成人肾上腺术中超声表现

目的 观察成人肾上腺术中超声（IOUS）表现。方法 收集71例因肝脏、胆道或胰腺病变而接受外科手术治疗患者,观察肾上腺IOUS表现,并与CT/MRI双侧肾上腺显示率和厚度测值进行比较。结果 成人肾上腺IOUS表现为边界清晰、形态不规则的双侧弱回声结构。CT/MRI肾上腺显示率为97.18%（138/142）。IOUS肾上腺显示率为95.07%（135/142）,右侧92.96%（66/71）、左侧97.18%（69/71）,且可见4侧CT/MRI未能显示的肾上腺;IOUS所测肾上腺厚度均大于CT/MRI（P均<0.05）。结论 IOUS中,成人肾上腺表现为边界清晰、形态不规则的双侧弱回声,左侧显示率高于右侧。     

外伤性肾上腺血肿的CT表现

目的:探讨外伤性肾上腺血肿的形成机制、CT诊断特征及临床应用价值。材料与方法:回顾分析19例经CT复查证实的外伤性肾上腺血肿CT扫描资料。结果:19例肾上腺血肿均发生在单侧,其中右侧16例、左侧3例。CT表现为肾上腺区域长椭圆形、类圆形肿块影,CT值50～69Hu,大多数血肿密度均匀、边缘清楚,长径2～4cm,长径与肾上腺前后径一致。合并肾上腺周围组织器官损伤15例,远离肾上腺的下腹部、盆腔损伤3例,单纯性右侧肾上腺血肿1例。本组19例均在外伤后5～192天内做了1～4次CT复查,其中11例从血肿中央开始密度减低,5例从血肿边缘开始密度减低,其余3例不具备上述特点。本组病例中只有2例追踪到6个月后复查血肿吸收消失,肾上腺形态逐渐恢复正常。结论:外伤性肾上腺血肿应首选CT检查,CT诊断具有特征性,有别于其它肾上腺占位,可避免不必要的腹部手术探查。     

双层探测器光谱CT碘密度值对不同功能状态下肾上腺的评估

目的 探讨双层探测器光谱CT碘密度定量对肾上腺不同功能状态的评估价值.方法 2018年6月～2020年8月间于我院完成肾上腺光谱CT增强扫描的检查者中,按照不同的肾上腺功能状态收集病例,分为三组:感染性休克(双侧肾上腺肿大)26例(A组);肾上腺增生(双侧或左侧)14例(B组);右侧功能性肾上腺皮质醇腺瘤(左侧肾上腺反...     

Accuracy of CT scanning and adrenal vein sampling in the pre-operative localization of aldosterone-secreting adrenal adenomas.

In primary hyperaldosteronism, it is important to distinguish between unilateral and bilateral disease, as management strategies differ. In the period 1983-95, we identified 34 patients with primary hyperaldosteronism. Following further investigations, a diagnosis of aldosterone-secreting adenoma was made in 17 patients, and surgery was performed. Computed tomography clearly localized an apparent adenoma (discrete adenoma=1 cm diameter; normal contralateral gland) in only 10 of these patients (59%); two of these 'adenomas' were subsequently shown to be hyperplastic glands without adenomas. Histological examination showed adrenal adenomas in the remaining 15 patients. An 'adenoma' also appeared to be clearly localized in 3/17 patients later classified as having bilateral adrenal hyperplasia by adrenal vein sampling. CT scanning, therefore clearly localizes adenomas in only 50% of histologically proven cases, and can also produce misleading results. Adrenal vein sampling results altered our management approach in one third of cases. On the basis of our detailed results we would recommend surgery if there is clear evidence of unilateral aldosterone secretion along with CT findings which may not be strictly localizing but are in keeping with the dominant side on adrenal vein sampling. The decision to refer for surgery in primary hyperaldosteronism can be difficult, and we would caution against too heavy a reliance on CT results when recommending adrenalectomy, and suggest that adrenal vein sampling should remain a routine part of the investigation of patients with primary hyperaldosteronism.     

肾上腺髓样脂肪瘤的CT表现

目的 分析肾上腺髓样脂肪瘤的CT表现,提高CT诊断的准确性。方法 本文报道螺旋CT检出的7例肾上腺髓样脂肪瘤并分析其CT征象,包括男性1例,女6例,年龄30-76岁,平均56岁。其中5例肿瘤起源于右侧肾上腺,1例起源于左侧肾上腺,另外1例为双恻性髓样脂肪瘤。结果 CT检查显示所有病例均起源于肾上腺并检出瘤体内脂肪成分,所有瘤体均位于肾上腺内外侧肢夹角的后方。肿瘤中6个以脂肪成分为主,2个以软组织成分为主：3个肿瘤中见点状钙化;2个以软组织成分为主的肿瘤可见完整的包膜,而6个以脂肪成分为主的肿瘤根据CT图象未能显示肿瘤包膜。在3例患者的对侧正常肾上腺周围可见大量脂肪。结论 螺旋CT薄层扫描可提供肾上腺髓样脂肪瘤详细解剖细节,有较高的诊断正确性。     

