西宁地区创伤性膈疝的诊治体会

目的：探讨西宁地区（2260m）创伤性膈疝的病因、早期诊断、鉴别诊断与治疗的方法。方法：对15例创伤性膈疝患者临床资料进行分析,全部病人行手术治疗。结果：左侧13例,右侧2例;术前确诊12例,误诊3例（其中1例为慢性膈疝）,均行膈肌修补术;12例经胸切口,2例经腹切口,1例经胸腹联合切口。14例治愈出院,1例死亡。结论：术前详细体检,结合胸部X线片及钡餐检查多能早期确诊;诊断困难者可结合CT、MRI等检查并与手术中仔细探查膈肌。由于高原缺氧,创伤性膈疝对机体影响大,一旦确诊即应急诊手术。     

膈疝的临床及影像学分析

目的：加深对膈疝的临床及影像征象的认识并对检查方法进行比较。方法：回顾性分析14例经手术证实的膈疝的影像表现。结果：膈疝具有下列征象：①膈面异常：膈面轮廓部分或全部不清与缺如;假膈面升高;膈上半圆形块状阴影;②胸腔积气积液阴影或块状影：中下肺野囊状或蜂窝状透光阴影;胸腔宽大气液平面;心膈角区肿块影;③胸腔阴影形态的可变性：不同时间、不同体位阴影形态、数量或密度发生改变;④邻近脏器的异常：纵隔向健侧移位;腹部正常脏器的向上移位;⑤钡餐及钡灌肠检查胸腔内见胃肠道影;⑥CT扫描胸腔内见胃肠道、网膜及肠系膜、肝脾肾。结论：影像学检查对膈疝的术前诊断有重要价值。胸腹部平片及透视对膈疝有提示作用,钡餐（钡灌肠）能直接显示胸腔内胃肠道,胸腹部CT扫描能显示疝入胸腔的空腔脏器或实质性脏器。     

多层螺旋CT在创伤性膈疝诊断中的应用

目的 探讨多层螺旋CT多平面重组图像在创伤性膈疝诊断中的应用.方法 回顾性分析10例经手术证实的创伤性膈疝的多层螺旋CT表现,重点分析多平面重组图像特点.10例患者术前均行胸部正位片及多层螺旋CT检查.结果 8例X线有阳性发现,提示创伤性膈疝;而10例患者经多层螺旋CT多平面重组图像后矢状位、冠状位清晰可见膈肌连续性中断,并清晰显示裂口的位置、裂口的大小及疝入胸腔的内容物.全部病例均经手术治疗并痊愈.结论 多层螺旋CT多平面重组图像在创伤性膈疝中有重要价值,确诊后均应及时手术治疗.     

螺旋CT多平面重组在膈疝诊断中的价值

目的探讨膈的CT多平面重组(MPR)对膈疝诊断的价值及其临床意义。资料与方法对临床有相关提示或胸、腹部CT轴面图像疑为膈疝的病例同时进行MPR,对膈肌裂孔显示情况和不同成像方式测得膈肌裂孔左右径数值进行统计学分析。结果临床确诊食管裂孔疝15例、外伤性膈疝3例、膈膨升2例、腰肋三角疝2例、术后膈疝1例。比较CT轴面和MPR图像对膈疝的显示情况,并通过Wilcoxin秩和检验分析两者的差异,得出Wilcox-in为425.500,P<0.01,两者之间的差异有统计学意义。对于13例两种成像方式都能清楚显示膈疝的病例分别测量膈肌裂孔左右径,采用配对t检验分析CT轴位、MPR图像上测量膈肌裂孔左右径的差异,得出t=-6.307,P<0.001,两者之间的差异有统计学意义,MPR测量膈肌裂孔左右径更直观、准确。结论膈CT的MPR对于确诊各种类型的膈疝及其与相关疾病的鉴别有重要价值,对于临床处理途径和方式的选择有指导意义。     

