艾滋病合并肠系膜淋巴结结核11例临床分析

目的 探讨艾滋病合并肠系膜淋巴结结核的临床特点.方法 回顾性分析深圳市第三人民医院1999年9月至2008年12月收治的158例艾滋病合并结核病患者,其中诊断为艾滋病合并肠系膜淋巴结结核11例(男7例,女4例);除1例8岁儿童外,其余10例年龄22～55岁.结果 艾滋病合并肠系膜淋巴结结核患者约占艾滋病合并结核病患者的7%,其中8例CD_4~+＜50×10~6/L,3例CD_4~+为(50～100)×10~6/L;临床表现以发热(11/11)、腹痛(11/11)、腹胀(11/11)、盗汗(7/11)、消瘦(10/11)、腹泻(7/11)、贫血(5/11)、腹部包块(3/11)和腹腔积液(1/11)为特点;腹部B型超声扫描示多个肠系膜淋巴结肿大,腹部CT增强扫描示典型环状强化;2例行肠系膜淋巴结组织活检,病理结果均可见结核结节、干酪样坏死物和朗汉斯巨细胞,抗酸染色均为抗酸杆菌阳性.11例均给予抗结核治疗6个月及抗病毒治疗5个月,病灶吸收和消失.结论 艾滋病合并肠系膜淋巴结结核的临床表现无特异性,CD_4~+＜50×10~6/L、腹部CT增强扫描出现典型环状强化为其特征性表现.     

腹部手术后急性肠系膜静脉血栓形成17例临床分析

目的探讨腹部手术后急性肠系膜血栓形成的相关因素及诊治方法。方法对17例腹部手术后肠系膜血栓形成患者的临床资料作回顾性分析。结果 17例急性肠系膜静脉血栓形成发生于腹股沟疝术后6例、肠梗阻术后6例、脾切除术后5例。17例均行腹部CT增强扫描（CTA）检查发现肠系膜静脉血栓形成。15例行手术治疗,2例仅行抗凝、溶栓治疗;其中16例痊愈出院,1例死亡。结论腹部手术后患者易发生急性肠系膜静脉血栓形成,腹部CTA可作为其诊断的首选检查,手术及抗凝是本病的主要治疗方法。     

急性肠系膜静脉血栓形成30例临床分析

目的分析急性肠系膜静脉血栓形成的临床特点和治疗。方法对我院30例急性肠系膜静脉血栓患者的临床资料进行回顾性分析,并结合文献总结急性肠系膜静脉血栓的临床特点、诊断及治疗方法。结果30例急性肠系膜静脉血栓患者,年龄19～78岁,平均年龄51．9岁。手术治疗19例,死亡7例;溶栓治疗11例,放弃治疗1例。结论腹部CT可对早期急性肠系膜静脉血栓做出正确的诊断,早期溶栓或手术治疗可以降低死亡率。     

成人小肠扭转26例临床分析

目的提高成人小肠扭转的诊治水平。方法回顾性分析26例小肠扭转病例的临床资料,分析其临床特点。结果 26例患者均表现为突发剧烈脐周绞痛,持续发作,阵发加剧,伴有频繁呕吐及肛门停止排气排便等肠梗阻症状,21例疼痛牵涉至腰背部,4例出现休克表现。腹部可见肠型,肠鸣音消失,腹胀不对称,并出现腹膜刺激征。腹部立位平片检查示23例有气液平面,其中2例见空回肠换位征,1例见假肿瘤征。10例行腹部CT检查发现腹腔积液,经穿刺证实为血性,其中4例见漩涡征。26例患者均行手术治疗,25例肠功能恢复出院,1例同时合并心功能衰竭死亡。结论突发剧烈腹部绞痛、频繁呕吐、不对称腹胀为小肠扭转的特征性表现,腹部X线及CT检查有助于该病诊断;本病一旦确诊应尽早手术治疗。     

