食道癌肉瘤的X线表现探讨及误诊原因分析

目的探讨食管癌肉瘤的X线学表现，提高对该病的认识。方法回顾性分析5例经病理证实的食管癌肉瘤，5例均行食管钡剂造影和电子纤维胃镜检查，并作病理检查和手术治疗。结果食管钡剂造影显示：病变位于食管中段2例，下段3例。食管腔扩张4例，狭窄1例。管壁柔软4例，僵硬1例。结论息肉型食管癌肉瘤有一定的X线特征性表现，浸润型食管癌肉瘤缺乏影像学特点。     

食和癌肉瘤X线诊断

探讨食管癌肉瘤的Ｘ线诊断。经手术病理证实的食管癌肉瘤７例，男５例，女２例。全部病例均行食管低张双对比造影检查。根据Ｘ线表现将７例食管癌肉瘤分成息肉型和浸润型。息肉型６例，表现为腔内带蒂或宽基的肿物，呈分叶状，瘤基底周围的食管粘膜不规则破坏，呈颗粒状隆起或钡占。     

食管癌肉瘤X线诊断(附7例报告)

目的：探讨食管癌肉瘤的Ｘ线诊断。材料和方法：经手术病理证实的食管癌肉瘤７例，男５例，女２例。全部病例均行食管低张双对比造影检查。结果：根据Ｘ线表现将７例食管癌肉瘤分成息肉型和浸润型。息肉型６例，表现为腔内带蒂或宽基的肿物，呈分叶状，瘤基底周围的食管粘膜不规则破坏，呈颗粒状隆起或钡点。浸润型１例，表现为管腔狭窄、管壁僵硬、粘膜破坏，可见腔内外软组织肿块。食管癌肉瘤中癌全部为鳞癌、肉瘤中２例平滑肌肉瘤、４例纤维间质细胞肉瘤、１例恶性纤维组织细胞瘤。结论：具有上述Ｘ线表现，结合患者年龄偏大，症状相对较轻，应考虑食管癌肉瘤。     

CT与钡剂造影精确确定非手术治疗食管癌放疗的GTV长度

 目的 应用定位CT与食管X线钡剂造影结合的方法测量食管癌病变长度,为快速、准确勾画食管癌GTV长度提供依据。方法 60例初治食管鳞癌患者拟行根治性放射治疗,在模拟定位机下吞钡行X线钡剂造影,用铅珠标记,确认食管癌病变两端长度,在相同体位固定下CT扫描。采用One-Way ANOVA方差分析进行统计分析。结果 食管癌病变长度从大到小依次为CT扫描长度、X线钡餐造影长度(铅珠标记)和内镜长度,三种检测方法分别为(8.82±2.40)cm、(7.03±1.74)cm和(6.27±1.68)cm,差异有统计学意义(P<0.05)。结论 应用定位CT与X线钡剂造影结合的方法,参考内镜检查结果,在CT上能够快速确定食管癌GTV长度。     

158例食管癌影像学及临床病理对照研究

目前对食管癌检查主要依靠X线钡剂造影和食管内窥镜活检病理诊断，可选择性行CT或磁共振补充检查。笔者对158例食管癌影像学与临床病理进行了回顾性研究。     

儿童结肠息肉的X线诊断与造影方法(附24例报告)

目的 :探讨 X线造影的技术方法 ,提高儿童结肠息肉的检出率。方法 :2 4例 ,男 1 5例、女 9例 ,年龄 3～ 1 2岁 ,手术证实。采用钡气双重造影并与单纯钡剂造影作对比。结果 :2 4例病例中 ,单纯钡剂造影仅显示 7例 (2 9% ) ,但钡剂双重造影显示 2 4例 ,其中无蒂息肉 1 5例 (62 % ) ,有蒂息肉 9例 (38% )。“靶征”及“礼帽征”是结肠息肉的特异 X线征象。结论 :单纯钡剂造影有一定诊断价值 ,但易造成漏诊。钡气双重造影检出率远远高于单纯钡剂造影检出率     

食管黏液表皮样癌的X线诊断

目的 探讨食管黏液表皮样癌(MEC)的X线钡餐造影表现及其临床价值.方法 搜集经手术病理证实的食管MEC 28例,对其发病率、生存率、发生部位、长度、X线分型等进行回顾性分析.结果 28例食管MEC约占同期食管癌手术病例的0.97%.术后1年、3年、5年生存率分别为79%、50%、37%,中位生存时间约31月.胸上段3例(占10.7%),胸中段24例(占85.7%),胸下段1例(占3.6%).最短20 mm,最长60 mm,平均31.25 mm.X线分型:髓质型8例,占28.6%,溃疡型1例,占3.5%,缩窄型19例,占67.9%.结论 X线钡餐造影在诊断食管MEC具有重要价值.     

