脐尿管癌的CT影像学分析

目的探讨脐尿管癌的CT表现特点及鉴别诊断要点。方法回顾性分析经病理证实的9例脐尿管癌及4例其他脐尿管病变患者的临床资料和CT表现。结果9例脐尿管癌患者的病变部位均在腹中线Retzius间隙脐尿管走行区,其中6例位于脐尿管膀胱交界区的膀胱顶壁或前壁,3例位于脐尿管上端。9例脐尿管癌中6例呈囊实性,3例为实性,4例可见病灶中心或周边斑点状钙化。增强扫描后均有不同程度强化。随诊复查腹膜转移者1例．肝转移者1例。结论脐尿管癌的CT表现具有特征性,CT扫描能提供较为准确的定位和定性。同时也是脐尿管癌术前明确诊断和鉴别诊断的重要措施之一。     

对比分析超声与CT诊断膀胱尿路上皮癌

目的比较超声与CT对膀胱尿路上皮癌的影像表现及诊断价值。方法选择45例膀胱尿路上皮癌患者,其中男性36例,女性9例;年龄27~83岁,平均年龄62.7岁。术前行超声和CT检查,分析其诊断结果。结果 45例膀胱尿路上皮癌中,超声检查发现43例,多表现为中等回声结节,回声较均匀,形态较规则,边缘较平滑,血液供应较丰富,超声诊断符合率为95.6%。45例膀胱尿路上皮癌行CT检查均发现病灶,多表现为膀胱壁较规则的乳头状突起,边缘较规整,36例行增强扫描均见较明显强化,CT诊断符合率为91.1%。结论超声和CT均为诊断膀胱癌的重要影像方法,而超声检查操作方便,无辐射,可作为首选检查方法。     

B超诊断卵巢巧克力囊肿及分型

分析了60例卵巢巧克力囊肿的超声显像特点,将其分为4种类型:①单纯囊肿型②均匀点状回声型③混合回声型④实体回声型,并提出与其它盆腔包块的鉴别要点,与手术病理相对照,其B超诊断符合率为65%,其中均匀点状回声型为94%,与其余3型对比差异有高度显著性(P<0.01)提示均匀点状回声型为卵巢巧克力囊肿的超声特征性图象.     

彩超对肝脏囊性病变的鉴别诊断价值分析

目的：探讨彩色多普勒超声对肝脏囊性病变鉴别诊断的价值。方法通过二维超声及彩色多普勒超声对临床和病理证实的16例肝脏囊性恶性肿瘤、19例肝脓肿和30例肝囊肿进行分析。根据声像图中病变的形态、囊壁厚度、病灶数目、囊内分隔、囊壁结节、血流信号的性质及部位、囊内回声等,对三种病态的患者的声像图进行比较评分。结果肝囊肿、肝脓肿及肝囊肿型恶性肿瘤的声像图变现出显著性差异(P<0.05)。肝脏囊性恶性肿瘤患者中,囊壁及囊壁结节、囊内分隔、囊壁或分隔内侧测定的血流信号和囊液透声性与其他两种病变患者比较存在显著性差异(P<0.05)。而在病灶形态、病灶数目和边界方面无显著性差异(P>0.05)。结论二维超声在肝脏囊性病变的鉴别诊断中起到一定作用,彩色多普勒超声在囊壁、分隔或乳头肌上的血流信号检测方面对肝脏囊性恶性肿瘤诊断有很高的特异性。     

B超诊断腹腔积液的临床价值——附282例分析

由各种原因所致的腹腔积液患者282例,男112例,女170例,平均年龄45.2岁。用岛津SDL—310型及日立EUB—305型超声显像仪进行检查,并对部分患者做了血清蛋白测定。结果表明,不同积液在超声下内部回声不同。肝硬化、心肾疾病、营养不良所致漏出液,暗区透声性好,内部光点回声少。癌性腹水暗区内出现散在或密集光点回声,内可有分隔粘连。62例肝硬化腹水胆囊壁全部增厚,80.6％患者呈双边影;癌性腹水54例中63％不增厚。血清白蛋白测定,32例(80％)肝硬化患者小于30s/L,35例(87.5％)呈A/G倒置,而癌性腹水中32例(82.1％)大于30g/L。作者认为结合临床对腹腔积液的成因进行探讨,可提高腹腔积液诊断的临床符合率。     

