CT诊断创伤性胸主动脉撕裂1例

患者男,31岁,主因"车祸后胸闷、胸痛5小时"入院.查体:痛苦表情,生命体征平稳,被动体位,左肺呼吸音减弱.X线胸片:左肺中、上野见10.0 cm大小的肿块,与纵隔分界不清,气管向右侧移位(图1).     

电子束CT在主动脉疾患诊断中的作用

目的:探讨电子束CT(EBCT)及其后处理技术在主动脉疾患诊断中的价值。方法:采用单层序列增强扫描(SSM)或连续容积增强扫描(CVS)方式行CT血管造影。三维重建方法分别采用最大密度投影法(MIP)、多层面或曲面重组法(MPR?CPR)、容积显示法(VRT)。CT仿真内窥镜技术(CTVE)用于显示血管内腔。结果:24例主动脉病变中,主动脉夹层16例,真性动脉瘤5例,假性动脉瘤3例。断层图像清晰显示主动脉夹层的内膜片、破口、分支动脉起源以及动脉瘤的形态、破口位置和瘤内血栓;三维重建技术可立体显示内膜片走行,主动脉全貌,动脉瘤大小、位置及其与周围组织关系;仿真内窥镜技术可动态观察血管内腔情况如破口、内膜片走行等。结论:EBCT诊断主动脉疾患尤其胸主动脉病变有重要价值,三维重建及仿真内窥镜图像对临床手术有重要指导作用。     

胸部急性钝性损伤CT表现

随着自动化交通工具使用的日益广泛,急诊胸部外伤、尤其是钝性外伤的发生率及其致死、致残率也明显升高[1].按照损伤由外向内的顺序,胸部损伤大致分为胸壁损伤、胸膜腔损伤、肺损伤、膈损伤及纵隔内损伤;其中纵隔内损伤又大致分为纵隔积气、气道损伤、血管损伤以及较少见的食管和心脏损伤等.     

闭合性腹部外伤致胰腺损伤的CT诊断

目的探讨胰腺损伤的CT表现,提高诊断的准确率。方法回顾性分析经手术和临床随访证实的15例闭合性腹部外伤致胰腺损伤患者CT平扫及增强时的表现。结果胰腺弥漫或局限性肿大9例,胰腺裂伤11例,胰腺断裂1例,胰腺局限性血肿8例,胰周被膜和肾周筋膜增厚以及胰周、肾旁间隙积液14例,假性囊肿4例。合并其他脏器损伤11例,其中脾挫裂伤7例,肝挫裂伤4例,肾挫裂伤4例,肠道及其系膜损伤5例。结论上腹部CT检查对胰腺损伤的早期诊断具有非常重要的参考价值。     

主动脉壁内血肿——一种不典型夹层的电子束CT诊断

目的:探讨主动脉壁内血肿(IMH)的电子束CT(EBCT)影像特征及对临床诊治的指导意义。方法:13例经EBCT连续容积增强扫描的主动脉IMH患者,综合分析其EBCT影像特征及临床特点。结果:EBCT所见IMH的直接征象:13例主动脉壁新月形或环形低密度增厚,无内膜片及真、假腔。7例血肿外缘轻度环状强化。血肿CT值60~108Hu。间接征象:穿透性溃疡征9例,钙化内移3例,主动脉壁粥样硬化8例,一侧或双侧胸腔积液7例(2例分别合并叶间裂或心包积液)。并发征象:动脉瘤2例,B型主动脉夹层1例。结论:EBCT是检出主动脉IMH的快速、无创检查方法,可清晰显示IMH的直接、间接征象及并发征象,对临床的诊治有重要的指导意义。     

CT征象诊断创伤性膈肌破裂

目的 探讨CT征象诊断创伤性膈肌破裂的价值。方法 回顾性分析256例可疑创伤性膈肌破裂的胸腹部损伤患者的资料,经手术证实膈肌破裂128例,膈肌无破裂128例。对所有患者术前均行CT检查,观察CT征象包括膈肌连续性中断或膈肌部分未显示、领口征、腹腔内容物进入胸腔、腹部内脏依靠、膈肌移位、膈肌增厚,计算各征象诊断创伤性膈肌破裂的敏感度和特异度。结果 膈肌连续性中断或部分未显示诊断创伤性膈肌破裂的敏感度和特异度分别为75.00%（96/128）和93.75%（120/128）,领口征为84.37%（108/128）和98.43%（126/128）,腹腔内容物进入胸腔为78.13%（100/128）和98.43%（126/128）,腹部内脏依靠为76.56%（98/128）和99.21%（127/128）,膈肌移位为54.68%（70/128）和93.75%（120/128）,膈肌增厚为46.87%（60/128）和84.38%（108/128）。MSCT征象综合诊断的敏感度为92.18%（118/128）,特异度为100%（128/128）。结论 MSCT征象对创伤性膈肌破裂有较高的诊断价值。     

