特发性肠系膜静脉硬化性肠炎1 例及文献回顾

特发性肠系膜静脉硬化性肠炎在临床上十分罕见,通常以反复腹痛、腹胀、呕吐等肠梗阻症状多见,极 易误诊。患者肠系膜断层扫描可见其典型的肠管周围沿血管走行的条索状高密度影,并可见血管钙化影,M-NBI肠 镜可见蜂窝状的毛细血管网消失,微血管结构紊乱,血管密度增加。     

Recurrent abdominal pain in a woman with a wandering spleen

A 28-year-old Malay woman presented with recurrent abdominal pain for five years. She had delivered her child seven months earlier. She was found to have bicytopenia, with a haemoglobin level of 7.9 g/dL and a platelet count of 85 x 10(9)/L. Computed tomography revealed a wandering spleen. Complications of a wandering spleen, for which splenectomy is advocated, include functional asplenia (due to torsion of the splenic pedicle), splenic infarction or splenic vessel thrombosis. A splenectomy was performed and at operation, splenomegaly with a long mesentery was found. Splenic histology was negative for malignancy. The bicytopenia resolved postoperatively, and she remains well.     

Clinics in diagnostic imaging (117)

A 76-year-old woman presented with a five-day history of fever and abdominal pain. Her urine culture grew Candida albicans. She was treated with intravenous antibiotics, as having a urinary tract infection, but her fever persisted. Computed tomography of the abdomen showed a cystic mass at the pancreatic head and uncinate process with peripancreatic lymph nodes. Given the patientos high operative risk and her clinical picture favouring sepsis, endoscopic ultrasonographical fine-needle aspiration (EUS-FNA) which was performed, revealed pus with acid-fast bacilli seen in the cell block material. The patient was started on antituberculous medication with rapid improvement of symptoms. Pancreatic tuberculosis (TB) is rare and can mimic pancreatic carcinoma both clinically and radiologically. Histological diagnosis is crucial before administration of appropriate therapy. The usefulness of EUS-FNA and its pitfalls, as well as the other radiological modalities for the evaluation and assessment of pancreatic TB are discussed.     

Clinics in diagnostic imaging (107)

A 90-year-old woman was admitted for progressively increasing lower abdominal pain. There was no history of prior surgery, and physical examination was non-specific. The supine abdominal radiograph revealed an abnormal collection of air over the right obturator foramen. Computed tomography showed a right obturator hernia with incarcerated bowel in the hernial sac, and a right sciatic hernia containing the right ovary. The anatomy of obturator and inguinal hernias is reviewed, and the use of various imaging modalities in evaluation of abdominal hernias is discussed.     

Xanthogranulomatous cholecystitis mimicking gallbladder cancer: report of a case

A 61-year-old woman was admitted to our hospital with abnormal findings of abdominal computed tomography. Whereas she had neither fever nor abdominal pain, a cholecystitis was suspected. Ultrasonography showed a mass in the gallbladder with several stones, and an unclear border between the gallbladder and liver. Computed tomography showed a large-mass in the gallbladder with findings that seemed to indicate hepatic invasion and para-aortic lymph node metastasis. On the basis of these findings, we made a diagnosis of gallbladder cancer associated with hepatic invasion and lymph node metastasis. We treated this gallbladder tumor by hepatic arterial infusion chemotherapy via catheter with cisplatin and 5-fluorouracil. Four weeks after administration of the anti-cancer drugs, the tumorous lesion of the gallbladder could not be detected by abdominal imagings, and the gallbladder wall revealed no irregular findings. During laparotomy, the gallbladder showed signs of chronic cholecystitis, and a cholecystectomy was performed. Findings of the resected specimens showed severe inflammation, fibrosis, and bleeding in the gallbladder wall with infiltration by many foamy cells. Histopathological diagnosis was xanthogranulomatous cholecystitis. We report here a case of xanthogranulomatous cholecystitis mimicking gallbladder cancer and review the literature.     

