主动脉窦瘤破入右心系统的MRI诊断及影像学比较（附23例分析）

目的 :探讨主动脉窦瘤破裂的MRI表现及其临床应用价值。材料和方法 :经手术证实的主动脉窦瘤破裂 2 3例 ,其中无冠状窦破入右心房 3例 ,右冠状窦破入右心房 4例、右心室 15例和肺动脉 1例。术前均行X线平片、超声心动图和MRI检查 ,9例行心血管造影检查。结果 :MRI正确诊断 19例。典型表现为窦壁信号中断 ,破裂处窦壁漂入相邻心腔 ,此征象亦为鉴别诊断的主要依据。结论 :MRI是诊断主动脉窦瘤破裂的有效方法 ,辅助超声心动图检查 ,可提高对该病的诊断水平。     

16排螺旋CT 诊断自发性结肠破裂的应用价值

目的：探讨16排螺旋C T在自发性结肠破裂中的诊断价值。方法回顾性分析经手术病理证实的12例自发性结肠破裂的CT影像资料及临床资料,采用16排螺旋CT扫描,3例急诊CT平扫,9例均行平扫加增强扫描,获得图像采用多种后处理技术。结果12例自发性结肠破裂C T表现为腹腔游离气体10例、肠系膜小气泡征5例、肠外粪块8例、破裂口显示3例、毗邻破裂口肠壁增厚水肿3例、弥漫性腹膜炎4例、破裂口周围局限性渗出9例、腹腔或腹膜后区积液5例。结论16排螺旋C T在诊断自发性结肠破裂上具有重要价值,为临床手术治疗提供有利依据。     

自发性食管破裂2例误诊报告

自发性食管破裂２例误诊报告江苏省扬中县人民医院放射科黄裕宏自发性食管破裂系指无原发病变，又无外伤、异物所致的食管破裂。临床较少见，起病急、病情重，容易与胸腹部病变相混淆，稍有疏忽，会造成误诊，我们误诊２例现报告如下，以吸取教训提高诊断准确性。１病例报...     

自发性肾破裂CT诊断价值

目的:探讨CT对自发性肾破裂诊断的价值。方法:经手术证实自发性肾破裂6例,对其CT表现作回顾性分析。结果:CT可以确定自发性肾破裂病因、血肿分布及形态以及显示破裂位置。结论:CT扫描简单迅速,对于大多数自发性肾出血能做出病因学诊断,为临床选择治疗方案提供重要依据。     

肝细胞癌自发性破裂出血CT诊断及病理基础

目的分析原发性肝细胞癌(HCC)自发性破裂出血的病理基础及CT特点。材料与方法对13例HCC自发性破裂出血的临床表现,病理基础及CT特点进行分析。结果HCC自发性破裂出血病理基础与HCC发生部位、类型,以及HCC自身病理,血液动力学有关,而癌肿内出血、包膜下出血以及腹腔内出血是HCC的CT特征。增强检查对明确肿瘤破裂出血颇有帮助。结论HCC自发性破裂出血的诊断需密切结合临床及CT特点。     

自发性食管破裂的诊断和外科治疗

目的:探讨自发性食管破裂的诊断和外科治疗效果。方法:回顾性分析1996-11～2012-06收治的15例食管破裂患者临床资料及治疗经过,14例行食管修补术。结果:1例于术前死于多脏器功能衰竭,1例术后出现食管胸膜瘘,13例恢复顺利。结论:早期诊断是提高治愈率的关键,手术治疗是自发性食管破裂的有效治疗方法。     

肝癌自发性破裂出血23例超声诊断分析

为探讨超声诊断肝癌患者中，癌肿自发性破裂出血的声像图表现，我们对1998—05—2004-01收住的23例肝癌自发性破裂出血患者进行了分析、讨论，现将结果报道如下。     

夜间急诊彩色多普勒超声诊断自发性膀胱破裂1例

尿潴留在老年患者中比较常见,但超声诊断自发性膀胱破裂并发腹膜炎在临床工作中比较罕见的。本文报告1例53岁男性患者,因下腹部疼痛伴无法排尿主诉入住我院泌尿外科住院部。住院前,在夜间急诊超声检查室进行灰度超声检查和彩色多普勒超声（彩超）检查,诊断为待查膀胱破裂、膀胱尿潴留、腹腔积液（大量）。住院后,患者经影像检查诊断为膀胱破裂可能,伴周围少量积血及积液,经过外科手术,术中发现膀胱右侧顶壁纵行破裂口长约6.0 mm,裂口与腹腔相通。本组病例超声诊断与手术结果相符。因此,彩超可以早期诊断自发性膀胱破裂,患者及早获得手术的机会,减少严重并发症的发生。     

