肠结核的临床影像诊断及与克罗恩病的鉴别诊断

结核病在全世界仍处在一个较高发病区间,是全世界的重大公共卫生问题。中国是占全球结核病总数2/3的8个国家中的一员,结核病防控形势依然严峻。肠结核多继发于肺结核,是腹部结核中最常见的一种,肠结核85%～90%位于回盲部,即位于回盲瓣及其相邻的回肠和结肠,其他发病部位依次为升结肠、空肠、横结肠等。肠结核一般起病缓慢,可表现为腹痛、腹部包块、腹泻与便秘等。影像学检查对肠结核诊断具有重要意义,尤其是腹部CT检查对了解肠道病变的内部结构、肠壁的浸润程度等均有较大价值;X线气钡双对比造影、PET/CT检查有一定的诊断意义,但临床上较少应用。腹部CT平扫,肠结核多表现为肠壁环形增厚、肠腔狭窄,可呈肠道跳跃性改变;CT增强扫描见病变段肠壁明显呈均匀强化,且有分层现象,表现为“靶征”和“双环征”。克罗恩病是一种原因不明的肠道炎症性疾病,亦好发于回肠及右半结肠,病变呈节段性、跳跃性改变。影像学和纤维肠镜检查发现,克罗恩病与肠结核两者黏膜溃疡不同,克罗恩病为多发纵横交错的线形溃疡,以纵行溃疡为特点,肠结核则以横行的、全周性的带状溃疡和星状溃疡为特点。克罗恩病与肠结核鉴别困难时需依靠病理检查,克罗恩病组织病理...     

成人肠套叠10例X线诊断体会

成人肠套叠临床较为少见，且多为继发性，可继发于肠息肉、肠肿瘤、美克尔憩室等。其影像学诊断方法主要依靠X线平片，钡餐造影，结肠双对比造影及CT检查。我院1994～2005年共收治成人肠套叠10例，现将其临床和X线资料进行回顾性分析，以提高对本病的认识和诊断水平。     

肠结核与克罗恩病的鉴别诊断

在诸多肠道炎症性病变中,肠结核和克罗恩病是两大重要的疾病,近年来两者的发病率均呈上升趋势。肠结核与克罗恩病的临床、影像学、内镜和病理学表现均十分相似。肺结核的存在和结核杆菌的发现有利于肠结核的诊断,但克罗恩病误诊为肠结核的概率仍很高。本文就这两种疾病的诊断和鉴别诊断作一综述。 一、诊断标准 1.肠结核:符合以下任何一项标准即可确诊:①肠壁或肠系膜淋巴结找到干酪样坏死性肉芽肿;②病变组织病理检查找到结核杆菌;③病变处取材培养结核杆菌阳性;④病变处取材动物接种有结核改变。一般病例根据临床症状、体征以及X线检查有典型结核改变、肠外找到结核灶和抗痨试验治疗6周病情有改善,便可作出临床诊断。     

CT诊断血吸虫病结肠病变9例

血吸虫病结肠病变的影像学检查既往多为X线结肠双对比造影，CT用于血吸虫病结肠病变检查的报道较少，我们总结9例经结肠镜活检病理证实或粪便虫卵阳性确诊的慢性血吸虫病结肠病变的CT资料，分析其对血吸虫病结肠病变的诊断价值。     

肠结核26例分析

目的通过对26例肠结核临床特点进行分析,提高对肠结核病的诊断能力。方法回顾性调查了肠结核病患者26例,分析结核病既往史、临床表现、辅助检查、组织病理学检查、药物及手术治疗情况。结果26．92％肠结核继发于肺结核;65．38％肠结核合并有肠外结核。除肺结核外尚有结核性胸膜炎、结核性腹膜炎、淋巴结结核、皮肤结核、肝结核等。合并小肠憩室2例。26例中,24例经腹部手术和病理组织学检查确诊。肠结核临床表现常无特异性,部分患者全身情况较好,无结核中毒症状,无伴发肠外结核病,易误诊、误治。结论临床医师应提高对肠结核病的判断力,重视对肺内、外结核病的检查,在急腹症的鉴别诊断中不能忽视肠结核。结肠镜检查加组织病理学检查及结核杆菌检查是确诊肠结核的较好方法,全消化道钡餐检查及钡灌肠检查、PPD试验对诊断有重要意义。     