儿童甲状舌管囊肿合并感染超声图像分析

目的总结分析儿童甲状舌管囊肿(TDC)合并感染的超声图像特点,提高该病的诊断准确率。方法经病理组织检查证实的67例TDC合并感染的儿童患者,其中男性44例,女性23例;年龄2~13岁,中位年龄5.6岁。回顾性分析其超声图像,分别从病灶部位、大小、形态、边界、囊壁厚度、内部回声、后壁回声增强及彩色多普勒血流成像(CDFI)等方面总结该病图像特点。结果儿童TDC合并感染主要超声图像特点为厚壁或囊壁显示模糊多见,内部回声以混浊、伴粗光点、絮状回声及不均匀混合回声为主,多无后壁回声增强,CDFI于病灶囊壁间、病灶内部及周围组织可检出血流信号。结论儿童TDC合并感染有相对特异的超声图像特点,超声对该病可早期作出诊断及鉴别诊断,为临床医生提供有效可靠的诊疗依据。     

钼钯X线联合超声检查对乳腺癌的早期诊断价值探讨

目的旨在探讨钼钯X线联合超声检查对乳腺癌的早期诊断价值。方法选取我院2016年1月～2018年2月收治的64例乳腺癌患者作为研究对象,患者均进行钼钯及彩色多普勒超声检查,观察乳腺癌在钼钯及超声中的影像学表现特征,比较钼钯联合超声对乳腺癌的诊断符合率。结果超声对乳腺癌病灶诊断总符合率为83.37%,钼钯对乳腺癌病灶诊断总符合率为78.12%,两种单一检查方式诊断符合率比较差异无统计学意义(P0.05);超声+钼钯对乳腺癌诊断符合率为98.43%,明显高于单一检查方式(P0.05)。超声图像显示多数病灶外观形态不规则,边界模糊,内部回声低回声者41例;彩色多普勒图像中,92.18%乳腺癌患者均可检出血流信号,平均RI(0.73±0.16)。钼靶图像显示乳腺内可见片状、细小状钙化,多见"毛刺征"或放射状纠集改变。结论钼钯X线联合超声检查对乳腺癌的早期诊断符合率高,值得推广。     

超声检查在血吸虫肝病临床诊断中的应用及图像特征分析

目的:分析血吸虫肝病患者经超声检查后的临床诊断与图像特征情况.方法:回顾性分析2018年3月至2021年3月本院诊治血吸虫肝病78例患者的资料,收集患者超声检查图像,对影像学图像特征进行总结,对比不同肝实质回声分级、不同分期患者的超声表现.结果:超声检查对早期、中期、晚期不同级别血吸虫肝病诊断符合率分别为93.10％、97.14％、100.00％,超声检查对血吸虫肝病患者诊断总符合率为96.15％.超声检查特征:①在肝实质回声分级中,0级4例(5.12％),4例患者图像呈现肝实质回声大致正常.I级17例(21.79％)患者肝脏形态与大小未见明显变化,仅4例患者肝实质回声稍增强.II级45例(57.69％)患者图像主要表现为肝包膜变厚,肝实质回声增粗且分布不均匀.Ⅲ级12例(15.38％)图像主要表现为肝形态大小发生变化,右肝缩小,门静脉明显增宽.②早期患者肝包膜光滑,门静脉显、主干内径值正常.中期患者肝包膜线呈"细波浪状".晚期右叶肝脏体积缩小明显,门静脉增宽>12 mm.结论:不同肝实质回声分级、分期的血吸虫肝病患者超声影像学表现各有特征,临床可依据超声表现提高对血吸虫肝病的诊断符合率.     