X线和PET/CT在早期食管癌诊断中的应用

目的:探讨早期食管癌的细微X线征像。方法:回顾性分析16例经手术病理证实的早期食管癌X线表现和其中6例PET/CT征像。结果:16例患者中食管鳞状上皮重度不典型增生1例,鳞癌14例,原位癌1例。食管钡餐造影表现有:①结节样充盈缺损;②扁平样充盈缺损;③粟粒样充盈缺损;④粘膜线增粗。PET/CT检查显示6例患者病灶均显示FDG代谢增高。结论:早期食管癌的钡餐造影检查表现多样,PET/CT对病灶的检出敏感性高,多种检查方法相结合可以提高诊断准确性,同时更准确的进行术前评估。     

先天性食管闭锁与食管气管瘘的X线、CT表现

目的 探讨先天性食管闭锁与食管气管瘘的X线、CT诊断价值.资料与方法 回顾性分析7例先天性食管闭锁与食管气管瘘的影像学表现,7例均行X线平片和食管造影,其中3例进行了CT检查.结果 7例中Ⅰ型2例、Ⅱ型1例、Ⅲ型4例(Ⅲa型1例,Ⅲb型3例).X线胸腹平片显示胃肠积气4例、吸入性肺炎6例及右上肺不张2例;食管造影显示近端呈盲端6例、近端食管气管瘘1例;CT检查显示远端食管气管瘘3例.结论 综合应用X线、CT检查对先天性食管闭锁与食管气管瘘的确诊及分型具有重要意义.     

食管癌肉瘤1例

食管癌肉瘤较罕见,我院在收治254例食管恶性肿瘤中遇到1例。 鹿某,女,49岁。主诉进食时自觉有异物感1月余,进硬食时更加明显。1964年曾患肺结核,胸X线片见右肺尖有少许斑点状陈旧性钙化灶。食管居中,左右斛位钡剂造影可见食管中段有6～7 cm充盈缺损区,造影剂在此有停留,放射线科报诊为中段食管     

食管憩室并食管及贲门癌的X线诊断价值

目的：探讨X线钡餐造影对食管憩室并食管及贲门癌的诊断价值。方法：回顾性分析18例经X线钡餐检查、纤维内镜和手术病理证实的食管憩室并食管、贲门癌的X线表现。结果：18例中,单发憩室15例,多发憩室3例,其中最多1例有5个憩室。3个有液气平面。11例食管憩室位于肿瘤之上,7例憩室与肿瘤重叠。食管癌15例,贲门癌3例。憩室X线表现为囊袋状或尖角状钡影突出,肿瘤处黏膜不规则中断破坏、不规则充盈缺损及龛影形成,管腔狭窄,管壁僵硬,扩张度差,对比剂通过缓慢。结论：X线钡餐检查是诊断食管憩室并食管癌、贲门癌最简单、可靠、安全的方法,并能为内镜提供准确的定位,避免憩室穿孔危险。     

成人巨食管症诊断分析并文献复习

目的通过探讨巨食管症的影像表现,以提高对巨食管症的认识。方法回顾性分析1例巨食管症病人的影像资料并进行文献复习。结果病人颈椎MRI平扫检查提示气管后方椎体前方食管扩张,T1WI呈低信号,T2WI呈低信号。颈部、肺部CT平扫检查示食管全程显著扩张,扩张最宽处直径约7 cm,内见大量食糜,贲门部未见明显肿块,相邻气管及纵隔内结构受压推移,气管支气管狭窄,胃内见内容物,扩张尚可。服用钡餐后,腹部平扫CT示扩张的食管、胃内均见点状高密度钡剂显影。食管钡餐造影检查提示食管全程显著不均匀迂曲扩张,呈节段性囊样改变,钡剂下行缓慢,食管内见较多食物潴留及多个宽大液平,蠕动尚柔和,黏膜纹增粗,局部显示不清。结论巨食管症的影像表现具有特异性,熟悉巨食管症的影像表现有助于本病的诊断。     

食管结核的影像学诊断(附5例报告)

目的　探讨食管结核的影像学表现 ,提高对该病的认识。方法　回顾性分析 5例经病理证实的食管结核 ,男 2例 ,女 3例 ,年龄 2 4～ 3 6岁 ,平均 2 9岁。 5例均行食管钡剂造影、CT和电子纤维胃镜检查 ,1例行手术治疗。结果　食管钡剂造影示 :食管上段 1例 ,中段 3例 ,下段 1例 ,表现为充盈缺损 2例 ,向心性狭窄 2例 ,腔内点状钡斑 1例 ,腔外不规则窦道形成 1例。黏膜纹破坏2例 ,平坦或消失 3例。胸部CT平扫 :1例左肺下叶后基底段支气管扩张 ,右肺门增大 ,右胸壁有小结节 ;1例食管下段管壁不规则增厚 ;1例胸膜肥厚粘连 ;2例未见明显异常。术前影像学误诊 3例 ,正确诊断 2例。结论　食管结核缺乏影像学的特点 ,诊断应密切结合临床。     