89例X线胸片误诊肺结核的CT分析

目的探讨X线胸片误诊肺结核的原因及CT对肺结核的诊断价值。方法对X线胸片误诊而经临床确诊并具有完整临床、影像资料的肺结核病例89例进行X线胸片和CT对照回顾性分析。结果(1)X线胸片下肺叶病灶占44.9%,CT显示下叶基底段病灶最多,占32.0%。(2)胸部CT发现X线胸片漏检早期肺结核病灶11.8%、肺内隐匿部位病灶43.3%和早期粟粒性结核6例。(3)胸部CT对肺结核血行播散及支气管播散、支气管壁增厚、胸膜增厚及粘连、纵隔淋巴结肿大及钙化的显示率明显高于X线胸片。结论CT检查对肺结核诊断及鉴别诊断具有重要价值,建议在X线胸片诊断不明确时及时作CT检查。     

肺孤立性球形病灶的CT特征

肺孤立性球形病灶是胸部 X线常见的影像表现之一 ,多见于支气管肺癌、结核球、良性肿瘤及炎性病灶等。由于良、恶性病灶在 X线上缺乏特异性表现 ,故常导致误诊。CT是胸部X线平片的补充检查方法 ,特别是在肺内孤立结节的影像检查中 ,CT检查是最为有效的诊断技术。我们对 1996～ 2 0 0 0年经病理学确诊、CT检查显示为肺孤立性球形病灶患者的资料进行回顾性分析 ,旨在提高 CT检查对肺孤立性球形病灶的诊断水平。临床资料 :5 2例患者中 ,男 35例 ,女 17例 ;年龄 9～ 84岁 ,平均 4 3岁。经手术及病理学诊断为肺癌 19例 ,结核球 17例 ,良性肿…     

干燥综合征腮腺导管MRS与CT及X线造影对比研究

目的对比腮腺导管磁共振水成像(MRS)、CT造影与X线造影在诊断干燥综合征(SS)中的作用和价值。方法收集2011-01~2014-01共301例临床疑诊为SS患者的影像学检查资料,其中行磁共振水成像有65例,行CT造影有130例,行X线造影有106例。将磁共振、CT结果与X线腮腺导管造影结果进行对比研究,评价磁共振腮腺导管水成像诊断干燥综合症的应用价值。结果三种检查方法的敏感度、特异度、Youden指数分别为腮腺导管MRS 95%、80%、0.75,CT造影87.5%、80%、0.675,X线造影72%、90%、0.62。腮腺导管MRS、CT造影及X线造影的ROC曲线下面积分别为0.875、0.837、0.815。结论 SS腮腺导管MRS准确性高于传统X线造影,且为无创性检查,具有较高的临床应用价值。     

周围型肺癌X线与CT诊断的对比研究

目的探讨X线与CT诊断周围型肺癌的影像学特点。方法分析40例周围型肺癌患者的临床及影像学资料,对比X线与CT检查的影像学特点及检出率。结果除分叶征与胸水外,其它多种征象在两种影像学检查中表现出的差异均有统计学意义。两者结合对肺癌的检出率明显高于单独CT检查。结论 X线和CT诊断周围型肺癌各有其影像学特点,两者结合诊断准确率更高。     