成人腹部钝性损伤的CT平扫分析

目的评价CT平扫检查对成人腹部钝性损伤诊断价值及临床意义。方法对210例腹部钝性损伤的CT平扫进行分析总结。结果实质性器官损伤205例，肠道及系膜损伤4例。其中脾损伤147例，肝损伤34例，肾损伤10例，胰腺损伤1例。小肠、结肠破裂各1例。结论CT平扫是对腹部钝性损伤最有诊断价值的检查方法之一，且可对临床治疗方法的选择提供重要依据。     

主动脉夹层的多层螺旋CT诊断价值

目的探讨多层螺旋CT在主动脉夹层中的诊断价值。方法对57例主动脉夹层患者行多层螺旋CT平扫和增强扫描。原始图像在工作站行多平面图像重组（MPR）、曲面重组（CPR）和容积再现（VR）。结果按DeBakey分型,57例主动脉夹层表现为Ⅰ型20例,Ⅱ型7例,Ⅲ型30例。结论多层螺旋CT对主动脉夹层患者,是一种无创、安全、有效的诊断方法,具有重要临床应用价值。     

多层螺旋CT诊断不典型主动脉夹层

不典型主动脉夹层又称主动脉壁内血肿，是因主动脉内膜破溃或溃疡，血液进入主动脉壁中层内形成血肿．或由于主动脉中膜或外膜滋养血管破裂出血而形成。因无明显内膜破口，与真腔也无明显交通而命名。但可继续发展成为典型主动脉夹层或自行吸收，也被认为是一种变异的主动脉夹层及主动脉夹层的早期阶段，死亡率与典型主动脉夹层相似。因此、早期诊断对治疗及预后有重要意义。多层螺旋CT对不典型主动脉夹层的诊断有重要价值。现将我院收治的5例进行总结分析。     

64排螺旋CT诊断主动脉缩窄伴心脏畸形

目的 探讨64排螺旋CT在主动脉缩窄伴心脏畸形中的临床诊断价值. 方法 对15例主动脉缩窄患者进行64层螺旋CT扫描,采用容积再现(VR)、最大密度投影(MIP)、多平面重组(MRP)等三维重建. 结果 64排螺旋CT清晰显示15例主动脉缩窄,与手术结果一致;所有患者均为复杂畸形,其中合并动脉导管未闭6例、室间隔缺损6例(其中3例同时合并肺动脉高压)、主动脉瓣狭窄6例、继发心壁肥厚6例.VR明确显示主动脉缩窄的部位、长度和狭窄程度.64排螺旋CT在侧支循环及肺动脉显示方面明显优于心脏超声检查. 结论 64排螺旋CT可清晰显示主动脉缩窄的类型、范围、程度及合并的心脏畸形,可作为诊断主动脉缩窄首选.     

CT诊断肾损伤的应用研究

目的评价CT检查诊断急性肾损伤的应用价值及其临床意义。方法回顾性分析33例急性肾损伤的CT影像特征。结果Ⅰ型肾挫伤（肾内血肿）2例，Ⅱ型包膜下血肿11例，Ⅲ型严重肾损伤（肾横断或碎裂）14例，Ⅳ型单纯肾周血肿6例。结论CT检查迅速、安全，可明确诊断并确定肾损伤类型，为临床诊疗提供可靠依据，宜作为首选检查方法。     

胰腺钝伤的CT诊断(附4例报告)

目的探讨胰腺钝伤的CT诊断价值。方法回顺性分析经手术证实4例胰腺钝伤的CT表现及其特点。结果2例为胰腺离断CT表现为一条清楚分隔的低密度线,1例位于胰颈,1例位于胰尾,手术可见胰管断裂;弥漫性胰腺肿大1例,增强后强化不均匀;胰头局限性肿大1例;3例合并胰周积液,4例均合并邻近器官损伤。结论CT评价胰腺钝伤是准确可靠的,应列为首选检查方法。     

Penetrating and blunt cardiac trauma: Diagnosis and management

Cardiac trauma is often lethal in the field, but the majority of patients may be salvaged if they survive transport. Management of penetrating injury depends on rapid diagnosis of haemopericardium and prompt surgical repair. Identification of blunt injury is a diagnostic challenge, but most patients do well with appropriate monitoring and prompt recognition of complications. A review of diagnosis and management of penetrating and blunt cardiac injury is presented with extensive references.     

钝性肾损伤的CT表现及临床价值(附39例分析)

目的:评价肾损伤的CT表现及临床价值。方法:对39例钝性肾损伤病人进行CT检查并回顾性分析。结果:39例中肾包膜下血肿16例,肾内血肿10例,肾周血肿16例,肾撕裂1例。CT表现为肾实质高密度影,常伴有肾周积血,肾包膜下新月形影,同时伴有脾、肝、肋骨等复合性损伤。32例作保守治疗,7例手术治疗。结论:CT扫描能准确估计损伤范围、程度,为临床治疗提供重要的信息。     

Patency of cavopulmonary connection studied by single phase electron beam computed tomography

