胸部钝性外伤的CT表现

随着胸部钝性外伤病例的日益增多,影像学检查在该病的诊断和处理中发挥着越来越大的作用,CT有利于各种胸部外伤的快速确诊,特别是多层螺旋CT和各种容积重组方法又增加了人们对胸部外伤及其相关病变的新认识.综述肺、纵隔、大血管、膈肌和骨性胸廓等胸部各脏器和组织在钝性外伤时的CT表现.     

螺旋CT对胸部闭合性损伤的诊断价值

对160例胸部闭合性损伤患者的胸部X线片和CT图片资料进行比较分析。认为CT检查在胸部闭合性损伤检查中较X线片具有更高的临床应用价值。     

泪腺外伤的CT表现

目的 探讨泪腺外伤的CT表现. 资料与方法 回顾性分析65例眼外伤合并有泪腺损伤患者的CT资料,其中单侧泪腺损伤63例,双侧2例. 结果 65例67眼泪腺损伤CT表现为泪腺体积增大,边缘模糊, 6例泪腺内可见碎骨片, 5例泪腺与肿胀眼睑分界不清, 4例泪腺向前外下方移位, 2例泪腺密度增高;其他眼外伤表现包括眼睑肿胀、眼球损伤、眶壁骨折、眼外肌增粗、眼眶上壁骨膜下血肿等. 结论 眶壁骨折、眼球损伤、眼睑损伤等眼外伤常合并泪腺损伤,CT检查能及时发现泪腺损伤,有助于临床治疗及预后.     

胸部闭合性肺实质损伤的影像学表现(附68例报告)

目的 探讨胸部闭合性肺实质损伤的影像学表现.方法 回顾性分析了68例胸部闭合性肺实质损伤患者的影像学资料.结果 胸部闭合性肺实质损伤的影像学表现主要归纳为:①肺挫伤36例,影像学表现为肺纹理增多增粗,伴有斑点状、斑片状密度增高影;大片状密度增高影;磨玻璃样改变;②肺撕裂伤22例,影像学表现为边缘光滑的空洞样团块影;边缘模糊的团片状密度增高影,其内夹杂密度减低区,囊腔内可见气-液平面;③肺血肿10例:表现为圆形或椭圆形团块影,边缘尚清楚,可有分叶,周围略高于中心.肺外表现:血气胸28例、皮下气肿或纵隔气肿15例、单纯性气胸6例.结论 影像学检查是发现、诊断和动态观察胸部闭合性肺实质损伤的最佳方法,典型的肺实质损伤单凭X线平片、CT、外伤史即可诊断,但CT优于X线平片.     

钝性膈肌破裂的螺旋CT诊断

钝性膈肌破裂主要发生于胸、腹部钝挫伤的病人.该病临床症状隐匿,CT表现复杂多变,误、漏诊率发生较高.介绍钝性膈肌破裂的CT检查方法、表现及其含义,评价各种CT征象在钝性膈肌破裂诊断中的作用.     

显微镜下多血管炎的胸部CT表现

目的 提高对显微镜下多血管炎（MPA）胸部CT表现的认识。方法 回顾性分析5例明确诊断的MPA胸部CT资料。所有病例均行胸部常规CT检查，其中4例行高分辨率CT（HRCT）扫描。结果 胸部CT主要表现为磨玻璃影3例，实变影2例，纤维化2例，肺大泡3例，胸膜增厚3例，胸腔积液2例，胸内淋巴结增大3例；外周型为主3例，中央型及无明显区域分布各1例。2种及以上肺部病变并存4例。肺部病变合并纵隔淋巴结增大的3例。结论 MPA胸部CT无特异性，主要表现为磨玻璃影，明确诊断需结合临床、影像表现和实验室检查。     