胸部X线与螺旋CT对肺结核的诊断价值对比

目的比较胸部X线与螺旋CT对肺结核的诊断价值。方法选取2010年1月—2013年11月我院收治的肺结核患者126例,均行胸部X线和螺旋CT检查,比较两种检查方式的诊断正确率、病灶及空洞检出率,观察影像学特征。结果胸部X线诊断正确率、病灶检出率、空洞检出率均低于螺旋CT(P0.05)。胸部X线主要表现为病变密度不均匀,中心密度较高,螺旋CT可见高低混杂密度102例。结论螺旋CT检查能够提高肺结核诊断正确率,具有较高的临床应用价值。     

腹内淋巴结结核的影像学诊断

OBJECTIVE: To evaluate the value of X-ray imaging for diagnosing abdominal tuberculous lymphadenopathy. METHODS: 27 cases of tuberculous lymphadenopathy proved by clinical or pathohistological evidence were collected, all of which were examined with radiological imaging methods. RESULTS: The typical CT findings enlarged lymph nodes with peripheral or multilocular enhancement. Enlarged lymph nodes with multiple flecked or massive calcifications were important for diagnosis. Ultrasound examination showed enlarged lymph nodes with uniform echo (less than 2 cm) and with heterogeneous echo (larger than 2 cm). The aim of the barium meal examination of the gastrointestinal tract was to find tuberculous lymphadenopathy encroaching on intestine or merged with intestinal tuberculosis. Abdominal X-ray plain film was helpful to find the calcified tuberculous lymphadenopathy and intestinal obstruction. CONCLUSIONS: Various imaging methods have shown their diagnostic value, but CT was the most important tool for definite diagnosis of tuberculous lymphadenopathy. Ultrasound was more useful for follow-up cases.     

螺旋CT三期增强扫描在肾结核诊断和治疗中的价值

目的探讨螺旋CT三期增强扫描技术在肾结核诊断和疗效判定中的价值。方法对41例CT平扫怀疑肾结核的患者进行肾皮质期、实质期及延迟期三期增强扫描。结果皮质期及实质期扫描肾实质结核灶强化程度减低,呈不均匀低密度灶,并可见髓质脓腔,扩张肾盏呈“花瓣样”聚集排列,增厚肾盏壁强化;延迟期扫描对比剂进入扩张肾盏及髓质脓腔。结论螺旋CT三期增强扫描应作为肾结核诊断和疗效判定的常规检查方法。     

儿童十二指肠肠壁血肿3例

对上海市儿童医院3例临床怀疑为十二指肠肠壁血肿的患儿,通过GI、B超、CT平扫+增强,以及CT扫描随访检查,结合患儿病史,对影像学特点进行分析比较,发现GI、B超对十二指肠肠壁血肿诊断没有特异性,CT平扫+增强,以及CT扫描随访检查,在十二指肠肠壁血肿的诊断上具有很明显的特异性,结合病史可作为可靠的诊断依据.CT检查对于十二指肠肠壁血肿的诊断具有重要的临床价值.     

肾结核CT检查的临床意义

目的 探讨CT检查对肾结核患者的临床意义。方法 回顾性分析42例肾结核患者的CT及临床资料（其中16例有IVP结果）。结果 单侧肾结核34例，双侧8例，即患肾共50个。典型CT表现有肾实质内围绕肾盂排列的多个囊状低密度区相邻肾皮质变薄（34／50），肾盂输尿管管壁增厚及管腔扩张积水（22／50），肾实质钙化（8／50）。不典型表现有肾实质内单或多发直径小于1cm左右略低于密度结节（6／50）。30例增强CT扫描示，患肾有不同程度强化，其CT上升值在20－120HU之间。腹腔大量淋巴结钙化者2例；合并肝、脾结核4例；腰椎结核骨质破坏并椎旁肿肿6例；合并后腹壁结核脓肿1例。结论 CT检查不仅可用于肾结核的诊断，同时可明确患肾功能、破坏程度、患肾周围情况以及是否合并腹腔其它脏器结核，为临床提供更多更有价值的参考资料。     

