骨脂肪瘤及血管脂肪瘤的CT及MRI表现:9例报告并文献复习

目的探讨骨脂肪瘤及血管脂肪瘤的CT及MRI表现。方法收集手术病理证实的9例骨脂肪瘤及血管脂肪瘤的临床及影像学资料,9例术前8例接受CT扫描,3例接受MRI检查。结果9例中骨脂肪瘤6例,骨血管脂肪瘤3例。6例骨脂肪瘤发生于骨内4例,骨旁2例。骨内脂肪瘤跟骨1例,距骨1例,眶骨1例,肱骨1例。骨旁脂肪瘤颅骨1例,股骨1例。骨血管脂肪瘤发生于肋骨1例,颅骨1例,椎骨1例。骨内脂肪瘤CT显示病变骨质呈轻度膨胀性改变,边缘见轻度硬化环,病灶内见脂肪密度及条弧形、结节状钙化,MRI显示病灶T1WI呈高信号,PDWI及T2WI抑脂序列呈低信号。骨旁脂肪瘤CT呈不均匀高密度团块,MRI显示病灶T1WI呈高信号,T1WI及T2WI抑脂序列呈低信号。3例骨血管脂肪瘤CT显示病变骨质呈显著膨胀性改变,骨破坏边缘及内部见多发骨嵴及粗大骨小梁,高密度骨针呈放射状、簇状或不规则排列。结论骨内脂肪瘤及血管脂肪瘤CT及MRI表现均以脂肪成分为主要特征,骨旁脂肪瘤CT以骨化性团块为特征,骨血管脂肪瘤骨质膨胀性改变较骨内脂肪瘤显著,病灶边缘及中心以多发骨嵴及粗大骨小梁为特征。      

A case of endobronchial lipoma

Endobronchial lipomas are very rare tumors originating from the tracheo-bronchial wall. We have experienced a case of endobronchial lipoma which was found at the orifice of the left lower lobe bronchus and obstructive pneumonia distal to it. Left lower lobectomy was performed, and the patient has been well without any symptoms so far.Endobronchial lipomas are histologically benign tumors, but more than half of the reported cases underwent lobectomy or pneumonectomy due to the presence of varying degrees of irreversible peripheral lung damages.     

A rare case of a pedunculated lipoma in the pharynx

While lipomas on the trunk and limbs are common, they are rare in the upper aerodigestive tract. A case is reported of an 18 cm long pedunculated lipoma arising from the hypopharynx in a 73 year old man. The tumour was asymptomatic until it appeared in the mouth of the patient after a coughing episode.     

Ultrasound antenatal diagnosis of cleft palate by a new technique: the 3D "reverse face" view.

OBJECTIVE: To assess the clinical value of a novel three-dimensional (3D) ultrasound technique, the reverse face view (3D RF view), in the antenatal categorization of facial clefting and in particular clefting of the hard palate. METHODS: Eight cases of suspected orofacial clefting were examined by 3D surface rendering. The fetal lips and alveolar ridge were examined in the frontal plane and the face was then rotated through 180 degrees on the vertical axis to examine the secondary palate by the 3D RF view. RESULTS: In each case described, we were able to visualize the fetal face, lips and palate and make an antenatal diagnosis as to whether the palate was affected. In all cases, the antenatal diagnosis was subsequently confirmed. In one case with a left-sided cleft in the lips and alveolar ridge and an intact hard palate, the correct diagnosis was made but a cleft in the soft palate was missed. CONCLUSION: Although clefts of the lips and alveolar ridge are readily diagnosed on high-quality antenatal ultrasound, visualization of the fetal palate using existing techniques is unreliable. In the patients described here, the 3D RF technique allowed relatively straightforward assessment of the fetal palate with a high degree of accuracy.     

Uvular necrosis after upper endoscopy: a case report and review of the literature

Uvular necrosis after endotracheal intubation or upper endoscopy is rare. We report here on a case of uvular necrosis and ulceration after endoscopy. The combination of ulceration and necrosis suggests uvular ischemia during endoscopy. The uvula may have been sandwiched between the shaft of the endoscope and the gum or hard palate, or may have been pressed against the posterior pharynx, leading to prolonged ischemia and resultant ulceration and necrosis. Uvular trauma can also be caused by oral pharyngeal suction. We recommend that post-endoscopy uvular necrosis should be managed conservatively based on the patient's symptoms. In all reported cases, and in the present case as well, the uvula healed and the symptoms resolved within 2 weeks (5 - 14 days) after the procedure. The uvula regained its normal appearance. Overall, these patients should have a good clinical outcome.     