Entangled bilateral adnexal torsion in a premenarchal girl: a laparoscopic approach

Bilateral adnexal torsion is a rare event in children. A high index of suspicion, together with prompt surgical treatment, would help to save the ovaries and preserve its function. We report a case of entangled bilateral adnexal torsion managed successfully via laparoscopy. An 11-year-old premenarchal girl complained of chronic intermittent abdominal pain that worsened over 24 hours. Computed tomography of the abdomen and pelvis showed a bilobed cystic tumour (10 cm × 12 cm × 12 cm and 3 cm × 4 cm) lying in the left abdomen and another cystic tumour (10 cm × 6 cm × 5 cm) in the pelvis. At laparoscopy, entangled bilateral adnexal torsion was seen. After disentanglement and detorsion of both adnexa, bilateral ovarian cystectomy was performed, and both ovaries were preserved. This case illustrates that laparoscopic treatment is possible for large entangled bilateral adnexal torsion in children.     

单纯输尿管原位癌1例报告并文献复习

目的探讨单纯输尿管原位癌(carcinoma in situ,CIS)的临床特点及诊断治疗。方法总结1例单纯输尿管CIS患者的临床资料并复习相关文献。患者因左侧腰部及下腹部疼痛3周入院。超声提示左肾盂积水,CT提示左侧输尿管下段软组织占位,伴不均匀强化。结果患者行输尿管下段肿物切除、输尿管再吻合术,术后病理报告为输尿管CIS,患者术后1周痊愈出院。术后随访2年未见肿瘤复发转移。结论 CIS通常合并于移行上皮癌,单纯输尿管CIS少见,术前确诊较困难,术后膀胱癌发生率高。治疗应采取根治性肾输尿管全长切除+膀胱袖状切除术,术后应定期复查膀胱癌复发情况。     

Heterotopic ossification of the distal portion of biceps femoris: case report and review of the literature

Heterotopic ossification is the formation of mature lamellar bone in soft tissue. We report a very unusual case of heterotopic ossification arising in the distal portion of the biceps femoris muscle. A 29-year-old woman presented with knee pain after playing golf. She had had no apparent history of trauma. Radiography of the knee showed a calcified mass adjacent to the lateral side of her knee joint. The radiological diagnosis was calcification of the lateral collateral ligament. The pain soon disappeared without treatment. At the age of 45 years, she complained of a growing mass in her left knee that was occasionally painful. Computed tomography and magnetic resonance imaging demonstrated a well matured ossified mass in the lateral side of her left knee. Radiologically and macroscopically, it was found to be in continuity with the distal part of biceps femoris. The mass was excised en bloc. Microscopically, the lesion was mainly composed of well-matured lamellar bone with bone marrow and islands of cartilage showing enchondral ossification. No apparent zoning was found. Cellular atypia was not observed. Extraskeletal osteosarcoma was ruled out. The mass was diagnosed as a heterotopic ossification arising from the distal part of biceps femoris.     

B超诊断输尿管结石的体会和临床价值

目的探讨各段输尿管结石的超声检测方法 ,以提高该病的检出率,同时讨论分析超声诊断输尿管结石在腹痛患者原因分析中的临床价值。方法选取2011年5月~2016年5月我院门诊、住院30例腹痛患者作为研究对象,30例患者均行B超泌尿系检查。结果 30例患者最后经静脉肾盂造影及手术取石证实为输尿管结石,B超诊断符合26例,符合率约86.7%。结论超声检查输尿管结石具有快速、准确、方便、经济、无创、可重复性的特点,并且不受肾功能情况、结石成分及过敏的限制,可显著提高输尿管结石的诊断率,值得临床推广和应用。     

Clinics in diagnostic imaging (135). Cystic renal cell carcinoma

A 45-year-old man presented with right flank pain and haematuria for one month. Computed tomography showed a large, well-circumscribed exophytic complex cystic mass with enhanced, irregular thickened walls arising from the upper pole of the right kidney, which was associated with bilateral renal stones. Partial right nephrectomy with removal of the right renal stones was performed. Histopathology revealed papillary cell carcinoma confined to the kidney. The patient made good postoperative recovery. The Bosniak classification system of renal cystic lesions and cystic renal cell carcinoma are discussed. Various cases of renal cystic lesions and cystic renal cell carcinoma are shown.     

