小儿美克尔憩室及其合并症的CT表现

目的 探讨儿童美克尔憩室合并症的CT表现及诊断价值.方法 回顾性分析25例经手术及病理证实的儿童美克尔憩窒患者的临床及CT资料,25例均行CT平扫及增强扪描.结果 (1)直接征象:5例未发现明确憩室;20例于脐周或右下腹见憩室影,其中平扫呈含液管形表现9例,增强后均呈环形强化.憩室平扪呈实性结节样表现11例,增强后4例不强化,7例强化,其中3例呈均匀强化,4例呈不均匀强化.(2)间接征象:肠梗阻表现8例,憩室周围脂肪层肿胀、模糊9例,憩窒周边游离气体影3例,邻近肠系膜和(或)网膜增厚异常强化8例,腹水4例,继发肠套叠呈"同心圆"征1例.(3)CT分型:合并憩室炎和(或)出血型20例;合并小肠梗阻和(或)肠套叠型8例,其中索带压迫粘连7例,肠套叠1例;合并穿孔周围炎症型3例.结论 儿童美克尔憩室出现合并症后具有特征性CT表现,CT 可以清楚地显示其形态、内部成分和周边结构.     

小儿美克尔憩室及其合并症的CT表现

目的 探讨儿童美克尔憩室合并症的CT表现及诊断价值.方法 回顾性分析25例经手术及病理证实的儿童美克尔憩窒患者的临床及CT资料,25例均行CT平扫及增强扪描.结果 (1)直接征象:5例未发现明确憩室;20例于脐周或右下腹见憩室影,其中平扫呈含液管形表现9例,增强后均呈环形强化.憩室平扪呈实性结节样表现11例,增强后4例不强化,7例强化,其中3例呈均匀强化,4例呈不均匀强化.(2)间接征象:肠梗阻表现8例,憩室周围脂肪层肿胀、模糊9例,憩窒周边游离气体影3例,邻近肠系膜和(或)网膜增厚异常强化8例,腹水4例,继发肠套叠呈"同心圆"征1例.(3)CT分型:合并憩室炎和(或)出血型20例;合并小肠梗阻和(或)肠套叠型8例,其中索带压迫粘连7例,肠套叠1例;合并穿孔周围炎症型3例.结论 儿童美克尔憩室出现合并症后具有特征性CT表现,CT 可以清楚地显示其形态、内部成分和周边结构.

Abstract：

Objective To investigate the CT manifestations of Meckel's diverticulum and its complications in children. Methods Retrospective analysis of Clinical and CT findings in 25 cases with pathologically proved Meckel's diverticulum. The unenhanced and contrast-enhanced CT were obtained in all patients. Results (1)The direct signs: the diverticulum cannot be shown in 5 cases; the diverticulums were found around the navel or in lower right abdomen in 20 cases. The blind-ending fluid-filled or gas-filled structures were found in 9 cases, with heterogeneous ring-enhancement. The tubercle-like structures were detected in 11 cases, which showed no enhancement in 4 cases, and homogeneous enhancement in 3 cases,and heterogeneous enhancement in 4 cases. (2) The indirect signs included intestine obstruction in 8 cases,swelling fat layer surrounding the diverticulum in 9 cases, free gas around the diverticulum in 3 cases,thickened mesentery in 8 cases, ascites in 4 cases, and intussusception due to inverted Meckel's diverticulum with "target sign" in 1 case. (3) CT classification: with diverticulitis or diverticular bleeding in 20 eases; with intestine obstruction or intussusception in 8 cases; bands-caused obstruction in 7 cases;intussusception in 1 case; with perforation in 3 cases. Conclusion Meckel's diverticulum and its complications have typical CT findings, and CT can clearly demonstrate diverticulum's shape, margin,internal components and surroundiug tissues.     