甲状舌管囊肿的CT诊断价值

目的：探讨CT扫描在甲状舌管囊肿诊断中的价值。方法回顾性分析9例甲状舌管囊肿患者的CT表现。结果9例病例中,病灶位于舌骨上1例;位于舌骨水平层面2例;位于舌骨下6例;6例病灶位于颈前部正中,3例病灶偏向左侧。 CT平扫8例表现为圆形、卵圆形、不规则形囊性占位,囊壁光滑,边界清晰,囊内密度均匀;1例囊内可见分隔;增强扫描囊内无强化,囊壁及分隔可见强化。结论甲状舌管囊肿的CT表现具有特征性,CT扫描对甲状舌管囊肿的定性、定位诊断具有很大的价值。     

儿童甲状舌管囊肿合并感染超声图像分析简

目的总结分析儿童甲状舌管囊肿（TDC）合并感染的超声图像特点．提高该病的诊断准确率。方法经病理组织检查证实的67例TDC合并感染的儿童患者,其中男性44例,女性23例;年龄2～13岁,中位年龄5．6岁。回顾性分析其超声图像,分别从病灶部位、大小、形态、边界、囊壁厚度、内部回声、后壁回声增强及彩色多普勒血流成像（CDFI）等方面总结该病图像特点。结果儿童TDC合并感染主要超声图像特点为厚壁或囊壁显示模糊多见,内部回声以混浊、伴粗光点、絮状回声及不均匀混合回声为主,多无后壁回声增强,CDFI于病灶囊壁间、病灶内部及周围组织可检出血流信号。结论儿童TDC合并感染有相对特异的超声图像特点,超声对该病可早期作出诊断及鉴别诊断．为临床医生提供有效可靠的诊疗依据．     

Peritoneal mucinous cystadenocarcinoma of probable urachal origin: a challenging diagnosis

This report describes the case of a mucinous cystadenocarcinoma of probable urachal origin that presented with mass effect, precipitating deep venous thrombosis and pulmonary embolism. The patient presented with acute symptoms of leg swelling, pain and dyspnoea, and a vague awareness of lower abdominal distension. Computer tomography showed a cystic mass closely related to the anterior abdominal wall and the superior aspect of the bladder. A 1500 cm(3) cyst adherent to the dome of the urinary bladder was resected on laparotomy. Partial cystectomy was not carried out in the belief that the cyst represented a benign lesion. Subsequent imaging has shown cystic changes in the anterior bladder wall, and the patient has been referred for partial cystectomy.     

Urachal anomalies in children: a single center experience

The objective of this study is to define optimal diagnosis and treatment strategies for patients with urachal anomalies in the pediatric age group. The medical records of 21 children who had undergone surgery for urachal anomalies at Severance Hospital, Yonsei University College of Medicine from January 1990 to April 2005 were reviewed. The subjects included 14 males and 7 females (M:F 2:1). The four types of urachal anomalies confirmed were a urachal cyst in 10 patients (47.6%), a patent urachus in 6 (28.6%), a urachal sinus in 4 (19.0%) and a urachal diverticulum in 1 (4.8%) patient. The most common presenting complaint was umbilical discharge (n = 10, 40.0%), followed by abdominal mass (n = 9, 36.0%). Urachal anomalies were diagnosed by ultrasonography in 18 patients, and 7 of them were additionally examined by computed tomography. The remaining patients were diagnosed solely by surgical exploration. Excision was performed in all patients and was supplemented by partial cystectomy in three. Umbilical discharge was the most common clinical manifestation in our patients, suggesting that ultrasonography should be performed in patients with umbilical discharge to differentiate urachal anomalies. We found the most common anomaly to be the urachal cyst, and all patients were successfully treated by surgical excision.     

