Intramural hematoma of the esophagus: a pictorial essay

Intramural hematoma of the esophagus (IHE) is a rare but well-documented condition that is part of the spectrum of esophageal injuries which includes the more common Mallory–Weiss tear and Boerhaave’s syndrome. Acute retrosternal or epigastric pain is a common clinical feature, which can be accompanied by dysphagia, odynophagia, or hematemesis. An early differentiation from Mallory–Weiss tear, Boerhaave syndrome, ruptured aortic aneurysm, aortic dissection, acute myocardial infarction, or pulmonary pathology can be difficult. Computed tomography (CT) is the imaging modality of choice and characteristically reveals a concentric or eccentric thickening of the esophageal wall with well-defined borders and variable degree of obliteration of the lumen. Measurement of the attenuation values within the lesion will reveal blood density which varies according to the age of the hematoma. CT should be considered the preferred diagnostic technique, thereby facilitating proper clinical management. Early diagnosis is crucial as most patients maybe treated conservatively with good outcome.     

多层螺旋CT对食管壁内血肿的诊断价值

目的通过分析食管壁内血肿的CT征象,提高CT对该疾病的诊断准确性。方法收集并回顾性分析我院2007年7月至2011年6月经临床随访证实为食管壁内血肿的15例患者的临床及CT资料。结果在CT像上食管壁内血肿11例表现为管壁偏心性增厚,4例表现为同心圆形增厚,管腔狭窄;5例食管壁内血肿患者病变范围累及食管下段,10例累及食管中下段。结论多层螺旋CT在评价食管壁内血肿的形态、严重程度及累及范围方面具有重要价值。     

Periaortic lymphoma as a mimic of posttraumatic intramural hematoma

Computed tomography (CT) of an 87-year-old man who presented to the emergency department with chest pain after a motor vehicle collision demonstrated multiple broken ribs and a thoracic periaortic soft tissue mass which was high density on precontrast images and enhanced postcontrast. The scan also demonstrated a mass encircling the left ureter and masses in the axilla and pelvis. The enhancement of the periaortic lesion and the presence of the additional soft tissue masses suggested lymphoma as opposed to intramural hematoma (IMH). The diagnosis of follicular B-cell lymphoma was rapidly confirmed with fluorodeoxyglucose-positron emission tomography/CT and excisional biopsy of the axillary lymph node. While this is an atypical presentation, lymphoma and other extravascular pathology must be considered in the evaluation of a periaortic high attenuation mass seen on CT.     

主动脉壁内血肿的64层螺旋CT诊断价值

目的：评价64层螺旋CT对主动脉壁内血肿的价值及优势。方法：采用64层螺旋CT,连续容积增强扫描,对32例主诉急性胸背痛患者行CT检查并诊断为壁内血肿。结果：32例按Stanford分型：A型8例,B型24例。其直接征象：沿主动脉壁的环形或新月形低密度影,无撕裂的内膜片。间接征象：钙化的动脉壁内移10例,溃疡18例,主动脉粥样硬化改变8例。并发胸腔积液3例。结论：螺旋CT血管成像技术可以在无创或微创的情况下清晰地显示壁内血肿,为临床诊断和治疗提供有价值的依据。     

自发性冠状动脉壁内血肿致急性心肌梗死诊治1例

临床资料 患者,女,58岁.因“突发性持续性胸痛1h”就诊,既往有高血压史,无吸烟、肥胖、糖尿病史,无早发冠状动脉(冠脉)疾病家族史.查体:心率79次/min,血压150/80 mmHg.     

食管手术后的X线造影检查(附70例报告)

目的：探讨食管手术后的复查机，对比剂和体位的选择。方法：回顾性总结70例食管手术后X线造影复查的表现和结果。结果：15例术后7－9d内复查，发现吻合口瘘4例；50例术后10－15d复查，吻合口瘘2例，吻合口狭窄2例；5例术后15天－2个月内复查，吻合狭窄2例。此外，还发现其它合并症5例。结论：食管手术后，近期造影复查，应从碘剂开始，尔后过渡到钡剂，并应多体位观察，摄片，以便观察临床疗效，对术后并发症及早发现。     

