胸部急诊X线检查

胸部急诊X线检查在日常放射科急诊工作中占有较大的比重,发热、咳嗽、咯血、胸部外伤常为病人就诊的主要原因。急诊透视的工作量最大,目前多数大医院均已配备具有荧光增强设备的大型X线机。在荧光增强     

常见急诊的X线检查应用

作者通过近二十年的放射技术实践，意识到急诊X线检查在日常工作中的重要性，初步将七类急诊病人的X线检查做了一个总结。本文重点阐述这七类病人的X线检查投照位置及检查时应注意的必要环节。     

急诊骨外伤X线诊断存有争议及纠纷病例分析

急诊骨外伤做X线检查，是一种常规和十分重要的检查方法。一般来说，X线诊断骨折并不困难，但有时也会发生争议，涉及到各类纠纷。作回顾本院自2000年1月至2004年12月X线诊断有争议的21例病例，其中16例涉及纠纷，以探讨发生争议的原因及解决的对策。     

胃肠道损伤急诊超声和X线影像诊断及对比分析

目的：讨论胃肠道损伤的急诊超声和X线影像学表现及临床意义。方法：30例胃肠道损伤患分别行急诊超声和X线检查，并与手术结果对照分析。结果：30例患中，超声检查有：29例可见腹腔积液，占96．7％；20例可见腹腔游离气体，约占66．7％；19例有肠梗阻，占63．3％。X线检查有：26例可见膈下游离气体，占86．7％；16例可见肠梗阻的表现，占53．3％；超声和X线结合诊断胃肠道损伤，符合率达100％。结论：超声和X线检查对胃肠道损伤均具有较高的诊断准确率，超声检查并可同时发现其他脏器的损伤及估计出血量等，补充了X线诊断的不足。超声和X线检查结合，提高胃肠道损伤的诊断准确率，为临床治疗提供更可靠依据。     

超声检查在妇产科急诊中的诊断价值

目的 探讨超声检查对妇产科急诊的诊断及鉴别诊断价值。方法 总结80例总类妇产科急诊的声像图表现，对手术，病理证实的58例进行分析总结，对非手术治疗的22例进行随访观察，了解其治疗效果。结果 经手术，病理证实的58例各类妇科急诊中不全流产及稽留流产手术12例，异位妊娠11例，临床误诊1例，超声漏诊1例，妇科肿瘤16例，输卵管积水6例，黄体破裂5例。妊娠合并外科疾病，胎盘早剥，前置胎盘，葡萄胎各2例。非手术治疗病例中盆腔炎症15例，胎儿窘迫3例，宫外孕3例，妊娠合并输尿管结石1例，超声随访观察图像多有变化。结论 超声对妇产科急诊能够提供诊断依据对保守治疗部分患者超声引导穿刺治疗及随访观察也具有一定临床价值。     

小肠恶性肿瘤X线诊断

笔者收集了近 7年来本院经手术病理证实、资料较完整的 4 7例小肠恶性肿瘤患者临床资料 ,探讨总结气钡造影对小肠肿瘤的诊断价值 ,以期为临床提供有力诊断依据。1　资料与方法1.1临床资料　 4 7例中 ,男 33例 ,女 14例。年龄 14～ 77岁 ,平均 5 6岁。主要临床表现 :4 7例均有腹     

尿石症的X线诊断

尿石症是肾结石、输尿管结石、膀胱结石和尿道结石的总称 ,也可称为泌尿系统结石、尿石病和尿路结石。中医称之为“石淋”、“砂淋”等。按结石化学成分 ,尿结石可分为含钙结石、感染性结石、尿酸结石和胱氨酸结石 4类。1　临床表现尿石症典型的症状是疼痛和血尿。其他症状如恶     

颈椎病的X线诊断

颈椎病的Ｘ线诊断游晓辉颈椎病是因颈椎软骨退行性变和继发的失稳或骨关节增生肥大而引起症状和体症的疾病［１］。多见于中老年人。回顾我院１９８９～１９９３年１５５例颈椎病Ｘ线正侧位片，结合文献对颈椎的局部解剖、病理、Ｘ线表现进行了分析，总结了Ｘ线正侧位片诊...     