急性创伤性膈疝影像学诊断

目的 探讨急性创伤性膈疝的影像学表现及诊断价值。材料与方法24例均行胸腹透视、拍胸部平片,其中10例做胃肠道造影检查,8例行CT扫描,对X线征象及CT表现进行对比分析。结果X线表现为膈上胃泡影11例,多个液气平面6例,膈上肿块5例,漏诊2例。CT发现膈上疝囊5例,膈上肿块2例,漏诊1例。结论多种影像学检查方法综合应用能提高创伤性膈疝的诊断率。     

外伤性右膈疝的影像学诊断

目的 总结外伤性右膈疝的影像学诊断及价值.方法 对20例外伤性右膈疝患者行螺旋CT扫描、普通X线透视, 将前诊断结果与手术和临床随访结果进行对照.结果 右膈明显上抬,膈面模糊20例;右膈肌异常运动14例.右膈肌活动度减弱例;肝脏外形欠光整17例,分叶征11例,脐凹征8例;右膈肌脚增厚14例;疝囊、疝环9例;8例纵隔明显向左移位,6例右下肺实18例(90%)术后治愈,2例(10%)死亡.结论 螺旋CT扫描结合普通X线透视,对外伤性右膈疝损伤的诊断具有重要价值.     

MR 快速扫描技术在胎儿先天性膈疝中的应用

目的：探讨 MR 快速扫描技术在胎儿先天性膈疝(CDH)中的影像诊断价值。方法对12例孕20周以上超声诊断或怀疑 CDH 的胎儿行 MR 检查。采用快速扫描序列：半傅里叶采集单次激发快速自旋回波序列(HASTE)、真稳态进动快速成像序列(True FISP)、超快速 FLASH(Turbo FLASH)T1 WI 序列。重点对胎儿的头颅和躯干行横断位、冠状位、矢状位扫描,将产前 MRI表现与新生儿手术病例或引产后尸体解剖结果对照分析。结果12例胎儿 CDH 中9例为左侧膈疝,2例为右侧膈疝,1例食管裂孔疝;其中2例合并其他先天性畸形。MRI 主要表现：HASTE 及 True FISP 序列可见部分或大量肠管及胎胃跨过膈肌疝入胸腔,疝入的胎胃为高信号,肠管呈散在的高信号,并可见肠型,仅肺尖处见肺组织,心脏向对侧移位;Turbo FLASH T1 WI 序列获得 T1图像,该序列肠管中胎粪为特征性高信号,可清晰显示结肠和部分小肠轮廓。全部病例的 MRI 产前诊断结果与手术(10例)或尸检(2例)结果一致。结论MR 快速扫描技术能清晰显示胎儿 CDH,多序列扫描图像清晰、全方位显示疝入胸腔的组织结构及周围的解剖关系,具有一定的临床诊断价值。     

创伤性膈疝24例临床分析

目的探讨创伤性膈疝的诊断及治疗方法。方法回顾性分析24例创伤性膈疝患者的致伤原因及诊断、治疗过程。结果 24例创伤性膈疝患者均行手术治疗,治愈22例,死亡2例,治愈率91.7%。结论对胸腹部创伤患者详细询问受伤情况,全面体格检查,根据X线、CT和临床特点多能得到早期诊断,及时手术治疗是提高治愈率的关键。     

螺旋CT三维重建对膈疝及膈膨升诊断及鉴别诊断的价值

目的 我院以老年病人为主,膈位置、形态异常多见,回顾48例膈疝及膈膨升CT扫描,轴位横断像及三维重建成像,旨在提高对膈疝、膈膨升的诊断及鉴别诊断的认识.方法 收集我院2012年1月～2013年7月诊断为膈疝及膈膨升的48例影像资料进行分析,总结影像表现,易误诊的假像及鉴别要点.结果 胸膜裂孔疝16例;食管裂孔疝12例;胸骨旁疝1例;左膈完全性膈膨升13例;左膈局限性膈膨升2例;右膈局限性膨升4例.结论 螺旋CT三维重建可多角度显示膈肌形态及有无缺口,对膈周围胸腔、腹腔密度分辨率高,可清晰分辨其毗邻结构,从而判断膈肌的完整性,是鉴别膈疝、膈膨升的关键.     