带膜可回收支架置入治疗自发性食管破裂（附8例报告）

目的：探讨带膜支架置入治疗自发性食管破裂。方法：8例自发性食管破裂患者均先放置胸腔闭式引流,冲洗胸腔,通过导丝经口置入带膜可回收支架,经口进食,每天经胸腔引流管冲洗胸腔,5-7 d拔除胸引管及鼻腔冲洗管,1个月后取出支架。结果：全部病例支架均置入成功,恢复正常进食,1个月后取出支架,正常进食结论：带膜支架置入治疗食管自发性破裂安全有效的方法,其疗效确切,宜在临床上推广使用。     

MSCT及其后处理技术在主动脉壁内血肿诊断中的应用

目的:探讨MSCT及其后处理技术在主动脉壁内血肿(IMH)诊断中的应用价值。方法:采用GE 16层螺旋CT对11例AIH患者行平扫和CTA扫描。将采集的薄层数据在AW4.3工作站上行MPR和VR重建。结果:A型IMH 3例,B型IMH 8例。MSCT主要征象为:11例主动脉壁新月形或环形增厚大于5mm,呈等密度或高密度,无内膜片撕裂及真、假两腔形成;主动脉粥样硬化7例;内膜钙化内移4例;内膜渗漏3例;穿透性溃疡3例。结论:MSCT结合MPR和VR重建技术能准确、直观地显示IMH的范围和其它并发征象,对临床诊断和治疗有重要的指导意义。     

Predictive value of small ulcers in the evolution of acute type B intramural hematoma

Objective

To assess the long-term evolution and predictive factors of type B intramural hematoma (IMH).

Material and methods

34 patients (33 men), mean age: 67 years (47–87) diagnosed with type B IMH by computed tomography (CT) and followed up clinically and by CT yearly. Mean follow-up was 5.9 years (2–13 years). Two evolution patterns were considered: (a) regression and (b) progression. Clinical and imaging variables were analyzed for assessing their predictor values.

Results

Evolution at one year was to regression in 56% and to progression in 44% of cases. There were no association among age, sex, other aortic abnormalities, presence of atherosclerotic disease or blood pressure, initial maximum aortic diameter, indexed maximum aortic diameter, IMH thickness or length, presence or absence of mediastinal hematoma and the evolution of type B IMH. Ten patients had small aortic ulcers in the acute phase. The presence of ulcers was related with progression of IMH. No differences were observed in evolution between the control at first year and the last control.

Conclusions

The presence of small ulcers is a strong predictor of evolution in acute type B IMH. In addition, the regression group remains completely stable after the first year of evolution.     

多层螺旋CT血管成像在主动脉壁间血肿的临床应用

目的探讨主动脉壁间血肿（IMH）MSCT表现和诊断价值。方法10例经多层螺旋CT诊断及临床证实的IMH,男6例,女4例。使用16层螺旋CT检查,应用多平面重建、最大密度投影和容积成像等后处理方法显示壁间血肿及穿透性溃疡。结果10例IMH中,A型2例,B型8例,其中2例局限于胸主动脉,6例累及胸腹主动脉（止于肾动脉上方2例,髂总动脉分叉上方2例,2例累及双侧髂总动脉）。MSCT表现为主动脉腔内新月形或环形充盈缺损,内壁较光整,钙化内膜片内移及局灶性尖角样穿透溃疡形成,主动脉腔内无明确内膜片显示。结论多层螺旋CT能为主动脉壁间血肿的诊断、鉴别诊断和治疗提供准确的信息。     

单纯性主动脉壁内血肿的16层CT表现(附4例分析)

目的:探讨单纯性主动脉壁内血肿(intramural hematoma,IMH)的16层CT检查方法和影像表现。方法:4例单纯性IMH患者行16层螺旋CT平扫与增强扫描,使用心电门控,1例加扫静脉期。重组方法包括MPR、MIP和VR。结果:4例单纯性IMH均为B型。主要CT表现:主动脉壁呈半月形或环形增厚,CT平扫呈高密度,增强后无强化,1例静脉期强化;内膜钙化内移位2例;2例内膜多处渗漏。MPR、薄层MIP清晰显示血肿部位、厚度、累及范围及有无并发症。2例单纯性IMH采用内科保守治疗。2例IMH腔内隔绝术。结论:单纯性IMH的16层CT检查应包括平扫与双期增强。CT检查有助于单纯性IMH分型,具有重要的临床应用价值。     