肝细胞癌自发性破裂

肝细胞癌（hepatocellularcarcinomaHCC）自发性肝破裂是肝癌主要死亡原因之一。在日本及亚洲其他地区和非洲等高发地区HCC占其死亡率的10％～14．5％[1,2]。HCC一旦发生破裂出血如处理不及时或治疗不当死亡率几乎100％[3]。对HCC自发性破裂出血的早期诊断和预测比较困难，治疗效果较差，预后不佳。因此，提高HCC自发性破裂出血的早期诊断和选择最佳的治疗方案对延长患者生存期将十分重要。本文简述了其发生机理、诊断和早期预测价值及治疗等有关现状。1机理到目前为止，HCC自发性破裂出血的发生机理和肿瘤内部出血的部位尚属推测。…     

自发性食管破裂14例临床分析

目的总结自发性食管破裂的诊治经验。方法对14例自发性食管破裂患者行手术治疗11例,保守治疗3例。结果手术治疗组一期愈合8例,二期愈合2例;保守治疗组治愈1例,死亡3例。结论早期正确诊断和积极采用合适的手术方式,是成功治疗自发性食管破裂的关键。对延误诊断的病例,在病情允许时应采用手术治疗。     

MRI diagnosis of spontaneous uterine rupture of an unscarred uterus

Spontaneous uterine rupture is a rare, potentially catastrophic complication of pregnancy, and its prompt diagnosis and treatment are essential in limiting morbidity and mortality. Clinical diagnosis is difficult and relies heavily on diagnostic imaging. Radiological diagnosis is also often difficult with most documented cases involving the use of ultrasound and computed tomography. Although magnetic resonance imaging (MRI) is being used more frequently to assess patients, there are few reports illustrating the utility of MRI and its advantages over other imaging modalities in the diagnosis of uterine rupture. This report documents a case of spontaneous uterine rupture diagnosed by MRI in a postpartum patient with an unscarred uterus.     

Cardiac tamponade secondary to fulminant myocarditis - A case of custodial death

Cardiac tamponade following rupture of the heart occurs very rapidly, resulting in a fatal fall in the cardiac output and circulatory collapse. Spontaneous cardiac rupture is an uncommon occurrence and that too occurring secondary to myocarditis is a very rare event. Myocarditis is an inflammatory disease of the myocardium and its clinical presentation is highly variable. Due to its highly variable clinical presentation, the diagnosis is frequently made at autopsy. In this article, we report death of a prisoner due to cardiac tamponade following right ventricular rupture secondary to fulminant myocarditis.     

Pregnancy-unrelated spontaneous rupture of a right ovarian artery aneurysm

Spontaneous rupture of an ovarian artery aneurysm is extremely rare. It can lead to retroperitoneal hemorrhage that is often life-threatening. We report a case of pregnancy-unrelated spontaneous rupture of a right ovarian artery aneurysm in a multiparous woman. A 29-year-old woman, gravida 3, para 3, whose latest pregnancy involved uneventful gestation and delivery 2 years previously, was admitted for right flank pain. The urine test result for pregnancy was negative. Computed tomography revealed a large retroperitoneal hematoma and right ovarian artery aneurysm with contrast extravasation. After selective angiography, embolization of the right ovarian artery was successfully achieved using microcoils. Diagnostic angiography with subsequent transcatheter arterial embolization is an effective and less invasive technique for the management of ovarian artery aneurysm.     

Blunt trauma to the chest--a case of delayed cardiac rupture

Blunt traumatic cardiac rupture is a relatively uncommon diagnosis and is usually associated with a high mortality rate. A case of delayed cardiac rupture is described in an elderly person who sustained blunt chest trauma following a fall into a roadside ditch. In the case reported herein, the preliminary investigations at the time of admission did not show any evidence of haemopericardium. The patient deteriorated suddenly, possibly due to a delayed rupture of the right ventricle that was diagnosed postmortem. Acute cardiac tamponade resulting from rupture of the right ventricle is a serious and life threatening state. A high index of suspicion about the possibility of delayed cardiac rupture is required during the management of a case of polytrauma where significant cardiac findings can be masked by the presence of other injuries.     

Unexpected death due to spontaneous splenic rupture: A rare case in splenic angiosarcoma

Splenic angiosarcoma (SA) is a rare disease that can cause spontaneous splenic rupture leading to unexpected death. The rare incidence and non-specific clinical presentations made the early correct diagnosis of SA impossible in clinical practice. Even with medical intervention, 80% of patients died within 6 months after diagnosis. Here, we report a man who had complained of abdominal distension for 2 weeks and succumbed to the disease nine hours after admission. Diagnosis of hepatic and splenic angiosarcomas was based on post-mortem histopathological examination and immunohistochemistry, and the cause of death was hemorrhagic shock caused by spontaneous splenic rupture secondary to SA. This present case was the first forensic autopsy of spontaneous splenic rupture secondary to SA, which can highlight the diagnosis of rare diseases in forensic practice, and forensic pathologists should bear in mind these rare diseases even in routine practice.     