The "foamy" esophagus: a radiographic sign of Candida esophagitis

OBJECTIVE: The purpose of this study was to describe the radiographic features of the "foamy" esophagus, a new sign of Candida esophagitis seen on double-contrast esophagography, in six patients. CONCLUSION: The foamy esophagus was characterized by innumerable tiny (1-3 mm), round lucencies (bubbles) that intermingled with the barium suspension along the top of the barium column, producing a layer of foam. Candida esophagitis should be strongly suspected when a foamy esophagus is detected on double-contrast esophagography, particularly in patients with underlying esophageal involvement by scleroderma.     

Intramural tracking: a feature of esophageal intramural pseudodiverticulosis

OBJECTIVE: Our purpose was to determine the frequency of intramural tracking in patients with esophageal intramural pseudodiverticulosis and to characterize the morphologic features of this finding on barium studies. MATERIALS AND METHODS: A review of radiology files at two institutions revealed 30 cases of esophageal intramural pseudodiverticulosis diagnosed at esophagography. In all cases, the radiographs were reviewed retrospectively to determine the frequency and morphologic features of intramural tracking in these patients. The number and distribution of pseudodiverticula and the presence or absence of strictures or esophagitis were also noted. RESULTS: Fifteen (50%) of 30 patients with esophageal intramural pseudodiverticulosis had intramural tracking on esophagography. The tracks had an average length of 1.2 cm (length range, 0.3-7 cm) and an average width of 1.6 mm (width range, 1-4 mm). The pseudodiverticula were more numerous and had a more diffuse distribution in patients with tracking than in patients without tracking. Although patients with and without tracking had a similar frequency of strictures and esophagitis, patients with tracking were more likely to have strictures involving the upper or mid esophagus, whereas patients without tracking were more likely to have strictures in the distal esophagus. These findings indicate that intramural tracking is more likely to occur in patients with the diffuse form of esophageal intramural pseudodiverticulosis. CONCLUSION: Intramural tracking was detected on esophagography in 50% of patients with esophageal intramural pseudodiverticulosis, so this type of tracking is a more common radiographic finding than has previously been recognized. Although intramural tracking has little or no known clinical significance, it is important to be aware of this finding so that it is not mistaken for a large flat ulcer in the esophagus or for an extramural collection associated with esophageal peridiverticulitis.     

食管癌肉瘤和肉瘤样癌X线、病理分析

目的 探讨食管癌肉瘤和肉瘤样癌的X线表现及病理特点,以提高对其认识.资料与方法 分析10例食管癌肉瘤和肉瘤样癌患者的X线、病理资料并复习文献.结果 食管钡餐检查表现为食管腔内充盈缺损.病理表现为癌与肉瘤两种成分同时存在.结论 食管癌肉瘤是同一肿瘤中既有癌又有肉瘤成分的复合肿瘤,食管肉瘤样癌本质是一种特殊类型的癌.当食管吞钡见腔内充盈缺损,且病变段有梭形扩张时,应考虑本病可能.两者手术切除预后较好,区分两者实用意义不大.     

Diffuse esophageal spasm: CT findings in seven patients

OBJECTIVE: The purpose of this study was to determine the frequency and appearance of esophageal wall thickening on CT scans in a series of patients with findings of diffuse esophageal spasm on barium studies. CONCLUSION: CT revealed marked esophageal wall thickening in seven (21%) of 33 patients who had findings of diffuse esophageal spasm on barium studies. CT showed significantly greater esophageal wall thickening in the lower thoracic esophagus 5 cm above the gastroesophageal junction than in the upper thoracic esophagus at the level of the aortic arch or in the midthoracic esophagus at the level of the carina (p < 0.01). This esophageal wall thickening corresponded to the presence of multiple strong nonperistaltic contractions in the lower thoracic esophagus on barium studies. Our findings suggest that diffuse esophageal spasm should be included in the differential diagnosis when CT shows smooth circumferential wall thickening in the lower half of the thoracic esophagus, particularly in elderly patients with dysphagia or chest pain.     

食管黏膜下血肿的临床与X线表现

目的:分析食管黏膜下血肿的临床及X线表现。材料和方法:回顾性分析经食道镜确诊及处理的29例食管黏膜下血肿的临床及X线食管钡餐表现。结果:食管黏膜下血肿临床症状轻且定位不明确,X线食管钡餐表现为食管腔内充盈缺损21例、液-钡平面影6例及囊状钡剂充填影4例。结论:X线食管钡餐检查,结合临床表现能明确诊断食管黏膜下血肿,并对临床治疗有重要指导意义。