膈疝的CT诊断价值(附15例分析)

目的：探讨膈疝的CT诊断及其临床手术指导价值。方法：通过以横膈部位为中心行胸腹部螺旋CT扫描，获得理想的CT扫描图像，通过15例膈疝患者的扫描图像，结合临床综合分析。结果：膈上有疝囊15例，囊内有液平面13例，有小肠及结肠肠型的1例，有脂肪组织1例，胸腔内有积液2例。结论：CT检查对膈疝的诊断应当作为首选的检查方法，其不仅能对膈疝做出正确的诊断，而且，对临床手术指导具有重要的临床治疗意义。     

螺旋CT多平面重组在膈疝诊断中的价值

目的探讨膈的CT多平面重组(MPR)对膈疝诊断的价值及其临床意义。资料与方法对临床有相关提示或胸、腹部CT轴面图像疑为膈疝的病例同时进行MPR,对膈肌裂孔显示情况和不同成像方式测得膈肌裂孔左右径数值进行统计学分析。结果临床确诊食管裂孔疝15例、外伤性膈疝3例、膈膨升2例、腰肋三角疝2例、术后膈疝1例。比较CT轴面和MPR图像对膈疝的显示情况,并通过Wilcoxin秩和检验分析两者的差异,得出Wilcox-in为425.500,P<0.01,两者之间的差异有统计学意义。对于13例两种成像方式都能清楚显示膈疝的病例分别测量膈肌裂孔左右径,采用配对t检验分析CT轴位、MPR图像上测量膈肌裂孔左右径的差异,得出t=-6.307,P<0.001,两者之间的差异有统计学意义,MPR测量膈肌裂孔左右径更直观、准确。结论膈CT的MPR对于确诊各种类型的膈疝及其与相关疾病的鉴别有重要价值,对于临床处理途径和方式的选择有指导意义。     

螺旋CT三维重建对膈疝及膈膨升诊断及鉴别诊断的价值

目的 我院以老年病人为主,膈位置、形态异常多见,回顾48例膈疝及膈膨升CT扫描,轴位横断像及三维重建成像,旨在提高对膈疝、膈膨升的诊断及鉴别诊断的认识.方法 收集我院2012年1月～2013年7月诊断为膈疝及膈膨升的48例影像资料进行分析,总结影像表现,易误诊的假像及鉴别要点.结果 胸膜裂孔疝16例;食管裂孔疝12例;胸骨旁疝1例;左膈完全性膈膨升13例;左膈局限性膈膨升2例;右膈局限性膨升4例.结论 螺旋CT三维重建可多角度显示膈肌形态及有无缺口,对膈周围胸腔、腹腔密度分辨率高,可清晰分辨其毗邻结构,从而判断膈肌的完整性,是鉴别膈疝、膈膨升的关键.     

外伤性右膈疝的影像学诊断

目的 总结外伤性右膈疝的影像学诊断及价值.方法 对20例外伤性右膈疝患者行螺旋CT扫描、普通X线透视, 将前诊断结果与手术和临床随访结果进行对照.结果 右膈明显上抬,膈面模糊20例;右膈肌异常运动14例.右膈肌活动度减弱例;肝脏外形欠光整17例,分叶征11例,脐凹征8例;右膈肌脚增厚14例;疝囊、疝环9例;8例纵隔明显向左移位,6例右下肺实18例(90%)术后治愈,2例(10%)死亡.结论 螺旋CT扫描结合普通X线透视,对外伤性右膈疝损伤的诊断具有重要价值.     

64层螺旋CT多平面重组诊断创伤性膈疝1例

患者男性,65岁。汶川特大地震泥石流砸埋伤致全身多处疼痛及左下肢不能站立2天。2天前,患者在地震时被泥石流砸埋,3小时后被救出,感全身多处疼痛,尤以左前胸及右后背为重,咳嗽及吸气时加重,无昏迷,无气促。查体：全身多处擦伤,皮下淤血,无开放性伤口,左大腿肿胀畸形,胸廓对称无畸形,胸廓挤压征阳性。     

多层螺旋CT在创伤性膈疝诊断中的应用

目的 探讨多层螺旋CT多平面重组图像在创伤性膈疝诊断中的应用.方法 回顾性分析10例经手术证实的创伤性膈疝的多层螺旋CT表现,重点分析多平面重组图像特点.10例患者术前均行胸部正位片及多层螺旋CT检查.结果 8例X线有阳性发现,提示创伤性膈疝;而10例患者经多层螺旋CT多平面重组图像后矢状位、冠状位清晰可见膈肌连续性中断,并清晰显示裂口的位置、裂口的大小及疝入胸腔的内容物.全部病例均经手术治疗并痊愈.结论 多层螺旋CT多平面重组图像在创伤性膈疝中有重要价值,确诊后均应及时手术治疗.     

医源性膈疝MSCT多平面重组表现

目的 分析食管癌术后继发医源性膈疝(IDH)的MSCT多平面重组(MPR)表现,探讨其诊断价值.方法 回顾性分析2010年1月至2014年3月间食管癌术后继发IDH 16例.将其CT号随机混编入其他50例食管癌术后无食管裂孔(EH)扩大患者队列,由2名不知研究目的从事腹部影像诊断的高年资医师分别就横断位和MPR图像进行判断.对不同医师、不同方法判断结果及影像表现差异采用x2检验.结果 16例IDH中3例局限性于EH,横断位2例呈假“肠套叠”征,1例呈肠扭转表现;MPR直观显示肠管挤入EH顶压胸腔胃呈“壁贴壁征”.13例超出EH范围,横断位表现为胸腔内肠管于各方向汇聚于EH处胸腔胃,其中,前外、后外及前后外侧分别为9例、5例和2例,前外侧明显多于前后外侧(x2 =6.79,P＜0.05),2例并肠系膜扭转;MPR直观显示胸腔内管肠及其系膜血管通过EH与腹腔相应结构连通.由2名医师横断位提示IGH诊断分别为3例和4例,MPR全部提示IDH诊断,均显著高于横断位(x2=21.89,19.20,P值均＜0.05).结论 食管癌术后继发IDH横断位表现隐匿,仔细观察并及时辅以MPR,对诊断具有重要意义.     