Oropharyngeal histoplasmosis

Histoplasmosis, though usually a silent pulmonary infection, may progress to a severe, sometimes fatal disseminated infection. In the chronic form of disseminated histoplasmosis, granulomatous lesions of the upper aerodigestive tract are common. These lesions can be mistaken for carcinoma on initial presentation, as in the case we have presented here. The clinical course of patients with acute, subacute, or chronic disseminated forms of this disease correlates well with the histopathologic findings. Diagnosis is best made by culture or biopsy of a characteristic lesion. Although amphotericin B remains the standard treatment of disseminated histoplasmosis, the imidazole compounds such as ketoconazole, either alone or in combination with amphotericin B, have also been shown to be effective.     

Adrenal histoplasmosis: clinical presentation and imaging features in nine cases

Background: We describe a retrospective analysis of the clinical presentation and imaging features in nine patients with adrenal histoplasmosis in nonimmunocompromised patients from a nonendemic region.Methods: Clinically, a tuberculosis-like presentation in four patients and a tumor-like presentation in five patients were seen. All patients were seronegative for the human immunodeficiency virus. Ultrasound (US) in all patients, computed tomography (CT) in six, and magnetic resonance imaging (MRI) in three showed suprarenal masses. CT-guided (in five) and US-guided (in four) biopsy and fine-needle aspiration cytology established a definite diagnosis. The work-up for malignancy and tuberculosis was negative.Results: On cross-sectional imaging, eight patients had bilateral adrenal masses and one had a unilateral adrenal mass. Imaging features were variable. All adrenal masses were hypoechoic on US, homogeneous in five, and heterogeneous in four patients. All adrenal masses were hypodense on CT, homogeneous in four, and heterogeneous in two. Heterogeneous enhancement was seen in three, homogeneous enhancement in two, and no enhancement in one patient. MRI in three patients showed that the masses were of variable signal intensity on all pulse sequences.Conclusion: Our case series showed that adrenal histoplasmosis does occur in immunocompetent persons living in areas not endemic for the disease. The imaging features were variable.     

Cerebral histoplasmosis in the azole era: report of four cases and review

We report four cases of cerebral histoplasmosis and discuss features of six additional cases reported in the medical literature in the past 10 years, when azoles have been available for therapy. Most patients with this disease are immunocompromised or have a history that suggests heavy exposure to Histoplasma capsulatum. Fever and other clinical findings of systemic toxicity caused by disseminated histoplasmosis may be absent; 5 of 10 patients did not manifest these findings. Although the mainstay of treatment for central nervous system histoplasmosis remains amphotericin B, 9 of the 10 patients received itraconazole or fluconazole either as initial therapy or after a course of treatment with amphotericin B.     

Real-time ultrasonographic evaluation of normal fetal adrenal glands.

Using real-time ultrasonography, the normal fetal adrenal glands can be consistently imaged after 30 weeks of gestational life. It was found that the normal fetal adrenals had specific size, shape, and echogenicity and could be consistently separated from the adjacent kidneys. The long axis of the adrenal gland had a range of 14 to 22 mm, compared with a range of renal lengths of 27 to 42 mm, with a ratio of the long axes of fetal adrenal to fetal kidney of .48 to .66. These figures compare favorably with dimensions of the adrenals and kidneys found in newborn autopsies. Since certain in utero abnormalities change the size and shape of normal fetal adrenal glands, these data should serve as a reference to evaluate adrenal disturbances. In addition, it would be expected that failure to image either the kidney or adrenal gland after 30 weeks would strongly imply abnormality in that gland.     

Isolated gastrointestinal histoplasmosis: case report and review of the literature

The usual manifestation of histoplasmosis is in the form of respiratory illness. We report the case of a 67-year-old man who presented with chronic diarrhea and did not respond to the conventional treatment, including that for Clostridium difficile. He was found to have isolated colonic histoplasmosis infection, which was treated with itraconazole. There was no evidence of any disseminated disease. His only immunocompromised state was end-stage renal disease, for which he was on chronic hemodialysis. Although it is well documented as a part of disseminated histoplasmosis, our extensive review of the literature did not reveal any reported case of isolated colonic histoplasmosis in a patient on hemodialysis.     