Fetal ascites. A report of 3 autopsy cases

Three rare autopsy cases of fetal ascites were presented and the etiology of each case was described. Case 1 was a male neonate, delivered by cesarean section at 32 weeks' gestation, and died of respiratory failure. The abdomen was remarkably distended with 1020 ml of ascites. The etiology of Case 1 remained unknown even after macroscopic and microscopic examinations. We considered this as "idiopathic" fetal ascites. Case 2 was a female neonate, delivered at 31 weeks' gestation, with marked abdominal distension and cyanosis. Autopsy revealed 435 ml of ascites, and she was considered to have had "polysplenia syndrome" with cardiovascular malformations. Intrauterine heart failure due to cardiac anomalies was thought to be the cause of this ascites. In case 3 embryotomy was carried out under the diagnosis of fetal ascites by ultrasound examination at 22 weeks' gestation. An urachal cyst connected to the dilated urinary bladder and deficiency of musculature of the abdominal wall composed of loose connective tissue with calcification were observed. The abdominal wall was ruptured and 1,960 ml of ascites was measured. Polycystic kidney with renal dysplasia was also found. Case 3 showed "Prune-Berry syndrome" and fetal ascites may have arisen from these anomalies.     

Treatment of infected urachal cysts

The urachus is a fibrous cord that arises from the anterior bladder wall and extends cranially to the umbilicus. Traditionally, infection has been treated using a two-stage procedure that includes an initial incision and drainage which is then followed by elective excision. More recently, it has been suggested that a single-stage excision with improved antibiotics is a safe option. Thus, we intended to compare the effects of the two-stage procedure and the single-stage excision. We performed a retrospective review on nine patients treated between May 1990 and September 2005. The methods used in diagnosis were ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), and cystoscopy. The study group was comprised of three males and six females with a mean age of 28.2 years (with a range from three to 71 years). Symptoms consisted of abdominal pain, abdominal mass, fever, and dysuria. The primary incision and drainage followed by a urachal remnant excision with a bladder cuff excision (two-stage procedure) was performed in four patients. The mean postoperative hospitalization lasted 5.8 days (with a range of three to seven days), and there were no reported complications. A primary excision of the infected urachal cyst and bladder cuff (single-stage excision) was performed in the other five patients. These patients had a mean postoperative hospitalization time of 9.2 days (with a range of four to 15 days), and complications included an enterocutaneous fistula, which required additional operative treatment. The best method of treating an infected urachal cyst remains a matter of debate. However, based on our results, the two-stage procedure is associated with a shorter hospital stay and no complications. Thus, when infection is extensive and severe, we suggest that the two-stage procedure offers a more effective treatment option.     

FETAL ASCITES A Report of 3 Autopsy Cases

Three rare autopsy cases of fetal ascites were presented and the etiology of each case was described. Case 1 was a male neonate, delivered by cesarean section at 32 weeks’gestation, and died of respiratory failure. The abdomen was remarkably distended with 1020 ml of ascites. The etiology of Case 1 remained unknown even after macroscopic and microscopic examinations. We considered this as “idiopathic” fetal ascites. Case 2 was a female neonate, delivered at 31 weeks’gestation, with marked abdominal distension and cyanosis. Autopsy revealed 435 ml of ascites, and she was considered to have had “polysplenia syndrome” with cardiovascular malformations. Intrauterine heart failure due to cardiac anomalies was thought to be the cause of this ascites. In case 3 embryotomy was carried out under the diagnosis of fetal ascites by ultrasound examination at 22 weeks’gestation. An urachal cyst connected to the dilated urinary bladder and deficiency of musculature of the abdominal wall composed of loose connective tissue with calcification were observed. The abdominal wall was ruptured and 1,960 ml of ascites was measured. Polycystic kidney with renal dysplasia was also found. Case 3 showed “Prune-Berry syndrome” and fetal ascites may have arisen from these anomalies.     

