积气征

积气征是指在正常生理情况下不应存在气体的部位存在气体的征象。本文主要探讨各部位的积气征。     

急性胃肠炎伴胃壁、肠壁和门静脉积气一例

患儿 女．11岁。入院前2d因暴饮食出现腹胀、恶心，自感发热，无呕吐、腹痛、腹泻、畏寒等症状。在某诊所“输液后”恶心症状有所缓解。入院前1d．腹胀、恶心加重．并感腹痛和发热。     

肠壁积气的临床意义——与临床结果和治疗有关的MDCT表现

正摘要目的评估肠壁积气的临床意义,以及对治疗及临床结局的影响。方法 2位放射科医师共同回顾了149例患有肠壁积气的急诊病人(女53例,年龄21~95岁,平均64     

肠壁囊样积气症的多层螺旋CT表现及其诊断价值

 目的 分析肠壁囊样积气症(PCI)的多层螺旋CT(multisliecs helieal CT,MSCT)表现特点,以提高本病的诊断水平。方法 回顾性分析北京市石景山医院2008-01至2020-01收治的21例PCI患者的临床和MSCT检查资料,总结其MSCT影像学特征及临床诊断经验及教训。结果 21例PCI中,7例腹胀不适、间断隐痛且自行缓解,2例恶心呕吐,8例停止排便排气,肠镜及碎石后腹痛各2例。病变位于小肠5例,升结肠及盲肠4例,升结肠及横结肠3例,横结肠2例,乙状结肠7例,伴有腹腔游离气体13例,1例伴有肠系膜上静脉、脾静脉、门静脉积气。CT征象呈沿肠曲轮廓分布的黏膜和(或)浆膜下单发气泡影或多发“簇状”“串珠样”“环状”“条带状”含气低密度影,部分见肠内容物悬于肠道中央、见肠壁分层征。伴游离气体患者腹腔脂肪间隙见多发点状、片状气体影。21例中MSCT正确诊断7例,均经非手术治疗后治愈。结论 PCI在MSCT检查中具有一定的特征性表现,结合多平面重建、窗宽窗位技术使用能明确诊断并能显示周围组织情况,为临床治疗提供了重要依据。     

创伤性关节积气脂血征的多层螺旋CT诊断

创伤性关节积气脂血征指创伤后关节囊内气体、脂肪和血液同时存在，CT表现具有特异性，国内文献目前尚未见对此征象的详细报道。本文对2003年9月以来我院收治6例创伤性关节积气脂血征患者的多层螺旋CT（MSCT）及临床资料进行回顾性分析，探讨创伤性关节积气脂血征的CT表现及其发生机制。     

急腹症"双晕征"样肠壁增厚的CT诊断价值

目的 探讨急腹症CT示“双晕征”样肠壁增厚的临床诊断价值。资料与方法 搜集临床诊断为急腹症CT检出“双晕征”18例，其中急性机械性肠梗阻5例，放射性肠炎3例，肠系膜上静脉栓塞3例，阑尾脓肿2例，肠系膜上动脉栓塞、溃疡性结肠炎、中毒性痢疾、伪膜性结肠炎、肠结核各1例。结果 18例肠壁增厚6-15mm，均呈“双晕征”样改变，即内外层为相对高密度，中心层为水样低密度。除此之外．其他CT所见包括：肠管扩张积液7例，腹水7例。增强扫描直接显示肠系膜上静脉或其分支内血栓3例，阑尾脓肿2例。18例中CT诊断正确或基本正确16例。结论 “双晕征”样肠壁增厚主要是肠黏膜下水肿所致，有别于肿瘤性的肠壁增厚，见于多种病因所致的肠缺血性和炎症性疾病；该征象结合其他CT所见及临床病史，常能作出正确的病因诊断。     

主支气管壁显影征:纵隔积气的一种放射学新征象

作者报告一种新的纵隔积气征象——主支气管壁显影征,在1例有典型纵隔积气的15岁男孩的后前位胸片的启发下,作者随机分析了19例成人和青少年纵隔积气病例(男15例,女4例)的正位胸片。20例病例中8例见到主支气管壁(40％),以左侧更明显。其中5例只能见到左主支气管壁,另3例左右主支气管壁均可见到,任何一例中都未单独见到右主支气管壁。作者称这种征象为“主支气管壁显影征”。有2例的主支气管壁显影征是纵隔积气最显著的征象,其他6例中此征为附加征象。正常情况下主支气管壁的厚度是无法显示的,但当     

网膜囊积气征X线诊断(附7例分析)

目的 :本文报道网膜囊积气征 7例 ,并对其X线表现和价值作了探讨。方法 :透视、站立胸腹联合正位、左前斜位 (10°、4 5°)。结果 :网膜囊积气征X线表现为左膈下与胃底、脾之间一个倒置的三角形透亮区 ,左前斜位 (10°)显示最佳。结论 :网膜囊积气征是胃肠急性穿孔的一个最早X线征象。     