急性主动脉壁间血肿的多层螺旋CT血管造影影像学表现和诊断价值

目的探讨急性主动脉壁间血肿（AAIH）的多层螺旋CT血管造影（MSCTA）影像学特征和临床应用价值。方法回顾性分析临床确诊76例AAIH患者的主动脉MSCTA检查资料,依据Stanford分型分为A型和B型,比较不同Stanford分型AAIH的影像学表现有无差异。根据患者随访期间的不同变化分为进展组与稳定和缓解组,分析进展的相关因素。所有结果均行统计学分析,符合正态分布的定量资料采用两独立样本t检验;不符合正态分布的定量资料采用Mann-Whitney U检验。定性资料采用χ2检验。结果Stanford A型27例（35.5%）、B型49例（64.5%）。A型、B型壁间血肿最大厚度、溃疡类病变、局灶性强化、胸腔积液上的差异均无统计学意义（Z=-0.788、χ2=0.441、χ2=0.383、χ2=0.338,均P > 0.05）。A型、B型溃疡类病变的深度分别为（2.8±2.9）mm、（2.5±3.3）mm,差异有统计学意义（Z=-2.345,P=0.019）。心包积液15例（19.7%）,A型12例多于B型3例,差异有统计学意义（χ2=16.138,P < 0.001）。41例AAIH患者短期随访,进展组20例,稳定和缓解组21例。单因素分析显示,进展组与稳定和缓解组在溃疡类病变、溃疡深度、胸腔积液间的差异均具有统计学意义（χ2=9.227、Z=-2.689、χ2=4.111,均P < 0.05）;在Stanford分型、壁间血肿厚度、局灶性强化、心包积液上的差异均无统计学意义（χ2=1.453、Z=-0.874、χ2=0.006、χ2=1.733,均P > 0.05）。将单因素分析中有统计学意义的指标纳入多因素Logistic回归分析,显示溃疡类病变是影响AAIH的独立危险预测因子。结论AAIH在MSCTA上表现为平扫密度较高、增强无强化的环形或新月形增厚主动脉管壁。MSCTA检查可以对AAIH做出快速、准确诊断。溃疡性病变是影响AAIH进展的独立危险因素。AAIH早期需要密切随访,监测有无进展。     

体部自发性血肿的CT和MRI表现

目的探讨体部自发性血肿的CT和MRI表现,以期提高对该病的认识。方法回顾性分析15例经病理证实的体部自发性血肿的CT和MRI表现。结果 15例均为单发,右锁骨上1例,上腹部1例,胃底部1例,中腹部1例,肾包膜下2例,肾上腺3例,盆腔2例,腹壁1例,会阴1例,大腿1例,小腿1例。肿块形态12例呈椭圆形或类圆形,2例呈长梭形,1例呈不规则形。所有病灶边界均清晰。CT平扫呈稍高密度4例,低密度3例,混杂密度4例,2例内部见小钙化灶。T1WI低-等信号2例,高信号3例,混杂信号2例;T2WI低-等信号3例,高信号2例,混杂信号2例。增强扫描所有病灶中心无强化,6例边缘出现强化。CT诊断准确率54.5%,MRI诊断准确率87.5%。结论体部自发性血肿的影像表现有一定特点,MRI对该病的诊断准确性高于CT。     

主动脉壁内血肿的影像学诊断及鉴别诊断

目的：探讨主动脉壁内血肿的影像学诊断和鉴别诊断。方法：回顾性分析16例经临床及CT和MRI诊断的主动脉壁内血肿及5例可疑壁内血肿患者的病例资料。12例因胸痛或腹痛入院、经CT或MRI扫描时发现,4例为外伤或内科疾病行胸部或腹部检查时意外发现;另外搜集18例主动脉夹层及11例主动脉瘤患者的影像学资料。结果：16例主动脉壁内血肿,表现为主动脉壁环形增厚7例,新月形增厚5例,环形和新月形增厚同时存在或不规则增厚4例,腔内无内膜片及真假两腔形成,增厚的血管壁内无对比剂进入。5例可疑主动脉壁内血肿表现为管壁轻度环形增厚。18例主动脉夹层均可见真假两腔及内膜片,其中14例其真假腔在横轴面图像上表现为＂D＂字形或反＂D＂字形,真假两腔内均有对比剂进入;11例主动脉瘤表现为血管瘤样扩张或梭形扩张,无真假两腔和内膜片,其中8例可见附壁血栓。结论：CT平扫及增强扫描结合图像后处理技术及MRI多方位成像能够诊断较为典型的主动脉壁内血肿,并与主动脉其它常见疾病相鉴别。     