An unusual presentation of primary amyloidosis

A 65-year-old male patient presented with right upper-quadrant abdominal pain. Ultrasonography revealed hypoechoic lesion in the perihepatic and intraparenchymal area. Computed tomography (CT) showed hypodense lesion in the same localization. A fine needle biopsy specimen of the perihepatic lesion was hemorrhagic. On abdominal CT, the liver showed enhancement, but the spleen did not enhance. The spleen could not be detected by scintigraphic imaging using Tc99m sulfur dioxide. A diagnosis of primary amyloidosis was made by renal biopsy. Melphalan 10 mg/day for 4 days/month was started. The clinical and radiological follow up demonstrated a resorption of the hematoma. The patient is still alive at the eighth month of therapy.     

幕上高灌注原发性中枢神经系统淋巴瘤一例

报道高灌注幕上原发性中枢神经系统淋巴瘤1例。CT表现为双侧半卵圆中心对称性类圆形高密度病变,周边可见大片状水肿。磁共振成像表现为稍长及等T1、稍长及长T2信号影,扩散加权成像病变呈高信号影,表观扩散系数值高于邻近正常脑实质,增强扫描病变明显均匀强化,右侧病变内可见斑片状无强化影,磁共振灌注成像表现为明显高灌注。     

Endovascular stenting for nutcracker syndrome

Nutcracker syndrome (NCS) is a rare pathology manifested by pain or hematuria in males and females alike. It can be easily overlooked, and should be considered in young men or women with symptoms of extended duration. We present a case of a 54-year-old female with chronic lower abdominal pain radiating to the left thigh of 4 years in duration. Computed tomography (CT) eventually revealed engorged left renal, gonadal, and uterine veins due to compression between the superior mesenteric artery (SMA) and the abdominal aorta, consistent with NCS. After a successful endovascular stenting and a 6-month period of antiplatelet and anticoagulant therapy, the patient returned to stable health. NCS, while rare, should be suspected in patients of both sexes with persistent pain or hematuria.     

The oldest patient with gallstone ileus: report of a case and review of 176 cases in Japan

We report a 91-year-old woman presenting bowel obstruction due to impacted gallstone, who was the oldest patient which has been reported in Japanese scientific literature. The patient was referred to our hospital due to vomiting and abdominal pain. Computed tomography and abdominal X-ray showed dilated loops of small intestine associated with air-fluid levels, pneumobilia, and a calcified mass in the left iliac fossa. After the diagnosis of bowel obstruction due to gallstone was made, an enterotomy and lithotomy was performed under spinal anesthesia. The postoperative recovery was uneventful. We also reviewed 176 cases of gallstone ileus which were reported in the Japanese literature in the past 20 years. The retrospective analysis demonstrated that one-stage enterolithotomy alone may be acceptable as the first choice of operative treatment. The gallstone ileus is a rare, but important disease because urgent and appropriate surgical therapy is required.     

特发性、假性甲状旁腺机能减退症与基底节钙化——36例脑CT的临床研究

本文以脑CT与X线平片观察甲旁减36例,发现伴发软组织钙化者以颅内脑钙化为多见,而未见到脑以外的软组织钙化。与X线平片相比,CT对脑钙化有较敏感的分辨率,本组阳性率36%,其在CT呈现的特点是以基底节为中心的范围较广的多发性脑钙化,几乎均呈双侧对称性分布,而不同于头颅平片强调的钙化局限于基底节的认识。     

Clinics in diagnostic imaging (44). Testicular tumour with retroperitoneal lymphadenopathy and inferior vena cava thrombosis

A 20-year-old Indian man presented with a two week history of non-specific abdominal pain. Abdominal ultrasonograpy incidentally detected a thrombus in the inferior vena cava (IVC). Computed tomography revealed the presence of extensive para-aortic lymph node disease as well as a filling defect in the IVC. Scrotal ultrasonography located a heterogeneous intra-testicular tumour in an otherwise palpably-normal testis. The extent of the IVC thrombus was evaluated by the use of magnetic resonance imaging. Inguinal orchidectomy was performed and histology revealed a non-seminomatous germ cell tumour. Combination chemotherapy led to complete resolution of lymph node disease and IVC thrombus. The patient remained well 9 months after diagnosis. The causes of IVC obstruction, role of imaging in investigating IVC obstruction and the management of tumour involvement of the IVC are discussed.     

