右上纵隔增宽的CT诊断价值(附56例分析)

目的探讨X线平片右上纵隔增宽的CT诊断价值。方法分析56例经手术、病理或CT增强扫描、心脏超声证实的右上纵隔增宽X线和CT表现。所有病例均行X线平片和CT平扫,其中51例行CT增强扫描。结果非侵袭性胸腺瘤6例;侵袭性胸腺瘤致上腔静脉综合征2例;胸内甲状腺肿瘤2例;升主动脉或无名动脉迂曲14例;胸主动脉瘤3例;肺动脉狭窄致主肺动脉扩张1例;右位主动脉弓2例;淋巴瘤4例;右肺纵隔型肺癌16例;隐匿型肺癌2例;食管下段癌致胸上段食管明显扩张2例;食管异物继发上纵隔脓肿2例。经CT平扫 增强扫描、手术、病理、心脏超声证实病例数分别为33、10、12、1例。结论CT扫描是诊断右上纵隔增宽的可靠检查方法。     

青少年自发性纵隔气肿2例并文献复习

目的 :分析青少年自发性纵隔气肿(SPM)的影像学表现,以提高诊断水平。方法 :分析我院2例青少年SPM的资料,并回顾近年来相关文献。结果:X线平片示纵隔气肿呈纵隔增宽,纵隔缘透亮影,胸骨后透亮隙影。CT更能清晰显示气管、支气管、食管、血管周围积气及间质性肺气肿。结论:SPM多见于青少年,X线平片有一定的诊断价值,CT更有利于纵隔气肿的诊断及病因的发现。     

胸部结节病的CT表现

目的:探讨CT诊断胸部结节病的影像学表现。方法:回顾性分析经临床和病理证实并在治疗前后均进行CT检查的20例胸部结节病的CT征象。结果:20例均可见胸部淋巴结增大,其中14例有广泛的纵隔和对称性肺门淋巴结肿大;4例纵隔和单侧淋巴结肿大;2例可见纵隔淋巴结肿大。13例出现肺部病(包括9例肺内多发结节,3例斑片状融合块影,1例肺纤维化);1例胸膜病变。结论:结节病的胸部平片及临床表现缺乏特异性,CT对胸部结节病的诊断及鉴别诊断有一定的价值。     

纵隔炎2例报告

纵隔炎是一种发展迅速的致死性炎症性疾病 ,临床上少见 ,笔者报告 2例 ,并着重讨论分析其影像学表现及鉴别诊断问题。病例 1,男 ,3岁。因反复高热伴流涕 5ｄ来院就诊。Ｔ40℃ ,Ｐ 12 5次 ｍｉｎ ,Ｒ 30次 ｍｉｎ ,全身浅表淋巴结无肿大 ,双肺呼吸音粗 ,患儿已接种卡介苗。血ＷＢＣ 2 5× 10 9 Ｌ ,ＲＢＣ 3 .6 4×10 1 2 Ｌ ,Ｈｂ 10 3ｇ Ｌ ,ＰＰＤ试验阴性 ,痰脱落细胞检查未查到癌细胞。Ｘ线检查 :胸部正位片示上纵隔向两侧增宽 ,边缘不清晰 ,双肺门增大模糊 (图 1) ;侧位片示中上纵隔密度增高 ,未见明显肿物影 (图 4)。胸部ＣＴ示中…     

1例主动脉夹层合并全身多发骨折的术后护理

病例男,30岁,因车祸致左大腿、髋部疼痛、畸形、活动受限3 h,于2010年1月1日就诊于当地医院.X线检查示：（1）左股骨中段骨折 （2）左髋臼骨折 （3）双肺挫伤.胸部CT示：胸主动脉瘤.为进一步治疗,于2010年1月4日就诊我院,经各项检查和复查CT及血管造影,同意他院诊断.鉴于患者有胸主动脉瘤,经会诊后建议不宜行骨科手术.     

自我测验(六)

1.下列有关夹层主动脉瘤CT 诊断的描述是否正确?a.非增强CT 检查不能证实夹层主动脉瘤。b.CT 不能证实主动脉并闭锁不全。c.CT 容易证实向纵隔及胸膜的外渗以及对诸如气管和上腔静脉的压迫。d.CT 将确切证实主动脉大分枝的闭塞。e.夹层主动脉瘤的CT 诊断基本上依靠内膜片     

软骨肉瘤的影像学诊断

目的:探讨软骨肉瘤的影像学诊断。方法:回顾性分析经病理证实的32例软骨肉瘤的影像学特点。32例均行X线平片检查,其中25例行CT检查,MR检查14例。结果:32例平片发现病变内钙化28例。25例做CT者均见骨质破坏和钙化影,软组织肿块21例,骨膜反应2例。MR表现:肿瘤呈等长T1长T2为主的混杂信号,可见长T1短T2信号分隔,增强扫描示分隔强化和肿块周边部强化,钙化呈长T1短T2信号。结论:骨质破坏、钙化、软组织肿块、弓环状分隔等构成软骨肉瘤的主要影像学特点,对诊断和鉴别诊断具有重要价值。     