病例报告:双重对比钡灌肠所致气腹、网膜内积气和肠壁内钡剂穿孔

病例报告:患者,女,64岁,因腹泻3个月而就诊。以前无任何胃肠道病史及症状。体检来发现异常;钡灌肠前未做过乙状结肠镜检。检查前准备主要采用两袋硫酸吡啶钠清洁肠道。检查采用不带气囊的软端导管。当用充气球向肠腔内充气时,患者感到腹部不适和眩晕,并在站立位时出现虚脱。X线片证实腹腔内有多量的气体和颗粒状肠粘膜,呈轻度的结肠炎改变。虽然结肠并无过度扩张,但仍可见相当量的钡剂和气体由结肠进入回肠末端,在横结肠中段肠腔外有一不随体位变动的固定钡池,提示钡剂进入浆膜下层。     

A Review of Pneumatosis Intestinalis in the Setting of Systemic Cancer Treatments,Including Tyrosine Kinase Inhibitors

Purpose

Pneumatosis intestinalis is a radiologic diagnosis that manifests in a variety of clinical settings. We report 4 cases of pneumatosis intestinalis in patients undergoing cancer treatments that included cytotoxic agents and/or tyrosine kinase inhibitors. These reports aim to provide insight into the clinical interpretation and pathogenesis of pneumatosis intestinalis in the setting of cancer treatments and demonstrate a potential association with tyrosine kinase inhibitors.

Methods

Radiologists responsible for the interpretation of adult imaging at our tertiary care centre were surveyed to identify cases of pneumatosis intestinalis arising in the midst of cancer treatment. The case histories were reviewed by physicians with expertise in cancer treatment.

Results

Four cases of chemotherapy-related pneumatosis intestinalis were identified. The diagnosis was made in 1 patient during investigations undertaken for non–life-threatening abdominal symptoms and incidentally in 2 patients by abdominal imaging used to measure chemotherapy response. A fourth patient presented in a life-threatening manner, and abdominal imaging was symptom guided. Interestingly, 3 of the 4 patients were receiving treatments that included a tyrosine kinase inhibitor, and this agent was the only identifiable potential etiology in 1 patient.

Conclusions

The significance of pneumatosis intestinalis arising during cancer treatments is difficult to interpret because of the complex nature of the diseases and the treatments that often include combinations of cytotoxic agents and/or novel therapies. These reports demonstrate the importance of classifying this radiologic finding according clinical severity rather than etiology and underscore the need for continued observation for unexplained adverse effects when using novel therapies.     

Pneumatosis coli in non-Hodgkins lymphoma

Two patients with poorly differentiated lymphoma who developed pneumatosis coli are described. In one case, the intramural gas was associated with diffuse nodular submucosal deposits of tumour. An annular stricture due to lymphoma was the underlying aetiology of the pneumatosis coli in the second case. The pathogenesis of pneumatosis coli in the context of malignant lymphoma is discussed.     

Pneumatosis intestinalis in cystic fibrosis

We retrospectively reviewed the clinical and radiographic findings in patients with pneumatosis intestinalis (PI), who were identified among 441 patients with cystic fibrosis. Since 1944, the age at onset and the incidence of PI have increased. Pneumomediastinum, pneumothorax, or pulmonary interstitial emphysema was found in 95% of patients with PI compared with 62% of patients without PI. The type, distribution, and severity of PI often changed with time. PI is correlated with the development of obstructive pulmonary disease, which facilitates air dissection into interstitial spaces. Dissection of air is often clinically silent and tends to be self-perpetuating.     

Pneumatosis intestinalis after liver transplantation

Purpose

To evaluate clinical features and CT findings of pneumatois intestinalis in recipients following liver transplantation and to determine whether certain clinical and CT findings enable differentiation of indolent pneumatois intestinalis from fulminant cases.

Materials and methods

This retrospective study was approved by our institutional review board, with informed consent waived. Among 2080 liver transplantation recipients at our institution between January 1998 and April 2008, 22 (1%) presented with pneumatois intestinalis on postoperative follow-up. Patients were divided into recovery and mortality groups, and then clinical features and CT findings were compared between two groups.

Results

Although indolent pneumatois intestinalis more frequently presented incidentally (61%) after 2 weeks of surgery (89%) than fulminant pneumatois intestinalis (0, 50%), there were no statistically significant differences (P = .14, .09). Right colon was affected in the recovery group without exception (n = 18,100%), and all four patients (100%) in mortality group showed small bowel involvement (P < .05). Caliber changes of superior mesenteric artery and vein in mortality group were significantly greater (49.6%, 67.0%) than those in recovery group (101.7%, 99.0%) (P < .05, respectively). Pneumatois intestinalis in mortality group more commonly accompanied portomesenteric air-embolism, visceral infarction, hemorrhagic ascites, and small bowel ileus than indolent counterpart (P < .05, respectively).

Conclusion

Typical indolent pneumatois intestinalis is found incidentally later than 2 weeks of liver transplantation surgery, but there is some overlap between indolent and fulminant pneumatois intestinalis in terms of onset and mode of presentation. Among CT findings, grave signs are small bowel involvement, caliber changes in mesenteric vessels, portomesenteric air-embolism, visceral infarction, hemorrhagic ascites, and small bowel ileus.     

Pneumatosis intestinalis appearance on MR examination

We describe the magnetic resonance (MR) appearance of pneumatosis intestinalis in two patients. Pneumatosis is suggested by the finding of circumferential collections of air adherent or within the bowel wall. This air is more apparent on gradient-echo images due to “blooming” associated with magnetic field inhomogeneities at air-tissue interfaces. While MR is not routinely indicated as a diagnostic tool for the detection of pneumatosis, the radiologist should nevertheless be familiar with its appearance on MR examination.