系统产前超声检查在胎儿先天性畸形中的应用

目的探讨中国医师协会超声医师分会公布的“产前超声检查指南”系统产前超声检查（Ⅲ级）胎儿畸形的应用价值,以此提高产前胎儿畸形的检出率。方法2912年10月至2014年2月间在我院接受胎儿系统检查的单胎孕妇521例。以“产前超声检查指南”为检查标准对胎儿进行系统超声检查：（1）对确诊的6大致死性胎儿畸形（产前诊断技术管理办法公布的无脑儿、脑膨出、开放性脊柱裂、胸腹壁缺损内脏外翻、单腔心及致死性软骨发育不全）建议临床终止妊娠;（2）对6大畸形以外的胎儿畸形进行跟踪随访;（3）对疑有染色体异常或难以确定的胎儿畸形病例进行转诊。结果521例单胎孕妇中检出致死性畸形5例（无脑儿I例,脑膨出2例,腹裂内脏外翻1例,单心室1例）,唇裂2例,唇腭裂1例,一侧肾积水2例,孤立性肾缺如1例,膈疝2例,肺囊腺瘤2例,单脐动脉2例,十二指肠闭锁2例,共计19例,其中漏诊和误诊各1例。结论“产前超声检查指南”临床应用,易于操作,遵循规范系统超声检查有利于提高胎儿畸形的检出率,避免漏诊率。     

Stage 0 mucinous adenocarcinoma in situ of the urachus.

Adenocarcinomas of the urinary bladder are rare (1-5% of bladder tumours) and of notoriously poor prognosis. About one third of such tumours arise in urachal remnants related to the bladder. This is believed to be the first report of in situ change in the urachal remnant. The patient presented with mucusuria and computed tomography showed a typical urachal cyst. After excision the cyst was found to contain mucinous adenomatous epithelium but without invasion of the basal lamina. Pathological stage is the best prognostic indicator in urachal tumours. Prompt investigation and management of mucusuria may allow the diagnosis of urachal tumours in this preinvasive stage.     

Mucinous adenocarcinoma arising in a giant urachal cyst associated with pseudomyxoma peritonei and stromal osseous metaplasia

An unusual urachal lesion, which Is a muclnous adenocarcinoma arising in a giant urachal cyst and is associated with pseudomyxoma peritonei and stromal osseous metaplasia of the cyst wall, was examlned in a 45-year-old male. m cyst was encapsulated, measured 22×20 ×20 cm and weighed 3800 g. The unilocular cavlty was filled with much. Most of the cystic cavity was lined with tall, slmple or stratifled columnar eplthellum wlth a focus of papillary provon into the cavity. These findings suggest that this cystic lesion represents cystadenoma rather than a simple cyst. Foci of lnvasive moderately differentiated mucinous adenocarclnoma were detected in the area of macroscopic papillary fronds. Carcinoembryonic antigen and CA19–9 were immunohistochemically positive for tumor cells and their serum levels were also elevated. Stromal dystrophic calcification was extensively observed In the cyst wall with focl of osseous metaplasia. Muclnous Implants, whlch histologically demonstrated adherent muclnous masses without epithellal components on the surface, were observed in the pelvic and abdominal cavity, lndicating pseudomyxoma peritonei.     

Urachal Cystadenoma with Abundant Glycogen: Ultrastructural Study

A cystadenoma arose in the urachus of a 32-year-old man. The mass was a multilocular cystic tumor filled with light yellow mucoid material. It was located in the anterior abdominal wall between the umbilicus and the dome of the urinary bladder. Overall, the mass was 14 cm × 8 cm × 5 cm, with the largest internal cyst being 6 cm in diameter. The lesion was characterized histologically by columnar cells with focal cellular and nuclear stratification. Ultrastructural examination revealed columnar cells with abundant glycogen, moderately pleomorphic microvilli without prominent filamentous cores, and apical mucin vacuoles. Nuclei had pleomorphic contours. An intact basal lamina was present. A similar urachal cystadenoma has not been described.