气管小憩室CT表现

【摘要】目的：分析气管小憩室的CT表现,提高对本病的认识。方法：回顾性分析81例气管小憩室的CT表现及42例随访病例的CT改变。结果：81例气管小憩室均位于气管右后方6～7点处。81例气管小憩室中,类圆形75例,三角形3例,不规则形3例。81例共86个小憩室,其中单发者73例(73个),多发者8例(13个)。86个气管小憩室平均最大径为2.2mm。本组86个小憩室中64个可见开口与气管相通（64/86）,41个窄开口使小憩室呈瓶颈样改变(41/64),23个宽开口使小憩室呈凹槽样改变(23/64)。42例随访病例的CT表现:小憩室消失1例,小憩室变大7例,小憩室生成7例,小憩室消失后再度出现3例。结论：CT能准确清晰显示气管小憩室的形态、位置、数目、大小和开口。典型的气管小憩室形态改变为烧瓶状和凹槽状。通过CT可观察到气管小憩室的发生、发展、消失及消失后再生的复杂过程。     

Imaging of the small bowel

Radiologic imaging continues to play an integral role in the diagnosis and management of diseases of the small bowel. Except for the most proximal jejunal loop, which may occasionally be reached during upper gastrointestinal tract panendoscopy, and the terminal ileum, which can frequently be examined by the colonoscope, the mesenteric small intestine is the only gastrointestinal tract segment for which diagnostic study is not principally dependent upon endoscopic viewing. To the extent that radiologists assume primary responsibility in the diagnostic evaluation of the small bowel, it is essential that methods capable of accurately demonstrating small bowel morphology are appropriately applied (Maglinte et al., Radiology 1987, 163:297-305). Barium contrast studies and enteroclysis in particular remain the primary diagnostic methods in the small bowel for most clinical indications. Cross-sectional imaging modalities often provide unique diagnostic information, but their role remains either complementary to the demonstration of surface details by barium contrast studies or directed toward specific clinical circumstances that require discrete evaluation of the small-bowel wall and the adjacent tissues and organs.     

Value of the small bowel feces sign at CT in adhesive small bowel obstruction

PURPOSE: The purpose of this study is to describe the CT features of the small bowel feces sign and to determine its value as a positive criteria of non-severity in adhesive small bowel obstruction. MATERIALS AND METHODS: We performed a retrospective study of adhesive small bowel obstructions diagnosed by CT from January 2001 to December 2002. All CT examinations featuring a small bowel feces sign were included. Clinical follow-up was available for all included patients. RESULTS: Twenty patients were included in this study. Twelve patients underwent successful conservative treatment with nasogastric aspiration. Urgent laparotomy performed in 6 cases and delayed surgical intervention performed in 3 did not show ischemic complication. Surgical management always consisted in lysis of adhesions without intestinal resection. CONCLUSION: Recently described in the radiological literature, the small bowel feces sign appears to be the first criteria of non-severity in adhesive small bowel obstruction.     

Magnetic resonance enterography/enteroclysis in acquired small bowel diverticulitis and small bowel diverticulosis

Purpose

Small bowel (SB) diverticulosis is a rare disorder that may entail serious complications, including SB diverticulitis. Both are often missed in imaging. Magnetic resonance enterography/enteroclysis (MRE) is increasingly used to assess SB disease; awareness of the appearance of SB diverticulitis is essential to ensure appropriate management. Our aim was to systematically describe imaging characteristics of SB diverticulosis and diverticulitis in MRE.

Methods

This retrospective, HIPAA-compliant study identified 186 patients with suspected SB diverticulosis/diverticulitis in medical databases of two tertiary medical centres between 2005 and 2011. Patients with surgically confirmed diagnoses of SB diverticulosis/diverticulitis were included. Two observers analyzed MR images for the presence, location, number, and size of diverticula, wall thickness, and mural and extramural patterns of inflammation.

Results

Seven patients were recruited. MRI analysis showed multiple diverticula in all (100 %). Diverticular size ranged from 0.5 to 6 cm. Prevalence of diverticula was higher in the proximal than the distal SB (jejunum 86 %, ileum 57 %, distal ileum43%). Diverticulitis occurred in 3/7 patients (43 %) showing asymmetric bowel wall thickening and focal mesenteric inflammation.

Conclusion

SB diverticulitis demonstrates characteristic MRE imaging features to distinguish this rare disorder from more common diseases. Asymmetric, focal mesenteric and mural inflammation and presence of multiple diverticula are keys to diagnosis.