Hemangiosarcoma of the adrenal glands: CT findings in two cases

Hemangiosarcomas of the adrenal gland, both benign and malignant, are exceedingly rare; only a dozen of them have been reported in literature to our knowledge. We describe herein the findings at CT of 2 primary hemangiosarcomas of the adrenal glands. We also discuss their etiology, incidence, and differential diagnosis, particularly in relation to more frequent primary adrenal lesions, such as adrenal adenomas and carcinomas. CT will generally show a heterogeneous mass with frequent necrosis, contrast-enhancement, and occasional calcifications. A prospective diagnosis cannot be made by imaging alone, and pathology represents the discriminating method for a correct diagnosis.     

肾上腺髓样脂肪瘤的CT诊断

目的分析和探讨肾上腺髓样脂肪瘤的CT表现特征及其诊断价值。方法回顾性分析21例经手术病理证实的肾上腺髓样脂肪瘤的CT表现。分析病变位置、形状、大小和病变内有无钙化、出血、脂肪和假包膜及增强后的表现特征等。结果本组共21例,均为单发,15例位于右侧。肾上腺,6例位于左侧。肿瘤最大径线为1．7—11cm,肿瘤多呈圆形或类圆形,病灶内部含有脂肪和髓样成分,CT表现因病灶内所含成分的比例不同而有所差异,其中16例呈脂肪与软组织混合密度,3例以脂肪密度为主,2例以软组织密度为主,无1例肿瘤内部有出血。3例肿瘤边缘可见钙化,所有病例假包膜完整,CT增强后脂肪成分未见明显强化,软组织成分轻度强化。结论肾上腺髓样脂肪瘤有比较典型的CT表现,通过CT平扫及增强扫描一般能做到术前诊断,部分不典型病变术前诊断比较困难,确诊仍依靠病理。     

Chronic meningoencephalitis due to Histoplasma capsulatum. Usefulness of serodiagnostic procedures in diagnosis

This study presents details of four male patients with meningoencephalitis of chronic evolution, probably due to Histoplasma capsulatum. The diagnoses were mainly made by immunodiffusion test (ID), counterimmunoelectrophoresis test (CIF) and complement fixation test (CFT) with specific antigens. In case 1, the diagnosis of histoplasmosis was established through the isolation of H. capsulatum from a cutaneous biopsy and in the other three patients, through the results of serological tests. The neurological changes were those typical of chronic meningitis of basal predominance, with non-purulent cerebrospinal fluid (CSF) and signs of hydrocephaly in three patients. Two patients had other organ involvement which was clinically consistent with histoplasmosis (nose, oral mucosa, lungs, adrenal glands). The four patients were treated with amphotericin B and received fluconazole, itraconazole, cotrimoxazole (TMS) and ketoconazole, in most cases as secondary prophylaxis. Three of the patients presented episodes of valvular obstruction which complicated their clinical courses.     

泪腺淋巴细胞增生性病变的CT、MRI诊断

目的 研究泪腺淋巴细胞增生性病变的CT和MRI表现及其诊断价值.方法 回顾分析10例经病理学证实的泪腺淋巴细胞增生性病变患者的CT及MR影像资料,总结病变影像学表现.结果 反应性淋巴细胞增生5例,表现为泪腺体积增大,CT呈均匀等密度,MRI T1WI、T2WI呈低或等信号,1例T2WI呈高信号,增强扫描呈明显强化.非典型性淋巴细胞增生1例,CT表现为双侧泪腺弥漫性增大,密度均匀.泪腺淋巴瘤4例,表现为双侧泪腺弥漫增大.结论 泪腺淋巴细胞增生性病变的CT及MRI表现与炎性病变相似,但有助于与泪腺上皮性肿瘤鉴别,并可准确显示病变累及范围.     

High-resolution real-time sonography of the adrenal glands: a routine examination?

The feasibility of imaging the adrenal glands during routine upper abdominal examinations was studied for 100 consecutive patients, 47 males and 53 females. The mean patient age was 46 years and the mean weight 63 kg. The suprarenal areas were scanned in a slightly oblique frontal plane through the intercostal spaces with the patient recumbent. The right adrenal gland was detected in 92 per cent of the patients, with a mean examination time of less than one minute. Visualization of the left adrenal gland was more difficult and was successful in only 71 per cent, even where additional views in the right lateral decubitus or erect position were added. The mean examination time on the left was 2 1/2 minutes. Complete visualization of the adrenal gland is impossible in one single plane because of the complex shape of the organ, which necessitates multiple contiguous scan planes. In 13 per cent of the visualized adrenals, cortex and medulla could be differentiated.     