胸部结节病的多排螺旋CT表现

目的探讨胸部结节病(sarcoidosis)的多排螺旋CT表现,旨在提高对该病的认识及诊断水平。方法回顾性分析经病理或临床随访证实的36例胸部结节病患者的CT和临床资料。结果 36例结节病患者中,仅肺门及纵隔淋巴结肿大者6例,肺门及纵隔淋巴结肿大并肺内浸润者25例,仅见肺内浸润无淋巴结肿大者5例;肺内表现:肺内小结节沿支气管血管束及胸膜下分布者19例,小叶间隔不规则增厚者16例,实变影17例,"磨玻璃影"3例,蜂窝变10例。淋巴结表现:双肺门、上纵隔右下气管旁、气管隆突下分布多见,平扫CT值均匀,增强扫描呈中度以上明显强化。结论双侧肺门淋巴结对称性肿大和/或纵隔淋巴结肿大,以及沿支气管血管束分布的不规则结节影是肺部结节病特征性影像学表现,多平面重组(MPR)图像对该病的诊断有较高的价值。     

钝性膈肌破裂的螺旋CT诊断

钝性膈肌破裂主要发生于胸、腹部钝挫伤的病人.该病临床症状隐匿,CT表现复杂多变,误、漏诊率发生较高.介绍钝性膈肌破裂的CT检查方法、表现及其含义,评价各种CT征象在钝性膈肌破裂诊断中的作用.     

肠及肠系膜钝性损伤的CT表现

目的 :探讨肠及肠系膜钝性损伤的CT表现。方法 :回顾性分析65例肠和肠系膜损伤患者的CT资料。结果 :65例中肠管破裂17例,表现为腹腔积液和积气;单纯肠系膜挫伤5例,表现为挫伤区域肠系膜脂肪模糊、水肿或血肿形成;肠和肠系膜并存损伤43例。10例合并肝、脾、肾等实质脏器中的1个或多个脏器损伤。结论:CT可作为肠及肠系膜钝性损伤的主要检查手段,腹腔积气和肠系膜血肿分别对肠管破裂和肠系膜挫伤的诊断具有较高特异性,而腹腔积液和肠管水肿对肠管损伤具有较高的敏感性。     

钝性脾损伤的CT诊断

目的探讨CT非增强扫描对钝性脾损伤的诊断价值。方法回顾性分析经CT非增强扫描并经手术及临床确诊的41例钝性脾损伤。结果脾脏包膜下血肿12例,脾内血肿16例,脾撕裂伤19例,脾粉碎8例,伴有腹腔积血30例。无假阳性,3例假阴性,CT非增强扫描诊断脾损伤敏感性92.7%,特异性100%,准确率92.7%。结论CT非增强扫描能够较好的显示钝性脾脏损伤的表现,为临床治疗提供可靠依据。     

Role of CT in excluding major arterial injury after blunt thoracic trauma

The role of CT in the diagnosis of major vascular rupture following blunt decelerating chest trauma is controversial. Its value in excluding major arterial injury has not yet been determined. During a 12-month period we obtained dynamic enhanced thoracic CT studies in 20 patients with blunt decelerating thoracic trauma who had abnormal or equivocal mediastinal contours on chest radiographs. In all cases diagnosis was confirmed by either digital subtraction (18 patients) or conventional thoracic angiography (two patients). CT scans showed evidence of direct aortic injury in three patients and evidence of mediastinal hematoma in five others. Four of these eight patients had major arterial injury verified angiographically and at surgery. In two patients the CT scan was considered equivocal; both patients had normal thoracic angiograms. CT excluded direct vascular injury or mediastinal hematoma in 10 patients. All 10 had normal thoracic angiograms. This preliminary study suggests that, in patients sustaining blunt decelerating thoracic trauma, thoracic CT may be more valuable than chest radiography in excluding major vascular injury and, in some cases, may reduce the need for thoracic angiography.     

Imaging of blunt pediatric thoracic trauma

The imaging evaluation of thoracic trauma is a central feature of the acute assessment and management of injured children. A reliable early clinical diagnosis of chest injury often is difficult. Cardiopulmonary symptoms may not be present in the first 24 hours, and there is no consistent relationship between external chest wall injury and underlying abnormalities. This is particularly evident in children, in whom increased compliance of the bony thorax allows major internal injury to occur without associated skeletal injury. Additionally, unlike the examination of injuries to the head and abdomen, which are often evaluated with computed tomography in the initial posttraumatic period, chest radiography remains the primary method for evaluation of chest injuries, although it may not demonstrate or may underestimate many abnormalities. This essay reviews the imaging appearance of common and uncommon thoracic injury in children.     