Purpose: The shunt patency and anatomic alteration of central PA after cavopulmonary connection was assessed by one phase electron-beam computed tomography (EBCT) Methods: Thirteen patients that received a bi-directional cavo-pulmonary shunt (BCPS, n = 7) or total cavo-pulmonary connection (TCPC, n = 6) were included. The patency of the shunt and the anatomy of intra-pericardial PA were evaluated by EBCT, and compared by angiography and echocardiography. Results: EBCT accurately evaluated shunt patency and the anatomy of the intra-pericardial PA, except for the incorrect diagnosis of SVC-PA shunt patency and peripheral pulmonary stenosis in two TCPC patients. Both of these patients had bilateral SVC and received either bilateral BCPS or ligation of the left SVC respectively. The baffle between the IVC and PA was partly opacified through a fenestration of the baffle, but was not opacified in two patients without fenestration. Conclusion: EBCT accurately evaluated shunt patency and the anatomy of central PA, however, the accuracy was limited in two cases with bilateral SVC. The opacification of the intra-atrial baffle was insufficient in TCPC cases. Multi-phase CT angiography may overcome this limitation in this patient subset.     

肺内单发的肺炎性假瘤CT诊断分析

目的 探讨肺炎性假瘤的CT表现及诊断价值。方法 分析8例经过手术或穿刺病理证实的肺炎性假瘤的CT表现进行回顾性分析。结果 肺炎性假瘤主要CT表现：（1）病变多位于胸膜下，可广基底，邻近胸膜可增厚；（2）6例呈球形，有完整假包膜者4例，边缘光整清晰。有部分假包膜者2例，部分边缘模糊。（3）2例呈不规则团块影，边缘有毛刺；1例肿块内可见小空洞形成。（4）病灶强化多较明显，其中5例CT值升高大于60HU，CT增强扫描有一定意义。（5）3例病灶周围有散在炎性浸润灶；（6）淋巴结肿大及胸腔积液少见。结论 肺癌、肺结核及肺炎性假瘤不易鉴别，要结合既往感染病史，重视CT增强扫描，注意动态随访，能够有助于肺炎性假瘤的诊断。穿刺活检是良好且有效的手段。     

Evaluation of the coronary venous system using electron beam computed tomography

New therapeutic strategies in interventional cardiology and electrophysiology involve the coronary veins. This study examines the potential usefulness of electron beam computed tomography to obtain detailed noninvasive definition of the coronary venous anatomy and of arteriovenous relationships. Electron beam computed tomography allows acquisition and three-dimensional reconstruction of tomographic images of the beating heart with high spatial and temporal resolution. Contrast-enhanced, thin-section electron beam computed tomographic coronary arteriographic images of 34 patients (21 men and 13 women, age 60 ± 10 years) were analyzed. The visibility of the coronary veins and their spatial relationship to the coronary arteries were assessed qualitatively on two- and three-dimensional displays. The coronary sinus was visible in 91%, the great cardiac vein in 100%, the middle cardiac vein in 88%, at least one vein overlying the lateral surface of the left ventricle in 97%, the anterior interventricular vein in 97%, and the small cardiac vein in 68%. A left marginal and a left posterior vein were seen in 44%, one of the two in 38%, and neither in 3%. The course of the anterior interventricular vein was parallel to the left anterior coronary artery in 79% and a crossover between the two vessels at an obtuse angle occurred in 12%. Contrast-enhanced electron beam computed tomography imaging of the heart noninvasively provides information on the coronary venous system and arteriovenous relationships that may help guide new interventional procedures.     

Frequency and follow-up of incidental findings on trauma computed tomography scans: experience at a level one trauma center

Objectives: Incidental findings found on computed tomography (CT) scan during the Emergency Department evaluation of trauma patients are often benign, but their presence must always be communicated to patients, who should be referred for follow-up care. Our objective was to quantify the frequency of these incidental CT findings in trauma patients. A secondary goal was to determine how often these lesions were communicated to patients and how often patients were referred for follow-up. Methods: We performed a retrospective chart review of 500 consecutive patients presenting as trauma activations. Subjects received head, chest, or abdomen/pelvis CT scans at our hospital. Patients were identified using our trauma registry. Final CT reports were examined and discharge summaries were reviewed for basic demographics. Scans with incidental findings prompted detailed secondary review of discharge summaries to determine follow-up. Investigators reviewed incidental findings and classified them into three groups by clinical importance, using predetermined criteria. Results: Of the 500 patient charts identified for review, 480 (96%) were available, yielding 1930 CT reports for analysis. Incidental findings were noted in 211 of 480 (43%) patients and on 285 (15%) of the 1930 CT studies performed for the 480 patients. Of available patient records, only 27% of patient charts had mention of the finding in the discharge summary, had documentation of an in-hospital workup, or had documentation of a referral for follow-up. Most-concerning lesions, such as suspected malignancies or aortic aneurysms, accounted for 15% of all incidental findings and were referred for follow-up in only 49% of cases. Conclusions: Incidental findings were noted in 15% of trauma CT scans. Follow-up was poor, even for potentially serious findings. Further studies should examine the long-term outcome of patients with these findings.