产前超声在评价腭裂骨缺损中的应用

目的 总结不同类型、程度腭裂骨缺损的胎儿产前超声特征.方法 回顾2018年2月至2019年10月在武汉大学人民医院诊断的唇腭裂、单纯腭裂和黏膜下腭裂胎儿上腭的二维和三维图像,对照出生后或引产后结果进行分析.结果 产前超声诊断并随访到47例唇腭裂、3例单纯腭裂和2例黏膜下腭裂.牙槽突裂病例中,均可见牙槽突回声中断,97....     

侧角度照射技术在胎儿腭三维超声成像中的应用价值

目的 评价侧角度照射技术对胎儿腭的容积数据采集及三维后处理的价值.方法 选取孕20~28周进行系统胎儿超声检查的孕妇566例,胎儿颜面部正常并经产后证实.在获取颜面部标准正中矢状切面和侧角度照射的正中矢状切面后分别采集容积数据,使用4D-View软件进行后处理.对1例唇腭裂胎儿采用同样的技术进行容积采集及数据后处理.结果 566例胎儿中分别有458例和411例成功采集到标准正中矢状切面及侧角度照射正中矢状切面的容积数据.胎儿原发腭在标准组和侧角度照射组均可很好地重建显示(100%).标准组中硬腭的轴平面不能重建,只有36%的胎儿硬腭的冠状面和经口裂斜冠切面可重建出,软腭重建的显示率为87%.在侧角度照射组中硬腭轴平面、冠状面及经口裂斜冠切面重建显示率均为100%,软腭重建显示率为82%.1例唇腭裂胎儿可清楚地显示牙槽突裂累及继发腭的情况.结论 侧角度照射技术在显示继发腭的基础上采集容积数据,采用三维后处理技术,可获取全部腭任意部位的常规三正交平面及其他任意切面,从而实现对胎儿腭的完整性的评估,对唇裂合并的腭裂进行诊断和分类,并使单纯腭裂的产前诊断成为可能.

Abstract：

Objective To evaluate the value of angled insonation technique in obtaining the volumes of the fetal palate and in three-dimensional post-processing.Methods Five hundred and sixty-six cases of 20~28 weeks fetuses with normal face were confirmed by systemic ultrasound examinations and post-natal examination.The volumes in the standard midsagittal plane and angled midsagittal plane were obtained,then post-processed these data by 4D-View software.The same technology was used for volume data acquisition and processing to 1 case of cleft lip and palate fetal.Results In 566 fetuses,two groups of volume data were successfully acquired in 458 cases (standard midsagittal plane group) and 411 cases (angled midsagittal plane group).Fetal primary palate in the standard group and the angled group can be both well visualized(100%).Axial plane of hard palate can not be reconstructed in the standard group.Only 36% of the fetal hard palate's coronal plane and transoral oblique coronal plane can be reconstructed.The visualization rate of soft palate was 87% in the standard group,which was slightly higher than the angled group (82%).The visualization rate of hard palate's axial plane,coronal plane and transoral oblique coronal plane was 100% respectively in the angled group.Cleft alveolar process involving the secondary palate can be clearly visualized in 1 case of cleft lip and palate fetus.Conclusions By using the angled insonation technique,which is based on clearly visualizing secondary palate to obtain volumes,using three-dimensional post-processing technique can obtain the conventional three orthogonal planes and any other section of the whole palate.By using it we can assess the integrity of fetal palate,diagnose cleft lip with or without cleft palate and classify the cleft palate,even make prenatal diagnosis of the isolated cleft palate possible.     

Multiple cardiac lipomas and pericardial lipomatosis: Multidedector-row computer tomography findings

Being rare tumors of the heart, cardiac lipomas are usually discovered incidentally during non-cardiac-related examinations of the chest. Although they are reported to be typically solitary, multiplicity has been described in tuberosclerosis patients. Here we reported the multidedector-row computer tomography (MDCT) findings of a nontuberosclerosis case with multiple cardiac lipomas along with pericardial lipomatosis, who presented with symptoms of left heart failure after a histerectomy surgery but otherwise healthy before that operation.     

Lipomes géants coliques

Colonic lipomas are rare, benign, nonepithelial tumors. Most cases are asymptomatic with a small tumor size. However, they may be giant, symptomatic, or complicated. We report two cases of giant symptomatic colonic lipomas including a case of colocolic intussusception. Reviewing the literature, combined with our experience, we discuss the clinical features, diagnosis, and treatment of this uncommon disease.     