迟发性闭合性胸部损伤的CT表现及动态观察

目的：探讨 CT 对迟发性胸部损伤的诊断及动态变化,为临床及时准确治疗提供诊断依据。方法：回顾分析110例迟发性胸部损伤的 CT 和临床资料,对其 CT 表现及动态变化等进行分析。结果：迟发性胸部损伤大都于伤后24～48 h 内发生,其中肺挫伤93例,单纯气胸3例;气胸合并血胸2例;单纯出现血胸12例;肺挫伤伴发迟发性血胸69例,伴发率高达74％（69/93）。迟发性肺挫伤大多发生在右肺,占72．04％（67/93）;发生在下叶的迟发性肺挫伤又比上叶明显多见,占76．34％（71/93）。结论：CT 不仅能及时发现迟发性胸部损伤,还能对发生的部位、性质、损伤程度、并发症、预后等做出及时判断,为临床及时准确治疗提供诊断依据。应将伤后48h CT 复查列为常规。迟发性胸部损伤不易完全吸收,易遗留肺纤维化及胸膜增厚、粘连。     

闭合性阴囊损伤的CT诊断

目的确定闭合性阴囊损伤的ＣＴ诊断价值。方法 对２３例闭合性阴囊损伤的ＣＴ资料及临床处理进行回顾性分析。结果 根据睾丸失去正常的卵圆形结构，白膜中断，睾丸组织突出或睾丸断片分离等征象，ＣＴ正确诊断睾丸破裂８例；ＣＴ亦能显示阴囊壁血肿，鞘膜积血，白膜下血肿，睾丸实质血肿，睾丸附睾挫伤，精索及附睾血肿等其他病理改变。１７例手术探查证实ＣＴ显示的各种病理改变与手术病理完全相符。结论 ＣＴ能准确诊断各种类型     

胰腺钝性伤的CT诊断

目的：总结分析胰腺钝性伤的CT征象。方法：经手术证实的胰腺钝性伤5例,回顾分析其CT表现及特点。结果：2例分别为胰腺断裂和实质出血的胰腺钝性伤患者,未能及时诊断和有效治疗,并发了重症胰腺炎、胰周感染和脓肿等严重并发症,致使住院治疗时间明显延长。另3例及时诊断和治疗,患者很快恢复出院,结论：CT是诊断胰腺钝性伤的首选方法。正确认识CT征象能及时作出诊断,为适时手术提供依据,从而减少并发症及死亡率,特别是对胰腺损伤程度严重的患者。     

闭合性喉损伤的CT诊断

目的 搪塞闭合性喉损伤的ＣＴ表现及诊断价值。方法 对１６例闭合性喉损伤病人的ＣＴ和临床资料进行回顾性分析。结果 软组织损伤５例,杓会厌襞和真假声带肿胀、气道狭窄４例,左环杓关节脱位,声带麻痹１例;声门损伤２例;均有会咽软骨骨折伴榴府厌襞和下咽部撕裂;声门损伤４例;甲状软骨右翼部骨折１例,甲状软骨前联合部纵行或粉碎骨折３例,其中１例骨折片进入喉腔形成异物,两侧声带和前联合撕脱;声门下损伤（５例）：左     

Esophageal entrapment with blunt thoracic spinal trauma

Esophageal injury due to blunt trauma rarely occurs. However, prompt diagnosis and treatment of such injury is essential to improve patient survival. We report an extremely rare case of esophageal entrapment within a hyperextension fracture dislocation of the thoracic spine, which was diagnosed by reviewing an esophagram and CT image simultaneously. Esophageal injury should be considered with thoracic spine trauma, especially if the T3/4 level is involved.