创伤性膈肌破裂的诊断与治疗(附20例分析)

目的:探讨创伤性膈肌破裂与膈疝的诊断与治疗.方法:对该院收治的20例创伤性膈肌破裂进行回顾性分析.结果:20例中开放性损伤7例,闭合性损伤13例,17例合并膈疝,X线检查10例有阳性表现,6例行胸部CT检查均为阳性,术前确诊16例,术中确诊4例,治愈19例(95%),死亡1例(5%).结论:X线和CT检查是诊断膈肌破裂和创伤性膈疝的主要依据,胸腹联合伤应警惕创伤性膈肌的损伤,应注意受伤的原因、体位、及外力作用的方向,早诊断,及时手术是提高治愈率、降低死亡率的关键.     

彩色多普勒超声诊断先天性膈疝的产前分析

目的：探讨先天性膈疝的产前超声表现。材料和方法：回顾性分析6例先天性膈疝胎儿声像图表现特征,并与病理结果相对照。结果：左侧膈疝5例,右侧膈疝1例,其中2例伴有其它复杂畸形。超声显示胎心、纵隔受压移位,心轴偏移明显。疝入器官见有胃泡、肠管、肝脏,胎儿呼吸样运动可致疝入器官运动幅度增加。结论：先天性膈疝的特征性声像图表现,可作为诊断的重要依据。     

膈肌脚后间隙占位性病变的CT分析

目的　分析脚后间隙占位性病变的CT表现 ,探讨其诊断与鉴别诊断。方法　回顾观察 5 6例经临床及病理证实的脚后间隙病变的CT资料。结果　 5 6例病变中脊柱转移性肿瘤 15例 ;脊柱结核 5例 ;淋巴结肿大 2 7例 ;腹主动脉假性动脉瘤 1例 ;奇静脉、半奇静脉曲张 3例 ;食管破裂感染 1例 ;肿瘤直接侵及 4例。结论　正确认识膈肌脚及脚后间隙有助于准确认识脚后间隙的病变     

小儿支气管异物冠状面CT诊断

目的:探讨小儿支气管异物的冠状面CT扫描特征。方法:22例患者进行冠状面CT扫描,6 例同时加轴扫。所有患者在CT扫描后进行支气管镜检查。将CT扫描结果和纤支镜结果进行对比分析。结果:CT冠扫诊断气管支气管异物17例,支气管肿瘤2例,另3例未见异常。纤支镜诊断异物14例,支气管肿瘤2例,痰栓1例,另5例未见明显异常。气管支气管异物的冠状面CT表现为支气管腔内高密度影(17/22),异物边缘呈线样异常密度(15/17),纵隔及膈肌“双边征”(21/22)。结论:小儿支气管异物在冠状面CT扫描上有较为特征性表现。冠状面CT扫描能部分了解小儿大气道梗阻原因,对支气管异物和支气管肿瘤鉴别诊断有重要意义。     

卵巢恶性肿瘤腹膜转移的多排螺旋CT诊断

目的:探讨多排螺旋CT在诊断卵巢癌腹膜转移中的价值。方法:对30例经手术病理证实的卵巢癌伴腹膜转移患者的多排螺旋CT资料进行回顾性分析。结果:30例患者中,手术发现腹膜转移部位为右半膈10例,右半结肠旁沟18例,胃小弯侧1例,阑尾1例,大网膜24例,盆腔(包括子宫直肠陷凹和子宫阔韧带)20例。CT发现右半膈4例,右半结肠旁沟14例,大网膜22例,盆腔(包括子宫直肠陷凹和子宫阔韧带)18例,胃小弯侧和阑尾病灶未发现。右半膈、右半结肠旁沟、大网膜和盆腔的病灶发现阳性率分别为40%(4/10),78%(14/18),92%(22/24),90%(18/20)。结论:结合多排螺旋CT可薄层扫描和多平面重组的优势,可提高卵巢恶性肿瘤腹膜转移诊断的阳性率,为下一步治疗提供有力帮助。     