Key points

? Small bowel diverticulosis and diverticulitis is rare and often missed in imaging ? Acquired small bowel diverticula are variable in size and number ? Small bowel diverticulitis demonstrates characteristic features on MR enterography/enteroclysis ? A focal or segmental asymmetric small bowel inflammation should prompt the search for diverticula

     

Embolisation in small bowel haemorrhage

As embolism of small bowel arteries carries the risk of bowel infarction, the technique is usually reserved for situations where a vasopressin infusion has failed to control bleeding. We report three cases in which embolisation was used as the primary treatment to control small bowel haemorrhage without the complication of bowel infarction.     

MR imaging of the small bowel

Small-bowel radiology has undergone dramatic changes in the past 2 decades. Despite important recent advances in small-bowel endoscopy, radiologic imaging remains important for patients suspected of having or with established small-bowel disease. Cross-sectional imaging techniques (computed tomography and magnetic resonance [MR] imaging), used to investigate both extraluminal abnormalities and intraluminal changes, have gradually replaced barium contrast examinations, which are, however, still used to examine early mucosal disease. MR imaging techniques clearly highlight endoluminal, mural and extramural enteric details and provide vascular and functional information, thereby enhancing the diagnostic value of these techniques in small-bowel diseases. Two MR imaging based techniques are currently utilized: MR enteroclysis and MR enterography. In enteroclysis, enteric contrast material is administered through a nasoenteric tube, whereas in enterography, large volumes of enteric contrast material are administered orally. MR enteroclysis ensures consistently better luminal distention than does MR enterography in both the jejunum and the ileum and more accurately depicts endoluminal abnormalities and early disease, particularly at the level of the jejunal loops. Moreover, MR enteroclysis provides a high level of accuracy in the diagnosis and exclusion of small-bowel inflammatory and neoplastic diseases and can be used for the first radiologic evaluation, while MR enterography may effectively be used to follow up both Crohn disease patients without jejunal disease and in pediatric patients where nasogastric intubation might be a problem. MR enteroclysis may also reveal subtle transition points or an obstruction in the lower small bowel, which may escape detection when more routine methods, including enterography, are used. MR imaging offers detailed morphologic information and functional data of small-bowel diseases and provides reliable evidence of normalcy, thereby allowing the diagnosis of early or subtle structural abnormalities and guiding treatment and decisions in patient care.     

Roentgen studies of the small bowel

Diseases of the small bowel are rare and this part of the gastrointestinal tract is the most difficult to explore radiologically. The examination results correlate directly with the indications. Whatever examination technique is used, it should be based on fluoroscopy. For most radiologists the combined single and double-contrast examination with air or methylcellulose is probably the most suitable. The interpretation should be done in a logical, stepwise way and with access to clinical information.     

CT findings of small bowel trichobezoar

A 14-year-old girl presented to our emergency room with abdominal pain and persistent vomiting. A plain radiograph of the abdomen showed features of small bowel obstruction, with dilated loops of small bowel and a mottled gas and debris pattern in the stomach and right lower quadrant. A CT scan of the abdomen and pelvis obtained to exclude appendicitis showed the distinctive appearance of a trichobezoar. A preoperative diagnosis of gastric and intestinal trichobezoar was made. Electronic Publication     

Cross-sectional imaging of small bowel malignancies

Small bowel malignancies are rare neoplasms, usually inaccessible to conventional endoscopy but detectable in many cases by cross-sectional imaging. Modern multidetector computed tomographies permit accurate diagnosis, complete pretreatment staging, and follow-up of these lesions. In this review, we describe the cross-sectional imaging features of the most frequent histologic subtypes of the small bowel malignancies.     

Imaging of the postsurgical small bowel

The small bowel is subject to a variety of surgical interventions for the treatment of a broad spectrum of disease processes. Most operative procedures applied to the small bowel are straightforward techniques encumbered by few complications, whereas other procedures are considerably more complex and can be associated with significant postoperative morbidity. Familiarity with the anatomic alterations related to the various operations is essential, both for evaluation of early postoperative complications and those abnormalities that manifest late in the postoperative course. The surgeon and radiologist should carefully coordinate clinical suspicion with the strengths of the various imaging modalities to optimize postsurgical assessment and provide timely and accurate diagnosis. Enteric anastomoses, the different forms of enterostomy, and the varied constructions of small bowel pouches and reservoirs are each associated with unique anatomy and therefore optimal techniques of assessment. Small bowel contrast studies such as enteroclysis--including its recent modification, CT enteroclysis--and CT imaging represent the primary modalities for imaging of the postoperative bowel and its related abnormalities. Small bowel transplantation continues to progress as a realistic treatment for intestinal failure, and the role of diagnostic imaging in these unique and challenging patients is evolving.