肠系膜脂膜炎的临床症状、CT影像特点及病理分析

目的探析肠系膜脂膜炎的临床症状、CT影像表现及病理特点。方法收集我院2012年1月-2015年7月收治23例肠系膜脂膜炎患者作为研究对象,均行多层螺旋CT扫描,总结患者临床症状、CT影像学表现及病理特点。结果肠系膜脂膜炎临床症状以腹胀、上腹痛、发热及消瘦、纳差等为主要表现。23例肠系膜脂膜炎患者中,11例炎性渗出型、7例纤维化型、5例脂肪坏死型。CT共检出17例,检出率为73.9%(17/23),其中8例炎性渗出型、5例纤维化型、4例脂肪坏死型。结论肠系膜脂膜炎的CT表现有一定特异性,且为无创、方便、廉价检查方法,通过鉴别诊断排除其它疾病后通常可初步确诊,若有所怀疑且无法排除其它疾病,则可行手术或活检明确。     

肝脏异位妊娠影像学诊断

目的报告国内首例肝脏异位妊娠病例,提高对本病的认识。方法患者因急性腹痛伴阴道流血14天,加重半天入院,主诉停经49天,无早孕反应,血清HCG8988miu/ml。先后采用超声、CT和MRI平扫及增强扫描发现肝左叶病变。结果超声显示盆腔少量积液;CT平扫显示肝左叶多边形稍高密度影,增强CT未见强化;MRI平扫T1WI呈类圆形低信号,T2WI呈高信号,增强后静脉期病灶内见轻度不规则斑片状强化;手术切除病灶,镜下见绒毛膜组织,病理诊断为肝脏异位妊娠。结论肝脏异位妊娠的CT和MRI平扫及增强为良性肿瘤样表现,结合阴道流血、停经史、血清HCG明显升高等比较容易诊断。     