CT检查在儿童Meckel’s憩室诊断的应用价值

目的分析CT平扫及增强检查在儿童Meckel’s憩室诊断的价值。方法回顾性分析2013年~2016年经临床表现及手术病理证实的儿童Meckel’s憩室的临床病史及相关影像资料,具有CT平扫或增强检查的患儿纳入研究,分析CT检查的图像质量(3分法),分析CT影像特点对Meckel’s憩室进行分型,包括囊状(管状)包块型,合并肠梗阻(包括肠套叠)型,合并穿孔周围炎型。结果一共48例患儿(平均4.7岁,男性36例,女性12例)纳入研究。CT检查具有满意的图像质量(平均评分2.7)。通过临床及病理资料,患儿Meckel’s憩室包括囊状(管状)包块型37例,合并肠梗阻(包括肠套叠)型8例,合并穿孔周围炎型3例。CT检出Meckel’s憩室的例数分别为23、8、3,总的检出的准确度70.8%。结论 CT平扫及增强对Meckel’s憩室畸形及其并发症的检出、评价及鉴别诊断提供非常重要的价值。     

螺旋CT对成人小肠套叠的诊断及临床价值

目的：探讨螺旋CT对成人小肠套叠的诊断及临床价值。方法：回顾分析20例经手术及病理证实的小肠套叠的螺旋CT表现及病理改变。结果：20例小肠套叠中小肠-小肠套叠15例,小肠-结肠套叠5例。CT表现直接征象有：靶形征10例,彗星尾征或肾形征7例,漩涡征3例。间接征象有：肠壁增厚12例,肠腔扩张16例,肠梗阻16例,邻近肠系膜或筋膜浸润4例等。20例小肠套叠的病因分别为：原发癌8例,转移瘤4例,淋巴瘤3例,息肉2例,平滑肌瘤1例,美克尔憩室1例,阑尾炎1例。结论：螺旋CT对小肠套叠的诊断和治疗有重要的指导作用。     

原发性肉瘤样肝细胞癌的CT诊断

目的 探讨原发性肉瘤样肝细胞癌(sarcomatoid hepatocellulax carcinoma,SHC)的CT表现.资料与方法 回顾性分析8例手术切除并经病理证实的SHC的CT表现.结果 肿块最大径约5～10 cm,属巨块型肝癌.6例为单发团块状,1例合并肝硬化,3例见门静脉癌栓形成.6例CT平扫表现为团块状囊实性低密度影,边界较清楚,其内见散在分布的结节状软组织密度影(4例)或不规则条状分隔影(2例);增强扫描示其中3例于动脉期呈轻度强化,静脉期强化程度稍有增加;3例于动脉期呈中度强化,静脉期强化程度减退.余2例CT平扫表现为不均质低密度影,边界不清楚,增强扫描呈轻度强化.结论 SHC的CT征象具有肝细胞癌(HCC)及肉瘤的双重特征,根据CT表现可以明确肿瘤的恶性特征及推测肉瘤样成分的存在,但确诊要依靠病理及免疫组织化学检查.     

膀胱憩室CT诊断

目的　探讨CT对膀胱憩室及并发症的诊断价值。方法　回顾性总结我院 7年以来经CT与B超诊断 2 4例膀胱憩室及合并症的影像学表现。结果　单发性膀胱憩室 18例 ,多发膀胱憩室 6例 ,膀胱憩室并发前列腺肥大增生 18例 ,前列腺肥大伴钙化13例 ,有 5例合并慢性膀胱炎 ,其中憩室合并结石 2例 ,膀胱憩室内并发癌 2例 ,均经手术病理证实。结论　CT能够较好地显示膀胱憩室的大小、部位、形态、开口及合并症。通过CT增强扫描能够及时发现憩室内早期的小肿瘤     

儿童非霍奇金淋巴瘤侵犯肾脏的CT表现

目的 总结儿童非霍奇金淋巴瘤(NHL)肾脏浸润的影像特点,提高对NHL侵犯肾脏的认识。方法 回顾性分析经临床病理确诊的11例儿童NHL肾脏浸润的临床资料及CT平扫和增强扫描结果,总结影像学征象。结果 双肾弥漫性结节5例,部分外凸,平扫与肾实质等密度,增强扫描强化低于肾实质,残余正常肾实质呈网状;双肾多发结节2例,平扫与肾实质比呈稍低密度影,增强扫描强化程度低于肾实质;双肾多发斑片状异常密度影2例,部分外凸,平扫与肾实质相比呈稍低或稍高密度影,增强扫描强化程度低于肾实质;双肾近肾盂不规则软组织密度影1例,增强扫描强化略低于肾实质,伴双侧肾盂积水;单肾不规则低密度影1例,强化程度低于肾实质。结论 儿童NHL肾脏浸润有一定的CT影像特点,主要表现为增强扫描双肾弥漫或结节状强化减低区,早期认识,有助于临床分期,对提高儿童NHL的预后有重要的意义。     