贲门癌的X线诊断

贲门癌的发病率居胃癌第二位,因其解剖位置及结构特殊易造成漏诊和误诊。为提高对本病的诊断水平,现将我们近年来经X线诊断并经病理证实的60例贲门癌分析如下。     

前置胎盘类型及产前出血与妊娠结局的分析

目的分析前置胎盘类型、阴道出血状况与妊娠结局的关系,探讨前置胎盘的处理以改善母婴预后。方法对本院2003年1月1日~2009年6月31日收治并分娩的112例前置胎盘伴产前出血患者的临床资料进行回顾性分析。结果近年来前置胎盘的发生率在上升;前置胎盘类型与产前出血、产后出血密切相关,中央性前置胎盘发生产前出血量最多(P<0.01),出血时间最早(P<0.01),产后出血概率越大(P<0.01),临床结局最严峻;边缘性前置胎盘则反之,而部分性前置胎盘则处于两者之间。结论 前置胎盘出血时间越早,出血量越多则威胁母儿生命越严重。前置胎盘患者的临床结局有很大差异,其类型及产前出血状况可预测临床结局。产前及时诊断是改善前置胎盘预后的关键因素,治疗的关键是控制出血。     

Acute Abdomen in Pregnancy

Objective. The purpose of this presentation is to review the role of sonography in evaluation of acute abdomen during pregnancy. Methods. Illustrative cases were collected from gravid patients who presented with signs and symptoms suspicious for acute abdomen and subsequently underwent sonography. Results. This presentation shows sonographic findings of various maternal complications that can present with acute abdominal pain in pregnant patients. Conclusions. Sonography remains the first line of imaging in pregnant patients presenting with acute abdomen. Patient triage or additional imaging may be obtained on the basis of the sonographic findings.     

B超在急腹症诊断中的应用价值

目的：探讨B超检查对急腹症的临床应用价值。方法：回顾性分析326例急腹症的超声表现并与手术后、病理诊断以及随访结果进行对照。结果：326例急腹症中以急性胆囊炎、输尿管结石、急性阑尾炎以及妇科急症常见,共289例,占88％,其他急腹症37例,占12％。经手术和病理证实217例,109例临床随访证实。超声符台率89．9％。结论：B超检查对急腹症的早期诊断以及鉴别诊断具有重要临床意义,是急腹症首选的诊断方法。     

妇科急腹症767例临床分析

目的：探讨妇科急腹症的诊断和鉴别诊断以减少误诊。方法：回顾性分析我院1995年10月至2004年5月767例妇科急腹症的临床资料。结果：异位妊娠和卵巢肿瘤蒂扭转的急诊诊断和术后诊断符合率为100％，卵巢破裂误诊率为56．4％，出血性输卵管炎误诊率为70％，2例卵巢巧克力囊肿均误诊。不全流产、难免流产、痛经和急性盆腔炎基本无误诊。结论：详细询问病史，细致的体格检查，血、尿HCG，B超检查和后穹隆或腹腔穿刺术是明确诊断妇科急腹症简便而重要的手段。     

Emergency Department Evaluation of Geriatric Patients with Acute Cholecystitis

Objective : To estimate the frequency of abnormal clinical symptoms, laboratory tests, and diagnostic imaging studies in the ED assessment of elderly (≥65 yr) patients with acute cholecystitis, and to compare these factors in the young-old (65–74 yr), middle-old (75–84 yr), and old-old (≥85 yr) population groups.
Methods : A retrospective, cross-sectional study was performed by review of ED records, hospital charts, and surgical operative reports of consecutive elderly ED patients determined at surgery to have acute cholecystitis. Records were reviewed between April 1990 and April 1995 at a large Midwestern tertiary care facility with 65,000 annual ED patient visits. Clinical signs and symptoms were compared in the young-old, middle-old, and old-old population groups.
Results : Of the 168 patients reviewed, 141 (84%) had either epigastric or right upper quadrant abdominal pain, and 8 (5%) had no pain whatsoever. Only 61 patients (36%) had back or flank pain radiation. Ninety-six (57%) experienced nausea, 64 (38%) had emesis, and 13 (8%) had visible jaundice. Ninety-four (56%) patients were afebrile and 69 (41%) had no increase of white blood cell count. Twenty-two (13%) patients had no fever and all tests were normal. No statistical difference was noted in any symptom or laboratory factor for the 3 age groups, except jaundice was more common among the patients aged ≥85 years. Ultra-sonography was diagnostic for 91%, and CT was beneficial for only 1 patient. Eight patients had normal results on their ultrasonographic and CT studies.
Conclusion : Classic symptoms and abnormal blood test results are frequently not present in geriatric patients with acute cholecystitis. Increasing age does not appear to affect the clinical and test markers used by clinicians to diagnose this illness. A high degree of awareness is essential for correct diagnosis of acute cholecystitis in geriatric patients.     