肠系膜静脉血栓形成的临床特点分析

目的分析急性肠系膜静脉血栓(acute mesenteric venous thrombosis,AMVT)和慢性肠系膜静脉血栓(chronic mesenteric venous thrombosis,CMVT)的临床特点。方法对首都医科大学附属友谊医院1980年10月至2005年12月确诊的33例肠系膜静脉血栓(MVT)患者的临床资料进行了分析,并结合文献,总结MVT的临床特点和治疗方法。结果33例MVT中,慢性肠系膜静脉血栓11例,年龄32~78岁(平均46.6岁),无急腹症的表现,均是在腹部CT检查中发现肠系膜静脉血栓;另22例为AMVT患者,年龄19~75岁(平均48.9岁)。主要症状和体征为腹痛、腹胀、腹部膨隆、腹膜刺激征,呕吐68.2%(15/22),发热36.4%(8/22)。误诊率59.1%(13/22),手术治疗17例,死亡7例,治愈10例;溶栓治疗5例痊愈。结论早期腹部CT结合肠系膜上动脉造影可对早期AMVT做出正确的诊断,早期溶栓或手术治疗可以降低病死率。     

多层螺旋CT在急诊老年血管源性急腹症中的特征及其临床研究意义

目的分析多层螺旋CT在急诊老年血管源性急腹症中的影像学特征及临床诊断意义。方法选取2016年7月—2018年5月于南京医科大学附属逸夫医院就诊且经病理检查证实的42例老年血管源性急腹症病患,组织进行多层螺旋CT扫描检查,观察患者CT影像学表现及诊断价值。结果 42例病患经多层螺旋CT检查确诊腹主动脉瘤6例、肝动脉瘤3例、肾动脉瘤5例、脾动脉瘤7例、肠系膜动脉栓塞5例、急性门静脉炎伴肠系膜静脉血栓形成6例、髂动脉瘤合并出血5例,恶性肿瘤侵犯血管2例,经病理诊断证实漏诊1例肾动脉瘤、1例脾动脉瘤、1例急性门静脉炎伴肠系膜静脉血栓形成,其余均与病理结果相符,即CT诊断结果与病理诊断结果比较差异无统计学意义(P0.05);不同疾病类型其CT影像学表现均存在差异:腹主动脉瘤呈不规则扩张,管壁增厚,注射造影剂后血管呈梭形扩张;肝动脉瘤接近肝实质可见多发囊性密度影,病变多呈囊状;肾动脉瘤多呈囊状或呈梭形膨大;脾动脉瘤见脾动脉局部膨大呈球状;肠系膜动脉栓塞影像学见肠系膜上动脉或分支中断,呈半月征、充盈亏损及肠壁强化减弱;急性门静脉炎伴肠系膜静脉血栓形成CT影像见肠系膜静脉梗死伴广泛性小肠肠壁增厚,肠系膜脂肪水肿;髂动脉瘤合并出血见髂总动脉管腔呈囊状,腹膜后间隙见不规则高密度阴影;恶性肿瘤侵犯血管动脉边界对比剂渗漏呈现云絮状,瘤体与周边组织无明显分界,可见肠扭转、肠套叠及血管扭转影像。结论多层螺旋CT用于急诊老年血管源性急腹症诊断中诊断准确率高,同时可见不同影像学表现,可为血源性急腹症诊断提供参考。     