肾上腺创伤的CT表现

目的 探讨肾上腺损伤(AGT)的CT表现特征.方法 回顾性分析1712例因腹部钝伤行CT检查的患者中AGT患者的CT检查结果.结果 1712例中,共发现AGT 29例(1.7%),右侧损伤23例,左侧3例,双侧3例,共32个病灶.主要CT表现:(1)肾上腺血肿:22例25个病灶,呈孤立立圆形或卵圆形肿块,平扫为高密度或混杂密度,三期动态增强扫描均无强化,肿块周围见推移张开的肾上腺肢体,呈弧形线状明显强化.(2)肾上腺肿胀:4例,表现为受损部肾上腺肢体肿胀,体积增大.(3)肾上腺弥漫性出血:3例,肾上腺被出血包埋,正常肾上腺结构消失.1例伴对比剂外溢,手术证实为肾上腺碎裂伴活动性出血.伴随征象主要包括伤侧肾上腺周围条纹状出血浸润影,膈肌脚增粗等.合并其他胸腹部脏器损伤25例.结论 AGT具有特征性CT表现,采用合理扫描技术并正确认识AGT的CT征象有助于避免漏诊和误诊.     

十二指肠憩室的螺旋CT诊断

目的:分析十二指肠憩室的螺旋CT表现,探讨螺旋CT对该病的诊断价值.方法:分析25例(27个十二指肠憩室)患者十二指肠憩室及其并发症的螺旋CT表现,所有病例均经胃十二指肠造影检查确诊.结果:27个憩室中1个憩室小于1.0 cm,其余26个憩室均大于1.0 cm,其中5例大于2.0 cm,1例超过5.0 cm.憩室表现为胰头右后方圆形或半圆形含气囊袋影,可有液平;服用阳性对比剂者均能见阳性对比剂进入憩室.部分憩室内可见食物残渣影.憩室与胰头交界部边界锐利,合并十二指肠憩室炎者,平扫边缘模糊.结论:上腹部螺旋CT扫描应用广泛,虽对十二指肠憩室的检出率不高,但对巨大憩室及并发症的发现有一定意义.     

超声诊断套叠性美克尔氏憩室的“双靶征”

靶征是US诊断儿童肠套叠的可靠征象。偶然,肠套叠可由美克尔憩室引起,作者报道2例。例1,女,13个月。频繁呕吐8小时,U S检查于右上腹探及直径50mm和30mm的两个靶征,钡灌肠未能使肠套叠复位。经手术复位,证实肠套叠是由位于结肠起始部的美克尔氏憩室翻转形成回回结肠型肠套叠,憩室20mm×30mm,手术切除。例2,男,5岁。因痉挛性腹痛、呕吐就诊,右上腹可触及6cm大的包块。超声在右上腹可探及直径46mm和20mm的两个靶征,急症剖腹探查,见为翻转的美克尔氏憩室形成回回结肠型肠套叠,憩室20mm×60mm,     

Imaging manifestations of Meckel's diverticulum

OBJECTIVE: Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract, found in 2% of the population in autopsy studies. Most patients remain asymptomatic during their lifetime. Complications of Meckel's diverticulum are reported to occur in approximately 4-40% of patients and include inflammation (diverticulitis), hemorrhage, intussusception, small-bowel obstruction, stone formation, and neoplasm. The purpose of this article is to familiarize the radiologist with the current imaging of Meckel's diverticulum and its presenting complications. The spectrum of diagnostic findings on various imaging techniques will be reviewed. CONCLUSION: Meckel's diverticulum and its complications are a serious health problem. Familiarity of the radiologist with the appearance of this pathologic entity enables an accurate diagnosis in emergent settings.     

Meckel's stone ileus.

Meckel's diverticulum is the most common congenital abnormality of the small bowel; it occurs in approximately 2% of the population. Complications of Meckel's diverticulum include hemorrhage, usually associated with heterotopic tissue within the diverticulum, intussusception, development of benign or malignant neoplasms, and inflammation. Formation of one or more enteroliths within a diverticulum is rare. An extremely rare complication is mechanical small bowel obstruction secondary to extrusion of an enterolith from a Meckel's diverticulum (Meckel's stone ileus). A case of Meckel's stone ileus is described herein, with a review of the literature of this extremely rare complication.     