Intriguing mass associated with cleft palate

Nasopharyngeal teratomas are rare and represent only 2% of all teratomas. They can lead to an embryopathogenic mechanical obstacle responsible for a cleft palate with few reported cases of this association in the literature. We report the case of a 14‐month‐old girl with this atypical association.     

Prenatal ultrasound and magnetic resonance imaging findings of a hypovascular epignathus with a favorable prognosis

Epignathus of a fetus is an extremely rare type of an oropharyngeal teratoma that commonly arises from the palate and often grows in the prenatal period, leading to polyhydramnios due to difficulty in swallowing before birth and a high mortality due to the airway obstruction after birth. We report here a very rare case of a fetus with an epignathus decreasing in size naturally in the prenatal period with a favorable prognosis. In contrast to previously reported cases of epignathus that grew rapidly in the prenatal period, color Doppler fetal ultrasound showed a hypovascular tumor in our case. Moreover, histopathologic examination revealed an epignathus with necrotic areas inside. Based on our experience, a hypovascular epignathus demonstrated by color Doppler fetal ultrasound may be an indicator of a favorable prognosis.     

Pedunculated lipoma of the colon: risks of endoscopic removal

Endoscopic removal of pedunculated submucosal lipomas of the colon has been considered safe and effective. I have reported a case of large submucosal lipoma of the descending colon, in which serosal invagination resulted in the formation of a "pseudopedicle." Endoscopic polypectomy in such a case would have resulted in colonic perforation. Caution should be exercised in endoscopic removal of large lipomas, even when a pedicle is present.     

Hepatic lipomas: Ultrasound and computed tomographic findings

Five cases of solitary hepatic lipoma are described. These rare tumors have ultrasound (US) and computed tomographic (CT) characteristics that suggest the diagnosis. As imaged by US, hepatic lipomas always correspond to a highly echogenic, well-limited lesion with posterior attenuation. Precontrast CT scans reveal a low-density lesion (–20 to –70 HU); following contrast material injection, the tumor density may either remain negative (pure hepatic lipoma) or become positive (limit, 40 HU) when there is an associated adenomatous component. Hepatic lipomas involve no risk of degeneration, and follow-up by US is sufficient.A case of lipoma of the falciform ligament and a case of a hepatic pseudolipoma are also described; sonograms were negative in both instances, and CT was required for diagnosis.     

Prenatal diagnosis of an epignathus: a case report and review of the literature.

An epignathus is an extremely rare form of teratoma that arises from the oral cavity, most commonly from the palate. We describe a case identified sonographically at 17 weeks' gestation after a raised maternal serum alpha-fetoprotein was recorded. This pregnancy was terminated but we review the literature over the last 10 years and describe the management options available in such cases.     

CT appearance of incidental pancreatic lipomas: a case series

Pancreatic lipomas are rare benign lesions, with only 15 examples documented in the current literature. We describe five cases of intrapancreatic lipomas from a single institution, all incidentally found using computed tomography within a 14-month period. Computed tomography depicted lipomas as homogeneous, nonenhancing, well-marginated lesions with a density coefficient consistent with adipose tissue.     

Giant rectal lipoma

Colonic lipomas are rare benign tumors usually occurring in the ascending colon. We present here a case of giant rectal lipoma measuring 11.5 cm in size with review of the literature. To the best of our knowledge, colonic lipoma exceeding 8.5 cm in size has not been reported previously.     

Antenatal sonographic diagnosis of epignathus at 15 weeks of pregnancy.

Epignathus is a rare, benign, congenital teratoma of the hard palate. Most of these teratomas are unidirectional and protrude through the mouth. Hence, the prognosis depends on the size of the tumor and the degree of face distortion and airway obstruction that it causes. However, some epignathi protrude bidirectionally, involving and destroying the brain tissue, resulting in a poor prognosis. This report presents a case of ultrasonographic detection of a bidirectional epignathus at 15 weeks of pregnancy.     

Colonic lipoma covered by hyperplastic epithelium: Case report

Colonic lipomas are submucosal nonepithelial tumors covered by intact or eroded mucosa. In rare cases, alterations in the mucosa covering a lipoma include hyperplasia, adenoma, atrophy, ulceration, and necrosis. Here, we report a case of a colonic lipoma covered by hyperplastic epithelium in a 68-year-old woman. Based on the colonoscopy findings, a snare polypectomy was performed for a presumptive diagnosis of an epithelial lesion; however, the histological examination revealed a colonic submucosal lipoma with overlying hyperplastic epithelium.     