肠道弥漫性大B细胞淋巴瘤的CT表现

目的探讨肠道弥漫性大B细胞淋巴瘤的CT表现特点,提高对该病的诊断准确性。 方法收集空军军医大学西京医院2011年1月至2016年12月经病理、手术或多学科会诊最终诊断为肠道弥漫性大B细胞淋巴瘤的16例患者的临床、肠镜、病理及CT等资料,回顾性分析、总结其CT表现特点并对比诊断准确性。 结果94%(15/16)为单发病变,仅1例为多发;病灶41%(7/17)位于回盲部。肿瘤41%(7/17)表现为肠壁肿块样增厚合并肠腔扩张,35%(6/17)表现为肿块样,肿块样增厚合并肠腔狭窄、肠壁轻度局限性增厚各占12%(2/17)。13例肿块内见"血管漂浮征",肿块密度均匀14例,内有坏死3例,16例肿块均为轻-中度强化,1例强化明显。14例见周围、腹膜后或肠系膜淋巴结肿大。5例见肠外侵犯。 结论肠道弥漫性大B细胞淋巴瘤的CT表现具有一定特点,总结并掌握这些特点可以提高诊断的准确性。     

胰腺恶性神经内分泌肿瘤误诊胰腺癌一例

患者女,50岁.自2005年5月起出现反复发作的上腹部隐痛不适,2010年10月左上腹部疼痛加重,腹痛与进食、排便无明显相关.就诊于潍坊市人民医院,行上腹部彩超检查,示右上腹部实性占位(考虑来自胰腺).后到北京协和医院行上腹部CT检查,示胰颈部占位,等密度,边界不清,胰尾部萎缩,胰管扩张.内镜超声示胰颈部近肠系膜上静脉旁—大小约1.77 cm×1.22cm大小的中低回声占位.于2011年1月14日行剖腹探查术,术中见胰腺颈部肿块大小约5cm×4cm,不规则,质硬,肿瘤包绕肠系膜上动脉,并侵犯肠系膜上静脉、门静脉,无法分离.鉴于局部侵犯严重,未行根治性切除术.行肿瘤细针穿刺细胞学检查,未找到癌细胞.术中诊断:胰腺颈部占位,癌可能性大.患者多次查CEA、CA19-9值均在正常范围内.     

肠系膜急性闭合性损伤的CT影像学特征及临床分析

目的通过对腹部闭合性外伤肠及肠系膜损伤的术前CT检查影像学表现与临床手术进行对比,探讨CT检查在腹部外伤肠及肠系膜损伤影像学表现及诊断优势,从而提高CT影像在肠及肠系膜损伤中的诊断符合率。 方法选取2008至2020年40例中山市东升医院收治疑似腹部闭合性损伤患者,均实施CT检查,将患者的CT检查结果与确诊结果进行对比,总结CT影像检查的诊断符合率,不同肠系膜损伤患者的CT影像学特征。 结果CT诊断符合率、漏诊率分别为97.5%、2.5%,与确诊结果比较,差异无统计学意义(P>0.05);CT检查的影像学特征有腹腔游离气体、腹腔以及肠间隙积血与积液、肠壁增厚水肿及肠壁血肿及肠系膜水肿。 结论CT检查在肠系膜急性闭合性损伤患者诊断中效果理想,其影像学特征显著,可鉴别不同类型肠系膜损伤,且诊断符合率高。     

成人腹部淋巴管瘤17例临床分析

背景：成人腹部淋巴管瘤是罕见的消化道良性肿瘤。目的：探讨成人腹部淋巴管瘤的特点和预后。方法：回顾性分析2000年1月～2010年4月温州医学院附属第一医院经术后病理证实的17例成人腹部淋巴管瘤患者的临床资料、影像学检查、治疗和预后。结果：17例患者中,13例（76．5％）有症状或体征,4例（23．5％）无症状;7例肿瘤位于肠系膜．6例位于脾脏,2例位于腹膜后．2例位于肠道;13例腹部B超、14例腹部CT有阳性表现,2例内镜检查发现肿块。所有患者均行手术治疗．术后病理示16例为淋巴管瘤,1例为淋巴血管瘤,随访期间无患者复发。结论：成人腹部淋巴管瘤的诊断需综合患者的临床表现、影像学检查和组织病理学结果．手术是腹部淋巴管瘤的主要治疗措施,术后患者预后良好。     