肾上腺假性囊肿的CT诊断

目的探讨肾上腺假性囊肿的CT表现,以提高诊断的准确率。方法回顾性分析手术病理证实的6例肾上腺假性囊肿的CT表现。结果6例肾上腺假性囊肿2例呈圆形,4例呈椭圆形,平扫囊肿密度均匀,CT值15～35Hu,6例囊内及囊壁均无强化,厚薄均匀,边缘光滑。结论CT是肾上腺假性囊肿定位诊断较为可靠和准确的方法。     

肾上腺节细胞神经瘤的MSCT表现

目的 探讨肾上腺节细胞神经瘤的MSCT表现。方法 回顾性分析10例经手术病理证实的肾上腺节细胞神经瘤的影像学资料,观察病灶的部位、形态、大小、MSCT表现及周围组织结构的关系,并测量平扫、动脉期、静脉期、延迟期的CT值。结果 所有病例均为单发病灶,其中4例病灶位于左侧肾上腺,6例位于右侧肾上腺,与周围组织结构分界清晰,2例呈椭圆形,6例呈水滴形,2例呈不规则分叶状。MSCT平扫病灶均表现为低密度,3例病灶内部见点状高密度钙化灶;增强扫描动脉期均未见明显强化,静脉期及延迟期病灶边缘或内部可见渐进性强化。平扫、动脉期、静脉期及延迟期病灶的CT值分别为（29.71±9.93） HU、（31.76±9.91） HU、（37.86±10.18） HU及（41.04±10.89） HU。结论 肾上腺节细胞神经瘤的MSCT表现具有一定的特征性,有助于该病的诊断及鉴别诊断。     

MR超清小视野DWI对正常肾上腺测量的应用研究

目的探讨MR超清小视野扩散加权成像（reduced field of view,r-FOV DWI）应用于肾上腺中的可行性及价值。方法收集19例健康志愿者（男：女为14：5）,所有被检者于3.0 T MRI扫描仪行r-FOV DWI（19例）及常规全视野扩散加权成像（f-FOV DWI,9例）（b=0,800 s/mm^2）扫描。由1名放射学诊断医师于r-FOV DWI图像采用多次测量取平均值的方法测量双侧肾上腺各部位厚度,并选取肾上腺各部位最大层面分别测量r-FOV及f-FOV DWI表观扩散系数（ADC值）,由2名影像诊断医师利用4分法对图像中肾上腺显示效果进行主观评分。利用SPSS 17.0软件对数据进行统计学分析。结果 r-FOV DWI对左、右侧肾上腺各部位显示主观评分高于f-FOV DWI,差异具有统计学意（P〈0.05）,r-FOV DWI各部位ADC值均小于f-FOV DWI,差异具有统计学意义（P〈0.05）,左、右侧肾上腺各部位ADC值及各部位厚度之间差异无明显统计学意义（P〉0.05）。2名影像诊断医师对图像主观评分具有显著一致性。结论 r-FOV DWI可清晰显示肾上腺形态及信号,提供更高空间分辨率扩散加权图像,为肾上腺疾病的准确诊断提供帮助。     

Adrenal congestion preceding adrenal hemorrhage on CT imaging: a case series

Introduction

Adrenal hemorrhage is an uncommon but potentially life-threatening condition, particularly in cases of bilateral adrenal hemorrhage causing primary adrenal insufficiency. It is difficult to diagnose clinically, particularly in critically ill patients, given its non-specific symptoms and signs, which include abdominal pain, vomiting, fever, weakness, hypotension, and altered conscious state. Non-traumatic adrenal hemorrhage has been observed to occur in times of physiological stress, such as post-surgery, sepsis, burns, and hypotension. This is hypothesized to be due to a combination of increased arterial blood flow to the adrenal glands, the paucity of draining adrenal venules and adrenal vein thrombosis, leading to intra-glandular vascular congestion and subsequent hemorrhage.

Case series

We present four cases of non-traumatic adrenal hemorrhage, which demonstrated features of preceding adrenal congestion (adrenal gland thickening and peri-adrenal fat stranding) on computed tomography (CT) imaging. Comparison was made with 12 randomly selected intensive care patients to observe if these findings were prevalent in this subgroup of patients.

Conclusion

Non-traumatic adrenal hemorrhage is an uncommon condition that is difficult to diagnose clinically. As such, it may be useful to recognize CT features of adrenal congestion as a sign for potential adrenal dysfunction and subsequent adrenal hemorrhage, so early steroid replacement therapy can be commenced to prevent death from adrenal insufficiency.

     

肾上腺嗜铬细胞瘤的MSCT表现特点

目的 分析肾上腺嗜铬细胞瘤的MSCT表现及其动态增强特征,以提高其诊断准确性.方法 回顾性分析经手术病理证实的肾上腺嗜铬细胞瘤15例,术前经多排螺旋CT平扫、动脉期和门脉期扫描.仔细复习CT扫描结果和手术病理作对照分析.结果 15例肾上腺嗜铬细胞瘤中,位于左侧肾上腺6例,右侧肾上腺8例,双侧肾上腺1例.肿瘤直径1.5～...