三维超声自由解剖成像新技术在胎儿腭显示中的应用

目的评价三维超声自由解剖成像新技术（全方位观中任选切面）在胎儿腭部显示中的应用价值。方法应用三维超声自由解剖成像技术对100例正常胎儿经下颌颜面部正中矢状切面的容积数据进行分析,在参考切面（颜面部正中矢状切面）上描画解剖线,获取横切面（经上颌、经口裂）、冠状切面、斜冠状切面（经梨状孔、经口裂、经颏下三角）以及腭的曲面平铺成像。对5例唇腭裂胎儿按照相同技术获取容积数据并进行分析。结果 100例正常胎儿中91例（91.0%,91/100）成功采集到颜面部容积数据,经三维超声自由解剖成像技术对91例容积数据进行分析,不同成像切面上腭部显示结果：（1）经上颌横切面显示胎儿牙槽突弓91例（100%,91/91）,声像图表现为＂C＂形的弓状结构;显示硬腭91例（100%,91/91）,声像图表现为两侧牙槽骨间片状强回声;经口裂横切面显示软腭81例（89.0%,81/91）,声像图表现为条状软组织带。（2）冠状切面显示硬腭91例（100%,91/91）,声像图表现为条状强回声带,分隔口腔和鼻腔。（3）经梨状孔斜冠状切面显示硬腭91例（100%,91/91）,声像图表现为短条状强回声带;经口裂斜冠状切面显示硬腭91例（100%,91/91）;经颏下三角斜冠状切面显示硬腭91例（100%,91/91）,声像图均表现为条状强回声带,其后方为声影,不能显示其上方的鼻腔及鼻中隔。（4）经梨状孔斜冠状切面显示软腭81例（89.0%,81/91）,显示悬雍垂25例（27.5%,25/91）,声像图表现为片状软组织回声,悬雍垂为软腭下缘正中乳头状突起;经口裂斜冠状切面显示软腭81例（89.0%,81/91）;经颏下三角斜冠状切面显示软腭81例（89.0%,81/91）,声像图均表现为条状软组织带,后上方为鼻咽部无回声区。（5）腭的曲面成像显示牙槽突弓91例（100%,91/91）,显示硬腭91例（100%,91/91）,显示软腭81例（89.0%,81/91）,显示悬雍垂25例（27.5%,25/91）,声像图表现为牙槽突弓呈＂C＂形弓状结构,硬腭呈片状骨性强回声,软腭为片状软组织低回声。在15例包含唇腭裂畸形的容积数据中,分析者能全部确认其中的5例畸形病例,并能确认腭裂累及的部位及范围。结论三维超声自由解剖成像技术易于获取二维超声难以显示的胎儿腭部横切面和冠状切面图像,并可获取继发腭的特殊斜冠状切面图像;通过追踪腭的结构画线,可获取腭的曲面平铺成像,形象直观地显示腭部全景图。此方法可简化胎儿腭的超声检测,减少对操作者技术和经验的依赖,能较快评估胎儿原发腭及继发腭的完整性,确认唇裂胎儿有无腭裂,并可明确腭裂累及的部位及范围。     

Central nervous system lipomas

The lipomas of the central nervous system are rare lesions of congenital origin and are located in the medial line and especially in corpus callosum. Intramedullary spinal lipomas can be seen in the life span of 30 years of age and most frequently coincide with initial puberty period. Magnetic resonance imaging and computerized tomography together with clinical trials are of crucial importance for diagnosis. The first case: A two-year-aged girl who had lipoma in quadrigeminal cistern and who suffered from encephalocraniocutaneous lipomatosis has been clinically studied. The fascial lipoma of the patient has been excised subtotally by the Plastic Surgeons; then the patient has underwent supracerebellar infratentorial operation where the intracranial lipoma has been excised by our team. The histopathology has been reported to be consisting of peripheric nerve tissue and calcification. The second case: A twenty-year-aged man with intramedullary lipoma localized between T1-T4 has been given our clinical trials. T1-T5 total laminectomy and subtotal excision were made for this patient. Due to the fact that the lipomas of central nervous system are rarely seen and are involved in nervous and calcific tissues except for fatty tissues they can be mistaken for hamartomatous masses. The total excision of the lipomas of central nervous system and especially the spinal intramedullary lipomas are quite difficult to be excised since they are tightly entangled with the neural tissue. So any attempt for total excision would be dangerous. Operation for decompression and biopsy is of primary concern.