Clinical significance of mesenteric panniculitis-like abnormalities on abdominal computerized tomography in patients with malignant neoplasms

AIM To clarify the association of malignancy with mesenteric panniculitis-like changes on computed tomography(CT).METHODS All abdominal CT scans performed at North Shore University HealthS ystem showing mesenteric panniculitis from January 2005 to August 2010 were identified in the Radnet(Rad Net Corporation, Los Angeles, CA) database. Patients with a new or known diagnosis of a malignancy were included for this analysis. Longitudinal clinical histories were obtained from electronic medical records.RESULTS In total, 147794 abdominal CT scans were performed during the study period. Three hundred and fiftynine patients had mesenteric panniculitis(MP)-like abnormalities on their abdominal CT. Of these patients, 81 patients(22.6%) had a known history of cancer at the time of their CT scan. Nineteen(5.3%) had a new diagnosis of cancer in concurrence with their CT, but the majority of these(14/19, 74%) were undergoing CT as part of a malignancy evaluation. Lymphomas were the most common cancers associated with MPlike findings on CT(36 cases, 36%), with follicular lymphoma being the most frequent subtype(17/36). A variety of solid tumors, most commonly prostate(7) and renal cell cancers(6) also were seen. CT follow up was obtained in 56 patients. Findings in the mesentery were unchanged in 45(80%), worsened in 6(11%), and improved in 5 patients(9%). Positron emission tomography(PET) scans performed in 44 patients only showed a positive uptake in the mesenteric mass in 2 patients(5%). CONCLUSION A new diagnosis of cancer is uncommon in patients with CT findings suggestive of MP. MP-like mesenteric abnormalities on CT generally remain stable in patients with associated malignancies. PET scanning is not recommended in the evaluation of patients with mesenteric panniculitis-like findings on CT.     

Clinical features of abdominal tuberculosis

The clinical features of 81 cases of abdominal tuberculosis (TB) are presented. The peritoneum was involved in 41 patients, the ileocecal area in 17, the anorectal area in 16, and mesenteric glands in 8. There was one case each involving the liver and sigmoid colon. Most patients were young women. The tuberculin reaction was significant in 83% of patients tested, and 54% had evidence of TB elsewhere. Tuberculous peritonitis was more common in native North American Indians and presented as an acute abdomen, abdominal tumor, or cirrhosis. Asians developed the majority of ileocecal and mesenteric lymph node disease and were frequently diagnosed as having Crohn's disease, appendicitis, or cancer. Anorectal cases presented with fistulae or abscesses and usually had concomitant pulmonary TB. The disease was fatal in five patients (6%), four of whom were diagnosed only after death. One noncompliant patient had a relapse. All other patients were cured after receiving treatment.     

Burkitt's lymphoma in Thai children: an analysis of 25 cases

Twenty five cases of Burkitt's lymphoma in Thai children were diagnosed at the Department of Pediatrics, Siriraj Hospital during the period of 13 years (January 1969 to April 1982). Males were more affected than females with the ratio of 1.7:1. The age ranged from 2 to 11 years with the median age of 4-5 years. The most common clinical manifestations were abdominal mass associated with nausea vomiting, abdominal pain, anorexia, weight loss and generalized lymphadenopathy which occurred in 50-60% of cases. Additional symptoms and signs included anemia, hepatosplenomegaly, edema and pleural effusion. Jaw tumor was found in only 37.5% of the patients. Definite diagnosis depended on the characteristic starry sky appearance of the lymph node biopsy or section of abdominal mass. In advance cases, the tumor cells could be discovered in bone marrow aspiration, ascitic fluid pleural fluid and cerebrospinal fluid. The typical blast cells were detected in the peripheral blood in 4 cases. Antibody to Epstein-Barr virus could be detected in almost all cases with high titers in some cases. Most patients responded very well to local irradiation and chemotherapy with prednisolone plus cyclophosphamide and vincristine or methotrexate. However, relapse occurred rapidly and 80% of the patients died within 3 months after diagnosis with the median survival of only 1 month. Five cases expired early before any specific treatment. The main causes of death were disease, sepsis, excessive bleeding and hyperkalemia.(ABSTRACT TRUNCATED AT 250 WORDS)     