体外受精与胚胎移植术后急腹症67例临床分析

目的：探讨体外受精与胚胎移植（IVF-ET）术后急腹症的发生种类、临床特点及误诊情况。方法：回顾性分析1534个胚胎移植周期术后发生的急腹症,分析其病因,发生率,临床特点,与妊娠的关系,本院与外院医生的首诊误诊情况。结果：急腹症的总发生率为4.3%（67/1534）,主要的病因有：卵巢过度刺激综合征、异位妊娠、卵巢扭转等,其中卵巢过度刺激综合征和异位妊娠占92%（62/67）,自然妊娠中罕见的宫内外复合妊娠占异位妊娠总数的13.8%（4/29）。IVF-ET后妊娠组急腹症的发生率显著高于非妊娠组（11.7%和0.7%,P=0.000）,67例急腹症患者有60例（89.6%）合并妊娠。外院医生的首诊误诊率显著高于本院医生（33.3%和5.5%,P〈0.05）。结论：IVF-ET相关急腹症的主要病因是卵巢过度刺激综合征和异位妊娠,与妊娠显著相关;宫内外复合妊娠发生率增高。应普及IVF-ET知识,降低误诊率。     

Timely Diagnosis of Perforated Jejunal Diverticulitis by Computed Tomography

Background

Perforated jejunal diverticulitis is an unusual entity that can present with acute abdominal pain. Due to the non-specific clinical findings, this condition is rarely diagnosed clinically.

Case Report

We present the case of a 75-year-old man in whom a perforated jejunal diverticulitis complicated by abscess formation was diagnosed by computed tomography (CT). He underwent a laparotomy with resection of the involved jejunal segment. He had an uneventful recovery and was subsequently discharged.

Conclusions

This case report demonstrates the utility of CT in accurately diagnosing this unusual entity that frequently perplexes clinicians.     

妇科急腹症的CT诊断

目的 探讨妇科急腹症的CT表现,以提高对妇科急腹症的CT诊断水平.方法 对35例妇科急腹症患者的临床资料及影像学资料进行回顾性分析.结果 35例患者中CT诊断为急性盆腔炎12例,表现为附件增粗及盆腔积液;盆腔脓肿4例,表现为子宫直肠陷窝囊性密度减低区,周边呈渗出样改变,边界模糊,增强扫描呈环形边缘强化,囊内低密度区无强化;异位妊娠及黄体破裂出血各6例,表现为子宫直肠陷窝或附件区类圆形混杂密度包块,边界不清,CT值为42～65 HU,增强扫描见包膜强化,囊内密度未见增高,并见盆腔内积液;子宫内膜异位4例,位于附件区,表现为不均匀混杂密度囊性病变,呈壁薄、多房性,边界不清,增强扫描囊壁呈不规则多环形强化;卵巢囊腺瘤蒂扭转并出血3例,CT表现为单房或多房囊性肿块,囊壁薄均匀,内见高密度积血影沉积,CT值为40～75 HU,增强扫描囊壁强化,囊内密度未见增高.结论 妇科急腹症中进行CT检查对临床定性诊断可以起到明显的辅助作用,能多方位显示盆腔组织器官解剖结构关系及病理变化表现,能快速诊断急性病因,可作为除育龄期女性及儿童外大多数女性患者的首选检查方法.     

A pregnant woman with a history of SLE with PPROM and severe thrombocytopenia: A case study

This study discusses the management of a pregnant woman with PPROM and a history of lupus. She was found to be severely thrombocytopenic which was unresponsive to prednisolone. During cesarean section, placental abruption was found and postpartum hemorrhage ensued.     

腹腔镜探查在急腹症诊治中的应用

目的 探讨腹腔镜探查在急腹症诊治中的应用效果.方法 对47例实施腹腔镜探查急腹症患者的临床资料进行回顾性分析.结果 全组患者术中均明确诊断,腹腔镜完成诊治45例(95.7％),中转开腹2例(4.3％).手术时间25～105 min,平均43 min;出血量为10～200 mL,均未输血.住院时间为4～16 d,平均7.6 d.均痊愈出院.结论 腹腔镜手术具有较高的诊断价值,比开腹手术痛苦小、住院时间短、并发症少,是普外科急腹症理想的诊治手段.