颈椎间盘突出物理治疗及其CT量化分析

目的:观察颈椎间盘突出患者的CT量化评价方法和单纯牵引、综合物理治疗的临床疗效以及椎间盘突出物治疗前后的变化。方法:采用单纯牵引组40例,牵引加中频电和磁热中药透入的综合疗法治疗组67例,并对颈椎间盘突出物进行CT量化评价及随访研究。结果:两疗程治疗后其显效率为82.97%,综合组疗效明显优于单纯组(u=2.33,P<0.01)。CT量化评价值与临床症状及体征呈明显相关(r=0.96,P<0.05)。CT随访发现,治疗后椎间盘突出物矢状径无显著减小(P>0.05),CT量化评价值有明显的减小(P<0.05)。结论:综合物理疗法治疗颈椎间盘突出有较好的临床疗效,但对颈椎间盘突出矢状径的减小作用不显著,CT量化评价方法对颈椎间盘突出临床疗效评价有一定价值。     

Post-traumatic omental herniation into pleural space: radiologic features

A 43-year-old male with history of trauma was admitted to our clinic for the further evaluation of a blunted left costophrenic angle on chest roentgenograms. Computed tomographic (CT) scans demonstrated a crescent, fat-dense, extra-pleural mass on the left lateral hemi-thorax. Vertical funicular densities consistent with blood vessels were identified in this extra-pleural lesion on enhanced CT scans. T1-weighted axial and coronal magnetic resonance images (MRI) disclosed that the omentum ran continuously from the abdominal cavity into thoracic cavity a long left lateral hemi-thorax through a defect in the diaphragm. Surgical exploration revealed the laceration of left diaphragm and left parietal pleura. The omentum was herniated into the left pleural space through small diaphragmatic defect. We report X-ray, CT and MRI features of post-traumatic omental herniation into the pleural space that, to our knowledge it has not yet been reported so far.     

Traumatic injury of the diaphragm: Report of seven cases and extensive literature review

Seven proven cases of traumatic rupture of the diaphragm (TRD) following blunt trauma and an extensive 32-article review of 1345 cases of penetrating and blunt trauma are presented. The distribution of TRD was relatively consistent through the decades, with 458 cases of penetrating trauma (34%) and 887 cases of blunt trauma (66%); less than 1% of the cases were iatrogenic. There were 853 left-sided cases (67.2%), 359 right-sided cases (28.3%), and 48 bilateral and 10 central tendon cases (4.5%). In penetrating TRDs, 188 were left-sided (50%), 158 right-sided (42%), and 30 bilateral (8%). In the blunt TRDs, 606 were left-sided (73.1%), 195 right-sided (23.5%), and 18 bilateral and 10 central tendon (3.4%). Over 94% of 926 cases had another organ injured along with the diaphragm. There was an overall mortality of 21.6%; however, no fatalities were directly related to the TRD. Eighty-seven percent of TRDs were diagnosed within 24 hours, 81% within 12 hours, and 72% in less than 6 hours. The location of the laceration along the surface of the diaphragm was imperfectly described in the literature, offering no statistical information. The role of radiographic studies [plain films, barium studies, ultrasound, nuclear medicine, computed tomography (CT), and magnetic resonance imaging (MRI)] vs. surgical outcome in making the diagnosis of TRD is examined. Emphasis was placed on analyzing TRD in blunt trauma since it poses a more challenging clinical and radiographic dilemma in making a preoperative diagnosis. Plain radiographs were suggestive in 77% and diagnostic in 50% of TRD cases, while 47% were diagnosed at surgery and 3% by other radiologic studies. Barium studies are especially useful following a misdiagnosed TRD where the patient presents with a clinical history suspicious for strangulated abdominal viscera that occurred after herniation into the thorax. Radionuclide scanning may demonstrate liver within the thorax that herniated following a right-sided TRD. The role of CT is uncertain since we found only 32 cases (3.6%) in which CT was utilized, and only six of these (18.2%) were diagnostic for TRD. Early studies using MRI show high accuracy in dignosing TRD; it is especially valuable in uncertain cases. At present, nasogastric tube placement and serial chest radiographs are the recommended initial management for evaluating patients with potential TRD. This article was presented as the Alan Klein Memorial Lecture at the Fifth Annual Meeting of the American Society of Emergency Radiology, Orlando, FL, April 11, 1994.     