A clinicopathological study of 13 cases of intravascular lymphoma: experience in a single institution over a 9-yr period

Intravascular lymphoma (IVL) is a rare type of extranodal lymphoma in which the lymphoma cells proliferate exclusively in lumina of small vessels. Here, we report a clinicopathological study of 13 cases IVL diagnosed at our institution between March 1999 and July 2007, and evaluated the clinical characteristics, usefulness of random skin biopsy and response to chemotherapy containing rituximab. Three of 13 patients were diagnosed at autopsy. The most common clinical features were unexplained fever, neurological deterioration, respiratory failure, and poor performance status. Thrombocytopenia, high serum lactate dehydrogenase and soluble interleukin2 receptor levels were the most common laboratory abnormalities. Adrenal tumor was detected in four cases and pituitary involvement was seen in all three autopsied cases and in two surviving patient by brain magnetic resonance imaging. Bone marrow invasion was seen in all 13 cases by bone marrow smear, and it was subtle in trephine biopsy. Immunohistochemical analyses revealed that CD5 was positive in one-third of the cases. Most of the cases were positive for MUM1/IRF, Bcl-2 and negative for CD10 and BCL-6 indicating the postgerminal center cell origin of this peculiar type of lymphoma. On random skin biopsy, the most recent seven patients were diagnosed promptly and chemotherapy containing rituximab was successfully administered. Patients with IVL exhibit the characteristic clinical and immunophenotypic features cited above and the use of random skin biopsy facilitates prompt diagnosis. Early commencement of chemotherapy containing rituximab appears promising for this peculiar lymphoma. As the recent seven patients were diagnosed by random skin biopsy over the past 13 months, the incidence of IVL is thought to be much higher than generally accepted.     

Caroli综合征患者18例的临床诊治特点分析

目的:对Caroli综合征(CS)患者的临床、实验室检查结果和影像学特点进行总结和分析,以期加深对本病的认识,并探讨提高早期诊断可能性的方法。方法:收集2008年1月至2021年6月在北京协和医院住院治疗并经病理或临床、影像学诊断为CS的18例患者,回顾性分析患者的一般资料,临床表现,实验室检查结果(白细胞计数、血红蛋...     

Hemorrhage from abdominal non-Hodgkin's lymphoma treated successfully by emergency transcatheter arterial embolization

A 49-year-old Japanese woman with follicular lymphoma who presented with severe abdominal and back pain is reported. She was known to have malignant lymphoma and had been previously treated with combination chemotherapy. An abdominal tumor occurring at the root of the mesentery and involving the superior mesenteric artery (SMA) had been diagnosed by computed tomography (CT), magnetic resonance imaging, and abdominal angiography. Emergent ultrasonography and CT findings showed intraperitoneal bleeding from the abdominal tumor. Selective SMA angiography revealed extravasation from a small branch originating from the dorsal pancreatic artery, which was embolized through a catheter by using platinum coils. It should be noted that a large tumor of malignant lymphoma, involving large vessels, may bleed, and in such a case selective transcatheter arterial embolization may be one of the effective modalities for hemostasis. © 1996 Wiley-Liss, Inc.     