多层螺旋CT与彩色多普勒超声检查辅助诊断骨与关节结核的对比研究

目的 对比多层螺旋CT检查(简称“CT检查”)与彩色多普勒超声检查(简称“超声检查”)辅助诊断骨与关节结核的效果。 方法 回顾性分析2015年1月至2019年12月解放军联勤保障部队第九二四医院经手术病理(9例)、细菌学检查(10例)及临床(4例)诊断为骨与关节结核的患者,共计23例。其中,单纯性骨结核12例,单纯性滑膜结核9例,全关节结核2例。所有患者均进行了CT检查与超声检查,对比分析两种检查技术对各型骨与关节结核的辅助诊断情况。 结果 CT检查诊断为骨与关节结核的正确诊断率为65.2%(15/23),超声检查诊断为骨与关节结核的正确诊断率为56.5%(13/23),两者比较差异无统计学意义(χ²=0.365,P=0.546)。对于单纯性骨结核患者的诊断,CT检查的正确诊断率(83.3%,10/12)明显高于超声检查(33.3%,4/12),差异有统计学意义(χ²=6.171,P=0.013);对于9例单纯性滑膜结核患者的诊断,超声检查正确诊断出8例,CT检查正确诊断出3例;对于2例全关节结核患者的诊断,CT检查均做出了正确诊断,超声检查正确诊断出1例。 结论 对于单纯性骨结核,CT检查的诊断正确率优于超声检查;但对于单纯性滑膜结核,超声检查的诊断正确率优于CT检查。     

Pitfalls in the diagnosis of intestinal tuberculosis: a case report

An 18-year-old long-term Norwegian resident of Somali origin was submitted to hospital with bloody diarrhoea, fever, weight loss and abdominal pain. On initial colonoscopy, colitis with segmental appearance was seen. Apart from a single polymerase chain reaction (PCR) from gastric aspirate staining, PCR and culture for acid-fast bacilli revealed negative results from the multiple samples taken including sputum, gastric fluid, stool, urine and intestinal mucosa. On physical examination and CT scan, there was no evidence of ascites, lymph node enlargement or pathologic pulmonary findings. Although the diagnosis was uncertain, tuberculostatic therapy was initiated. As the conformational testing of the PCR and the microbiological work-up remained negative and the patient's condition did not improve, tuberculostatic treatment was stopped and Crohn's disease was stated as the most likely diagnosis. Although the patient improved clinically under therapy with prednisolone, newly appearing fistulas deriving from the ascending colon were noted on follow-up. Thus tuberculostatic treatment was restarted. However, signs of an acute abdomen appeared and laparotomy was performed, thereby revealing a peritoneal spread of nodules. Resection of the ileum and ascending colon was performed. Diagnosis of intestinal tuberculosis with peritoneal spread was made by histology from resected bowel specimens showing caseating granulomas and a positive PCR result. The patient's condition improved after resection of the highly inflamed bowel segments and tuberculostatic therapy. Our case report shows the difficulty of proving intestinal tuberculosis by microbiological testing, macroscopic features on colonoscopy, histology, imaging such as CT scan and by empirical therapy. Therefore, in cases of colonic inflammation, where intestinal tuberculosis is an important differential diagnosis, a more aggressive diagnostic approach such as explorative laparoscopy should be considered.     

Diagnosis of miliary tuberculosis by cerebral computerized tomography.

We report a case of miliary tuberculosis with symptoms and signs of an intracranial mass. These were found to be multiple tuberculomas by computerized axial tomography (CT scan). We review the pathophysiologic features of intracranial tuberculomas. The CT scan allows a rapid and sensitive diagnosis of intracranial tuberculosis without utilizing invasive neurodiagnostic techniques. The value of using CT scans following treatment was confirmed.     

Duodenal duplication. Is ultrasound appearance enough to confirm the diagnosis?