成人Bochdalek疝的MSCT表现

目的：探讨成人Bochdalek疝的CT表现及诊断价值。方法：回顾性分析32例成人Bochdalek疝的CT资料。结果：32例中,单侧31例,左侧29例,右侧2例;双侧1例。3例胸部侧位片表现为后肋膈角区丘状影,1例胸部正位片表现为双侧横膈局限性膨隆,18例X线胸片阴性。CT表现为脊柱旁或后肋膈区的圆形、椭圆形或梭形脂肪密度肿块,边缘光滑,病灶向下延伸至膈下或腹膜后腔。结论：MSCT可清晰显示成人Bochdalek疝的发生部位和疝囊的形态、大小、密度及与腹腔脏器的关系,对诊断有重要意义。     

Helical CT amniography of congenital diaphragmatic hernia

OBJECTIVE: Accurate prenatal diagnosis of congenital diaphragmatic hernia is important for perinatal planning and potential fetal surgery. We describe the application and usefulness of helical CT amniography in the evaluation of suspected congenital diaphragmatic hernia in three fetuses. CONCLUSION: Helical CT amniography is an efficient means for evaluation of congenital diaphragmatic hernia. Accurate diagnosis was made in all three patients.     

In utero diagnosis of congenital diaphragmatic hernia by CT amniography

Congenital diaphragmatic hernia (CDH) was diagnosed using CT following intraamniotic contrast medium injection. Computed tomographic amniography may be helpful when the sonographic diagnosis of CDH is uncertain or prenatal surgical repair is being considered.     

CT diagnosis of delayed presentation of congenital diaphragmatic hernia simulating massive pleuropneumonia

A case of an 11-month-old infant with a delayed presentation of congenital diaphragmatic hernia is reported. Incarceration of the herniated colon caused a misleading appearance on the chest X-ray which was interpreted as massive pleuropneumonia. Computed tomography, performed because of continuing deterioration in the clinical condition, showed fluid-filled bowel loops in the chest and dilated bowel loops with air–fluid levels in the abdomen, suggesting the correct diagnosis. Received: 17 June 1998; Revision received: 8 September 1998; Accepted: 17 November 1998     

胎儿先天性膈疝MRI诊断的探讨

目的 探讨MRI在胎儿先天性膈疝诊断中的应用价值.方法 14名孕妇,孕龄16～39周.产前常规行超声(US)检查怀疑胎儿先天性膈疝后在24-48 h内行MR检查,采用二维快速平衡稳态采集(2D FIESTA)序列、单次激发快速自旋回波(SSFSE)序列以及快速反转恢复运动抑制(FIRM)序列,行胎儿颅脑、胸、腹部常规及胸腹部重点冠状面、矢状面及横断面扫描,将产前MRI、US表现与出生后影像表现或手术(13例胎儿)、引产后尸体解剖(1例胎儿)结果对照.结果 12例为单胎,2例为双胎之一.膈疝位于左侧12例,右侧2例.随访结果与产前MRI诊断完全一致,产前US误诊2例、漏诊2例.12例左侧疝中1例为左胸部被巨大结肠占据,1例仅整个胃泡疝入,5例仅部分肠管疝入,5例整个胃泡和部分肠管同时疝入;2例右侧疝中1例仅部分肠管疝入,1例为肝脏部分和部分肠管同时疝入.结论 MRI对胎儿先天性膈疝诊断具有较高的应用价值.     

Unusual late disclosure of left congenital diaphragmatic hernia

A posterolateral hernia through Bochdalek foramina was discovered in a 27 months old child under unusual circumstances. During lifting an heavy weight, migration occurred of the abdominal content through the foramina into the left thorax. The size of the pleuroperitoneal communication was well demonstrated by peritoneography. Possible rupture of a diaphragmatic relaxation was eliminated on findings at surgery. Reconstructive surgery led to an uneventful recovery which is the rule in this type of late-discovered hernia.     

Evaluation of pulmonary hypoplasia with congenital diaphragmatic hernia

Congenital diaphragmatic hernia (CDH) is a developmental defect of the diaphragm with herniation of abdominal viscera into the thorax. The morbidity and mortality in cases is caused primarily by pulmonary hypoplasia. A prenatal diagnosis of CDH can be established by ultrasound, but ultrasound cannot detect pulmonary hypoplasia with certainty. We evaluated pulmonary hypoplasia by the simple method of lung intensity. The subjects were eight fetuses. In four fetuses, the lungs showed low intensity, and these fetuses all had pulmonary hypoplasia. Two of the four fetuses with high intensity showed a good prognosis, however, the other two fetuses did not. One of the two cases with poor prognosis had complex congenital heart disease, and the other died of sepsis and pulmonary hypertension. A high signal did not always promise a favorable prognosis, probably because accompanying abnormalities dominated the prognosis. MR assessment of lung intensity in fetuses with CDH may be useful in evaluating the severity of pulmonary hypoplasia. Low signal of the lung may reflect pulmonary hypoplasia and suggests a poor prognosis.