隐匿性外伤性肠破裂的CT诊断

目的 探讨隐匿性外伤性肠破裂的CT表现,以提高对该病的诊断水平.方法 对11例手术证实的隐匿性外伤性肠破裂CT表现进行回顾性分析.结果 主要特异性CT征象有:(1)游离气体,共4例,位于外伤处小肠周围、膈下、腹膜后间隙,或位于包块内各l例;(2)肠间隙血肿或肌壁间高密度血肿(4例);(3)肠壁损伤征,受累肠肇局部低密度影,增强扫描强化局限性减弱,相邻肠管强化相对增强(3例);(4)外伤处小肠及周围包块(4例),增强扫描该包块有明显环形强化,延迟扫描有进一步强化.其他征象有:(1)腹腔及肠间隙积液(5例),周围脂肪间隙或肠间隙模糊改变(8例);(2)肠梗阻(11例).结论 CT对诊断隐匿性外伤性肠破裂钉重要诊断价值.     

小肠灌肠对美克耳憩室的诊断（附10例手术病例）

美克耳憩室导致消化道出血，每需手术治疗，但术前能为Ｘ线检查所确诊者为数不多，成年患者更易于漏诊或误诊。本文报道应用插管法小肠钡剂灌肠发现本病１０例，均经手术治疗而得到病理证实。本文讨论时提出：美克耳憩室缺乏特异症状和临床表现，应用插管法作小肠钡剂灌肠，易于显示憩室之囊袋状充盈像。偶尔美克耳憩室可出现多种并发症，憩室之典型Ｘ线征象常被隐匿，而其Ｘ线表现呈多样化。本病Ｘ线诊断需与下列疾病相鉴别：（１）     

小肠扭转的螺旋CT诊断

目的:探讨螺旋CT对小肠扭转的诊断价值.方法:对8例经手术证实小肠扭转患者的病例资料进行回顾性分析.1例患者行CT平扫,7例行CT平扫和双期增强扫描,并进行图像后处理,包括容积再现(VR)、多平面重组(MPR)和最大密度投影(MIP).结果:8例中7例有肠管和血管的漩涡征,5例有鸟喙征,2例见同心圆征,4例显示肠管壁强化减弱、肠壁水肿和腹水.结论:肠管和血管的漩涡征是诊断小肠扭转的特征性征象,同心圆征、肠管强化减弱、肠壁水肿和腹水的出现,则高度提示绞窄性肠梗阻;螺旋CT增强扫描和图像重组可对小肠扭转做出准确的定位和定性诊断.     

CT of Meckel's diverticulitis in 11 patients

OBJECTIVE: This study reviews the CT findings of Meckel's diverticulitis in 11 patients and, to our knowledge, represents the largest series of such cases reported to date. CONCLUSION: The inflamed Meckel's diverticulum may be visualized on CT in most patients, appearing as a blind-ending pouch of variable size and mural thickness and containing fluid, air, or particulate material with surrounding mesenteric inflammation. The location of the diverticulum may vary from the right lower quadrant to the mid abdomen, with most cases in this series located near midline. Optimal luminal opacification of the ileocecal bowel with oral contrast material facilitated detection of the diverticulum and also proved invaluable in enabling identification of the normal appendix. The diagnosis is most difficult in the setting of secondary intestinal obstruction.     

Anatomohistological characteristics of Meckel's diverticulum in human fetuses

BACKGROUND/AIM: Meckel's diverticulum (MD) is the most frequent anomaly of the small intestine. It appears after incomplete obliteration of the omphalomesenteric or viteline duct which normaly obliterates and disappears by the 9th week of gestation. The majority of MD do not give rise to any clinical symptoms and are encounted either incidentally, at examination or intervention, or due to complications which may occur (obstruction, hemorrhagy, rupture), and are described in many clinical reports. The aim of the study was to find out the incidence of MD in fetuses when the development of the alimentary tract is already finished. METHODS: The investigation was performed on 150 human fetuses of different sex and gastational age, using microdissection method. The cases with MD were photographed, described, their positions and dimensions were registered. The samples of MD taken for histological investigation were dyed with hematoksilin eosin method. RESULTS: Meckel's diverticulum was found in five fatuses (three male and two female); in one case the fibrous band was found. All of them were located on animesenteric margine of the small intestine at the average distance of 92.5 mm from the ileocecal junction. They were of different shape and dimensions, but of the normal constitution of the small intestine. CONCLUSION: The incidence of MD was 3.3%, and 4% of all the anomalies of the intestines connected to the disappearance of the viteline duct. It was more frequent in the male, located on antimesenteric margine of the small intestine, at the destination which highly correlated to the age of the fetus. Meckel's diverticule were of different shapes and dimensions but of the typical constitution of the small intestine.