A case of duodenal duplication is reported. It is a rare anomaly and is commonly discovered during infancy. Symptoms of partial obstruction dominate the clinical picture. Abdominal ultrasound (US) seems to be the best method to confirm the diagnosis especially when the two-layer pattern is present. In our case the radiological evaluation apart from US comprised plain film of the abdomen, upper gastrointestinal series and CT scan. The diagnosis of duodenal duplication made by US examination as well as by gastrointestinal series and CT scan was confirmed surgically. We consider that when at US the sign of two-layer pattern is present there is no need for further radiological evaluation for alimentary tract duplication.     

Pitfalls in the diagnosis of intestinal tuberculosis: A case report

An 18-year-old long-term Norwegian resident of Somali origin was submitted to hospital with bloody diarrhoea, fever, weight loss and abdominal pain. On initial colonoscopy, colitis with segmental appearance was seen. Apart from a single polymerase chain reaction (PCR) from gastric aspirate staining, PCR and culture for acid-fast bacilli revealed negative results from the multiple samples taken including sputum, gastric fluid, stool, urine and intestinal mucosa. On physical examination and CT scan, there was no evidence of ascites, lymph node enlargement or pathologic pulmonary findings. Although the diagnosis was uncertain, tuberculostatic therapy was initiated. As the conformational testing of the PCR and the microbiological work-up remained negative and the patient's condition did not improve, tuberculostatic treatment was stopped and Crohn's disease was stated as the most likely diagnosis. Although the patient improved clinically under therapy with prednisolone, newly appearing fistulas deriving from the ascending colon were noted on follow-up. Thus tuberculostatic treatment was restarted. However, signs of an acute abdomen appeared and laparotomy was performed, thereby revealing a peritoneal spread of nodules. Resection of the ileum and ascending colon was performed. Diagnosis of intestinal tuberculosis with peritoneal spread was made by histology from resected bowel specimens showing caseating granulomas and a positive PCR result. The patient's condition improved after resection of the highly inflamed bowel segments and tuberculostatic therapy. Our case report shows the difficulty of proving intestinal tuberculosis by microbiological testing, macroscopic features on colonoscopy, histology, imaging such as CT scan and by empirical therapy. Therefore, in cases of colonic inflammation, where intestinal tuberculosis is an important differential diagnosis, a more aggressive diagnostic approach such as explorative laparoscopy should be considered.     

胸部CT扫描显示簇状微结节样病灶对肺结核的诊断价值

目的 探讨胸部CT扫描显示簇状微结节样病灶对肺结核的诊断与鉴别诊断价值。方法 回顾性分析2016年1月至2019年8月北京胸科医院行CT扫描表现为簇状微结节样病灶并诊断明确的患者74例。其中70例患者经临床或实验室检查诊断为活动性肺结核,2例诊断为非特异性炎症,2例诊断为结节病。本研究重点分析其中70例诊断为肺结核患者的CT扫描特征,包括簇状微结节样病灶的分布部位、分布方式、形态特征,以及并存的肺内其他形态病变的CT征象。 结果 70例肺结核患者胸部CT扫描显示,簇状微结节样病灶分布于双肺上叶尖后段49例(70.0%),多发者49例(70.0%)。CT表现为均匀样、晕征样、反晕征样、混合存在等4种表现形式,分别占47.1%(33/70)、25.7%(18/70)、18.6%(13/70)及8.6%(6/70)。病灶内结节大小均匀29例(41.4%),大小不等、有融合41例(58.6%)。肺内簇状微结节样病灶之外,伴有其他肺野并存病灶表现为1种形态(实变、空洞、结节样病灶、纤维条索状病灶四种形态之一)者10例(14.3%),2种形态者15例(21.4%),3种形态者16例(22.9%),4种形态者6例(8.6%);纵隔和(或)肺门淋巴结肿大者14例(20.0%),胸腔积液9例(12.9%)。2例结节病和2例非特异性炎症也表现为簇状微结节样病灶,与肺结核的影像特征近似。结论 CT扫描表现为簇状微结节样病灶,无论是单发局限性或是多发性分布,均应首先考虑是继发性肺结核的一种较常见的不典型表现形式,值得重视。