A case report,bilateral spontaneous pneumothorax as a late complication for SARS CoV-2 infection

The beta-coronavirus discovered in Wuhan in 2019 (COVID-19) provokes a series of affections from mild symptoms to life-threatening complications. There is evidence that associates the disease to spontaneous pneumothorax, however, the mechanism is unknown. The patient was a 45-year-old male with previous pneumonia due to COVID-19 who was attended the emergency department, where chest radiography was taken, confirming the diagnosis of right pneumothorax. However, the patient developed a new episode of pleuritic pain three days later, and a new radiograph showed left pneumothorax requiring a new chest tube. The simple tomography shows intraparenchymal bullae in the apical region of both lungs. The patient was kept under observation, and when improving, both endopleural chest drains were removed, and the patient was discharged. Spontaneous bilateral pneumothorax is a rare and potentially life-threatening complication. Identifying pulmonary bullae in patients with COVID-19 could be an early sign for these patients to develop spontaneous pneumothorax.     

Giant fistula between the right coronary artery and the left ventricle: diagnostic significance of right posterior oblique chest radiograph.

Congenital coronary artery fistulas are uncommon. The prevalence of coronary artery fistulas in adults has been estimated as 0.13% [1]. Most of these fistulas communicate with the right atrium or ventricle or with the pulmonary artery; those emptying into the left atrium or ventricle are quite rare [2, 3]. Usually, patients with coronary artery fistula do not have clinical symptoms, and their chest radiographs do not show the corresponding shadow because the fistula is hemodynamically insignificant. When the fistula is large, however, chest radiographs show the secondary hemodynamic changes, such as cardiac enlargement or increased pulmonary vasculature, depending on the emptying site. Moreover, the silhouette of the dilated tortuous vessel itself can be seen on the chest radiograph. We have examined four patients, each of whom had a giant fistula in the right coronary artery emptying into the left ventricle, proved by coronary angiography. In this essay, we illustrate the chest radiographs of these patients and describe the radiologic features that permit a specific diagnosis or suggest a coronary artery fistula.     

轮胎爆炸致食管破裂的手术治疗

目的 探讨轮胎爆炸致食管破裂的临床特点及误诊原因,提出防范措施.方法 对我院收治的1例轮胎爆炸伤致食管破裂患者的临床资料进行回顾性分析.结果 入院时检查右侧气胸,右肺压缩60%,左眼出血、左眼泪小管断裂,头颅CT示:蛛网膜下腔出血.急诊收住眼科治疗.胸科会诊放置胸腔闭式引流管处理.后出现液气胸,胸腔引流管中引流出浑浊胸水,行胸部CT检查明确诊断食管破裂.受伤后28 h转入胸外科,二期手术治疗痊愈出院.结论 轮胎爆炸致食管破裂比较罕见、少见,易误诊.首诊时要尽早行胸部CT、食管造影等检查,以尽早明确诊断,尽早手术治疗.     

Spontaneous splenic rupture during infection of cytomegalovirus. A case report

Splenic rupture is most commonly encountered after blunt abdominal trauma. Spontaneous atraumatic splenic rupture is a rare but dramatic occurrence that is most commonly attributed to infection or neoplasia. We report the case of a 27-year-old female patient without pathological history. Admitted to the emergency department for the sudden onset of left hypochondrial pain associated with vomiting, rapidly progressing to hypovolemic shock. She had reported an influenza-like illness a week earlier for which her COVID-19 PCR was negative. Emergency abdominal ultrasound and CT-scan revealed a ruptured spleen and widespread hemorrhagic fluid in the abdomen. Exploration revealed multiple ruptures in the spleen capsule. The patient underwent splenectomy with good clinical evolution. Despite the rarity of this condition, physicians should consider the diagnosis of spontaneous non traumatic splenic rupture when encountering healthy patients presenting with nonspecific left hypochondrial abdominal pain and hypovolemia. Mortality is essentially related to the delay in diagnosis and treatment and to the severity of the underlying pathology. Treatment often consists of splenectomy.     

Spontaneous splenic rupture

Spontaneous splenic rupture is a rare entity. It is usually associated with infectious, neoplastic, or hematologic diseases. Unlike traumatic splenic rupture, spontaneous rupture of the spleen is not often considered in the differential diagnosis of abdominal pain and can be easily confused with other abdominal pathology. Failure to consider splenic rupture can be catastrophic. We report a case of atraumatic splenic rupture in a patient with no underlying disease pathology. This illustrates the importance of keeping a broad differential in patients presenting with acute abdominal pain and should remind the physician to consider the diagnosis of spontaneous nontraumatic splenic rupture.