT增强幅度大于其他种类疾病(P<0.05)。结论多排螺旋CT能对腮腺肿瘤进行有效定位,双期增强扫描对诊断及鉴别诊断良性肿瘤有一定的价值。