Multidetector-row CT of right hemidiaphragmatic rupture caused by blunt trauma: a review of 12 cases

AIM: To determine the usefulness of multidetector-row CT (MDCT) with multiplanar reformatted (MPR) images in the sagittal and coronal plane in diagnosing acute right hemidiaphragmatic rupture. MATERIALS AND METHODS: Twelve patients were identified who received chest and abdominal MDCT after major blunt trauma diagnosed with right diaphragmatic injury. Sagittal and coronal reformations were performed in all cases. The images were retrospectively reviewed by two experienced radiologists for signs of right diaphragm injury, such as direct diaphragm discontinuity, the "collar sign", the "dependent viscera sign", and intra-thoracic location of herniated abdominal contents. RESULTS: Of the 12 cases of right hemidiaphragm rupture, diaphragm discontinuity was seen in seven (58%) cases, the collar sign in five (42%), the dependent viscera sign in four (33%), and transdiaphragmatic herniation of the right colon and fat in another. Two variants of the collar sign were apparent on high-quality sagittal and coronal reformations. The first, termed the "hump sign", describes a rounded portion of liver herniating through the diaphragm forming a hump-shaped mass, and the second, termed the "band sign," is a linear lucency across the liver along the torn edges of the hemidiaphragm. The hump sign occurred in 10 (83%) patients and the band sign in four (33%). CONCLUSION: MDCT is very useful in the diagnosis of right hemidiaphragm injury caused by blunt trauma when sagittal and coronal reformatted images are obtained, and should allow more frequent preoperative diagnosis.     

腰椎椎弓峡部裂的CT诊断价值

目的 :探讨CT对腰椎弓峡部裂的诊断价值。方法 :回顾性分析 48例腰椎弓峡部裂的CT表现。根据腰椎定位像 ,采用与椎间盘前后缘中点连线平行角度 ,扫描范围包括病变椎体的椎弓平面至下一椎体上缘 ,层厚、层距 5 .0mm ,必要时 2 .0mm ,骨窗和脊髓窗双窗位观察。结果 :48例均显示脊椎椎弓峡部层面关节突间部低密度裂隙 ,断面呈锯齿状 ,即“裂隙征”。裂隙周缘骨硬化和 /或出现碎骨片 ,呈现“假肥大小关节”。脊椎滑脱则呈现“假性椎间盘突出征”及”阶梯征”。结论 :椎弓峡部CT薄层扫描对于峡部裂的清晰显示率较X线平片高 ,具有重要的临床意义     

多层螺旋CT胸部增强扫描的优化选择

目的：探讨多层螺旋CT胸部增强扫描最佳的对比剂注射流率和扫描方式。方法：80例CT胸部增强扫描随机分为4组，每组20例。组1、2、3、4注射流率分别为3.5ml/s、3.5ml/s、4.0ml/s、4.0ml/s；组1、3从肺尖向膈肌扫描；组2、4为膈肌向肺尖扫描。对比剂300mg I/ml，总量80ml。扫描延迟18s，平均扫描时间11.4s。扫描范围平均200mm。评价主动脉和肺动脉增强CT值、上腔静脉伪影和患不适感。结果：各组大血管强化CT值均数在250HU以上。3.5ml/s组和4ml/s，以及2种不同的扫描方向，其大血管总体增强程度均无显性差异（P＞0.05)。上腔静脉伪影以从膈肌向肺尖扫描为少（P＜0.05)。对比剂注射流率增加，伪影亦增加（P＜0.05)。组1和组2，患均无不良反应；组3和组4，各有1例患诉注射局部不适感。结论：以3.5ml/s注射流率从膈肌向肺尖部扫描，是多排螺旋CT胸部增强扫描较好的扫描方式。