系统性红斑狼疮合并自发性肾上腺出血1例

A 58-year-old female was referred to our department with intermittent suffocation for 1.5 years, aggravated for a month. 1.5 years before she developed oral ulcer, raynaud phenomenon, proteinuria, bilateral pleural effusion, ANA and anti-dsDNA positive. This patient was diagnosed with systemic lupus erythematosus (SLE). After given hormones, hydroxychloroquine sulfate (HCQ), her symptom relieved soon. The patient stopped her pills 1 year ago. One month ago, she had chest tightness, increased urine foam, and suffered from oliguria. Her admission medical examination: blood pressure (BP) 130/80 mmHg, conjunctiva pale, and lower lung breath sounds reduced. There was no tenderness, rebound pain and abdominal muscle tension in the abdomen. Liver and spleen rib inferior, mobile dullness negative, and lower extremity edema. Blood routine tests were performed with hemoglobin (HGB) 57 g/L. Urine routine: BLD (3+). 24-hour urinary protein 3.2 g. serum albumin 20.5 g/L, C-reactive protein (CRP) 12.85 mg/L, erythrocyte sedimentation rate (ESR) 140 mm/h. Antinuclear antibody (ANA) (H)1 ∶10 000;, anti-dsDNA antibody 1 ∶3 200;, anti-Smith antibody, anti-U1-snRNP / Sm antibody were positive, blood complement 3(C₃) 0.43 g/L, complement 4(C₄) 0.07 g /L. Anticardiolipin antibody (ACL), anti-β2-GP1;, lupus anticoagulant (LA) were negative, HRCT suggested bilateral medial pleural cavity product liquid. Admission diagnosis: SLE lupus nephritis, anemia, pleural effusion, and hypoproteinemia. We treated her with methylprednisolone 1 000 mg×3 d;, late to 48 mg/d and cyclophosphamide 1.0 g, HCQ 0.2 g bid, gamma globulin 10 g×5 d. Day 2 of treatment;, this patient developed acute right upper quadrant pain, not accompanied by nausea, vomiting, blood stool and diarrhea. Antipyretic antispasmodic treatment was invalid, after the morning to ease their own abdominal pain. Day 4 of treatment, daytime blood HGB 77 g/L. Bilateral renal vascular ultrasound: bilateral renal artery blood flow velocity was reduced. The abdominal pain of the above symptoms recurred at night, BP was 120/80 mmHg, and no positive signs were found on abdominal examination. No abnormality was found in the vertical abdominal plain film. Blood routine examination: HGB 53 g/L, Plasma D dimer 2 515 μg/L;, amylase in hematuria was normal, the stool occult blood was negative. Abdominal computed tomography (CT): normal structure of right adrenal gland disappeared, irregular mass shadow could be seen in adrenal region, CT value was about 50 HU. Morphological density of left adrenal gland was not abnormal. The retroperitoneum descended along the inferior vena cava to the right iliac blood vessel and showed a bolus shadow. The density of some segments increased. The lesion involved the right renal periphery and reached the left side of abdominal aorta. Most lesions surrounded the inferior vena cava, the right renal vein and part of the small intestine. The boundary between the upper lesion and the vena cava was unclear. Iodine-containing contrast agent was taken orally. No sign of contrast agent overflowing was found in the abdominal cavity. Hematoma and exudative changes were considered in retroperitoneum. Conclusion of contrast-enhanced ultrasound of blood vessels: The retroperitoneal inferior vena cava (volume 3.5 cm×3.5 cm×1.5 cm) was hypoechoic and had no blood flow lesion. The adrenal gland had a high possibility of origin. Left renal vein thrombosis extended to inferior vena cava. According to the above data;, it was analyzed that the cause of retroperitoneal hematoma of the patient was left adrenal vein thrombosis caused by hypercoagulable state, which led to vascular rupture and hemorrhage caused by increased vascular pressure in adrenal gland. Therefore, on the basis of continuing to actively treat the primary disease, and on the basis of dynamic observation of no active hemorrhage for 3 days, the anticoagulant therapy was continued with 10 mg/d of apixaban. Clinical symptoms were gradually eased, HGB did not decrease. Two weeks later, the ultrasonic examination showed that the irregular cluster hypoechoic range behind the inferior vena cava was significantly smaller than that before (1.8 cm×1.2 cm×0.7 cm). Abdominal CT examination after 1 month showed that there was no abnormal morphological density of bilateral adrenal glands and basic absorption of retroperitoneal exudation. Adrenal hemorrhage is uncommon. SLE with adrenal hemorrhage is rarer. In SLE patients;, especially those complicated with APS, if abdominal pain accompanied by HGB decrease occurs, except after gastrointestinal hemorrhage, the possibility of adrenal hemorrhage should be warned.     

输尿管中下段结石腹部CT联合超声检查操作方法分析

目的探讨CT联合腹部超声在输尿管中下段结石患者中操作技巧及其效果。方法选取2013年4月至2014年4月我院收治的496例输尿管中下段结石患者资料进行分析,入选患者均给予CT和腹部超声检查,检查时做好患者吸气、收腹、重压以及交替探测等操作,分析CT联合腹部超声检查时的操作方法及其临床效果。结果入选的496例中488例为单侧输尿管结石,占98%,8例患者为双侧输尿管结石,占2.0%。患者中,318例中断输尿管结石,占64%,176例下段输尿管结石,占36%;496例患者460例轻度积水,8例中度积水,6例重度积水,22例无积水。患者中,46例结石直径10mm,130例5mm直径10mm,320例5mm,350例结石直径在4mm以上。患者检查过程中3例出现并发症,占1.6%。结论输尿管中下段结石患者采用CT联合腹部超声检查效果理想,该方法操作简单、方便,患者诊断时应该注意操作技巧,提高检查效果。