原发性肺黏膜相关淋巴组织淋巴瘤4例临床病例分析

目的 总结原发性肺黏膜相关淋巴组织(MALT)淋巴瘤的临床表现、影像学特点、诊断手段、治疗方法及预后,提高临床诊治水平.方法 回顾性分析4例经病理确诊的原发性肺MALT淋巴瘤的临床资料并随诊分析预后.结果 4例原发性肺MALT淋巴瘤患者均为老年女性,为原发性肺非霍奇金淋巴瘤的最常见类型.其中3例为查体发现,1例因咳嗽、咳痰和痰中带血就诊.发病时间为7个月至5年.肺部体征无特异性.血炎症指标和肿瘤相关指标多为正常.影像学以肿块影和结节为主要表现.患者肺通气和弥散功能正常.经胸腔镜、CT引导下肺穿刺、开胸手术获取病变组织而确诊.病理表现为弥漫浸润生长的小淋巴细胞,可见淋巴上皮增生.治疗主要是化疗和手术.随访1～8.8年,1例随访4.5年时可疑复发,其余3例均病情稳定.结论 肺原发性MALT淋巴瘤为少见病,好发于老年女性,起病隐匿,临床表现不典型.诊断须靠有经验的病理专家作出.治疗尚无指南,无症状者可采取“观察等待”策略,待肿瘤进展或出现症状时,首选苯丁酸氮芥化疗,联合利妥昔单抗与否均可.预后良好,但复发率高.     

不典型胰腺实性假乳头状瘤的影像学诊断及病理对照分析

目的分析不典型胰腺实性假乳头状瘤的影像学表现并与病理对照,探讨其诊断价值,就类似影像学表现的疾病进行鉴别诊断。方法选取77例胰腺实性假乳头状瘤患者,均行手术治疗,并经病理学和免疫组化分析。术前诊断为胰腺实性假乳头状瘤47例,胰腺囊肿7例,假性囊肿4例,胰腺脓肿5例,胰腺浆液性囊腺瘤7例,胰腺癌5例,胰腺血肿2例。对77例患者临床资料进行回顾性分析,比较其影像和病理学特点。结果 77例患者中男性29例,女性48例,年龄2~79岁,平均41.5岁。18例因触及上腹部包块就诊,12例有腹胀,47例无症状。查体：影像学检查发现胰腺或胰周占位性病变,44例为囊实性肿块,16例为单个囊性肿块,10例为实性肿块,7例为多个囊性肿块（囊〈3个）。肿瘤位于胰腺头部29个,体部25个,尾部17个,难以确定的部位6个（以胰尾部周围为主）。有或无完整包膜,不伴有胆总管和胰管扩张。病理特点为肿瘤实性部分由实性区、假乳头区及两者过渡区以不同比例混合而成。囊性区由坏死、液化组织及陈旧性出血组成。结论胰腺实性假乳头状瘤典型影像学表现为较大囊实性肿块,诊断比较容易,但对于表现为单个或多个囊性或单纯实性者,诊断需与有类似表现的胰腺其他疾病鉴别,特别对于老年患者需要与胰腺癌进行鉴别。影像学表现和病理学有一定特征,有助于诊断。     

基于CT分型方法的儿童肺结核临床特征分析

目的 分析儿童肺结核CT特征的临床特点。方法 回顾性分析首都医科大学附属北京儿童医院2006年7月至2014年12月经临床诊断并确诊为肺结核的734例患儿的临床资料(包括年龄、性别、临床表现,疫苗接种史、接触史及实验室检查等),基于CT分型对其CT特征、临床特点进行分析。结果 734例患儿中159例(21.7%)为经病原学检测确诊;CT分型中原发性肺结核和气管、支气管结核最多见(365例,50.4%),并发2种及以上类型者次之(199例,27.3%);3岁以下婴幼儿以原发性肺结核和气管、支气管结核多见(189例,26.1%), 7~14岁青春期儿童以结核性胸膜炎多见(94例,13.0%);并发肺外结核患者以结核性脑膜炎(109例,34.5%)及肺外播散累及2个及以上器官或组织者(103例,32.6%)最多见。192例(26.2%)患儿并发其他疾病或患有基础疾病。结论 不同年龄阶段患儿的肺结核CT分型不同,且常并发肺外结核;儿童肺结核CT表现有其自身特点及年龄分布特点。