CT联合MRI在华法林致非创伤性自发性小肠壁内血肿的临床应用

目的探讨CT联合MRI在华法林致非创伤性自发性小肠壁内血肿的临床应用。方法选取14例华法林致非创伤性自发性小肠壁内血肿患者的临床资料,分析影像学表现。结果本组14例患者CT原发征象:1)肠壁增厚;2)肠壁密度增高。CT继发征象:1)肠腔狭窄;2)肠壁积气;3)肠周改变及其他伴发征象。MRI表现:T+1黏膜下层高信号,T+2信号不同程度增高,DWI呈弥漫高或稍高信号,T₂^*呈低信号。治疗情况:未经正确治疗的3例复查均表现为原征象无改善或加重。正确治疗的11例复查,10例原征象减轻或消失。结论对正在接受抗凝治疗的患者,突发腹痛伴凝血功能异常,CT显示肠壁增厚及密度增高、腹腔积血,伴肠腔狭窄、肠梗阻、肠周和肠系膜区积血,高度提示本病可能,MRI上T₁WI呈同心环或弹簧样高信号,DWI呈弥漫高信号,T₂^*呈低信号。     

IgG4 aortitis of the ascending thoracic aorta: A case report and literature review

IgG4 aortitis is a recently recognized entity that can have clinical and imaging features that mimic acute aortic syndrome. Therefore, it is imperative for radiologists to be aware of how to potentially differentiate the two. Although this entity has been previously described via case reports and meta-analysis in the context of inflammatory abdominal aortic aneurysm, very few cases of ascending aortic involvement have been reported. In this case report, we present a case of a 60-year-old female transferred from another facility for an initial diagnosis of intramural hematoma of the ascending aorta and later found to have IgG4 aortitis post aortic root repair. This is a histologically confirmed case of multi-segmented IgG4 aortitis with rare involvement of both ascending and infra-renal aorta. We will briefly discuss the pathophysiology of IgG4 aortitis, along with review of literature.     

Revisiting the canonical definition of heat hematoma: A rare case of postmortem subdural heat hematoma

Heat hematoma is generally recognized as a postmortem heat-induced artifact in extradural spaces found in burned bodies. Conversely, subdural hematoma in charred bodies is more indicative of antemortem trauma. Here, we present a rare case of a subdural heat hematoma in forensic practice. The subdural hematoma was found in a charred body that was determined to be dead before the fire without findings of antemortem head injury. Furthermore, the detailed determination and formation mechanism of this subdural heat hematoma are discussed. With this rare case, we propose a reconsideration of the canonical definition of heat hematoma. This report envisions benefitting forensic pathologists facing similar cases.     

Spontaneous retroperitoneal hematoma induced by vitamin K antagonist therapy: A case report

Vitamin K antagonists (VKA) are recommended in patients with mechanical heart valves. Major bleeding events remain the most life-threatening complication of this therapy and sometimes it can occur in unusual anatomic areas. Spontaneous retroperitoneal hematoma is one of the rare complications of anticoagulation therapy, which needs to be recognized early and managed promptly. Here, we report a case of a 40-year-old woman with mechanical heart valve treated with acenocoumarol, who was admitted to the emergency department with abdominal pain and whose investigations came back in favor of a massive retroperitoneal hematoma. The patient was successfully treated through conservative management resulting in a good outcome. Clinicians should be careful when prescribing VKA and should always think of retroperitoneal bleeding in the event of abdominal pain or a sudden decrease in the hemoglobin levels of anticoagulated patients.     

华法林过量引起自发性小肠壁内血肿的CT表现及其临床价值

目的 探讨华法林过量引起自发性小肠壁内血肿的MSCT表现及其诊断价值.方法 回顾性分析经临床确诊的6例自发性小肠壁内血肿的MSCT表现,其中5例行全腹增强CT扫描.结果 6例均出现单发弥漫性肠壁环形增厚,其中空、回肠各3例;3例表现为肠壁全层密度增高,另3例表现为肠壁黏膜下层密度增高;增强扫描可见“靶征”;1例出现小肠肠壁积气;6例均伴有肠腔狭窄、腹腔积血,均出现受累小肠周围及相应肠系膜区密度增高,其中3例并发肠梗阻.结论 对于正在接受华法林抗凝治疗的患者,突发腹痛伴凝血功能异常,且有典型的CT表现,应高度警惕自发性小肠壁内血肿的可能.早期诊断对患者的治疗及预后有很重要的临床意义.