纵隔型肺癌的影像学表现

目的:探讨纵隔型肺癌的影像学表现,为临床制定合理的手术方案提供更准确的信息。方法:回顾性分析15例经手术和病理证实的纵隔型肺癌的X线和CT资料。所有病人均行胸部正侧位片和CT平扫检查,13例病人还行CT增强扫描。结果:15例病人中有8例位于右肺门,3例位于左肺门,右上肺和左上肺各2例。平片显示纵隔增宽,气管受压移位,4例可见胸腔积液。CT显示肿块位于纵隔胸膜下,与纵隔呈宽基底相贴,边缘不规则,增强后不均匀强化。结论:结合临床症状和体征,仔细分析影像学表现,大部分纵隔型肺癌都可以作出准确诊断。     

儿童纵隔神经母细胞瘤的影像学诊断

目的　探讨儿童纵隔神经母细胞瘤的影像学诊断价值及限度。方法　回顾性分析经手术、病理证实的 8例纵隔神经母细胞瘤的X线平片、B超及CT检查的影像学特征 ,比较它们的作用及限度。结果　X线平片 7例见后纵隔包块 ,提示神经源性肿瘤可能 ;B超 8例均可见纵隔包块 ,6例显示包块内血流丰富 ;CT检查均可见类圆形软组织包块 ,6例见密度混杂 ,内有团片状钙化影。结论　X线平片适于初步的定位诊断 ;B超更适合配合不佳儿童的初步检查 ,并可显示瘤内血供特征 ;CT则为最佳方法 ,不仅可作倾向性定性诊断 ,而且可显示与周围组织的解剖关系。     

食管巨大憩室1例

患者女,57岁.餐后胸骨后不适13年,加重半年入院.患者1 3年前出现进食后哽噎感, 近半年症状加重,自行呕吐后缓解.入院查体未发现阳性体征,血、尿常规及肝、肾功能未见异常.影像学检查:胸部正位片示中下纵隔心影重叠处可见一椭圆形高密度影,约7.0cm×5.0cm,密度均匀,右侧边界光滑清楚(图1) .     

Optimization of the system of medical service of students of Cadet Schools of the Ministry of Defense of the Russian Federation

One of the factors of the successful military career guidance Cadet schools students is preserving and promoting their health. Medical support of children and adolescents aged 10-17 years should include the full range of medical and preventive measures defined for this group. The state of providing outpatient care for pupils at the Cadet School in St. Petersburg was studied. These results show that full medical care in accordance with the standards can be based only on children's health clinics. It is important that the organization of medical support pupils cadet schools should be cooperate with civilian health care.     

带状疱疹83例误诊原因分析

带状疱疹是由水痘—带状疱疾病毒引起的皮肤科常见疾病。其主要的病理损害,一是受累神经的严重炎症性浸润,继而导致受侵犯神经节内神经细胞变性、坏死;二是皮肤的水泡。迅速抑制神经节和相应的感觉神经纤维的充血、水肿和坏死,防止粘连形成,达到迅速镇痛、改善皮损,缩短病程及防止后遗症的发生是治疗的关键。因而,尽早明确诊断,     

Estimation of accumulated dose of radiation by method of ESR-spectrometry of dental enamel of mammals

ESR-spectrometry was used to investigate radiation-induced paramagnetic centers in enamel of mammals: carnivores (polar bear and fox), ungulates (reindeer, European bison, moose), and man. Values at half the microwave power saturation of the radiation signal, P_1/2, evaluated at room temperature, was found to range from 16 to 26 mW for animals and man. A new approach to discrimination of the radiation induced signal from the total ESR spectrum of reindeer enamel is proposed. ‘Dose-response’ dependencies of enamel of different species mammals were measured within the dose range from 0.48 up to 10.08 Gy. Estimations of ‘radiosensitivity’ enamel of carnivores and ungulates showed good agreement with radiosensitivity enamel of man by ESR method.     

Analysis of the results of the international comparison of activity measurements of a solution of Fe

The results of an international comparison of activity measurements of a solution of ⁵⁵Fe organized by the BIPM in 2005 are reported and analysed. This exercise, which follows the procedures of the CIPM mutual recognition arrangement to update older comparisons, is a renewal of the comparison organized by the BIPM that took place in 1978. A EUROMET comparison was organized in 1996 specifically to compare activity measurements of a ⁵⁵Fe solution by means of liquid-scintillation techniques. Results of these three comparisons are presented and discussed in this paper.

The radionuclide solution was provided by the NPL, which also distributed the samples to the participants. The activity of the ampoules was measured by 16 laboratories using 12 methods producing 25 results. Some general considerations on uncertainty assessments pertaining to the different techniques used are drawn. The outcome of four different estimators is compared from which the presence of at least one outlier can be confirmed. Further measurements should be made to try to reduce the discrepancy between the results. To date the outcome of the present comparison does not show an improvement to that of the 1996 comparison.     

Evaluation of the results of various technics of non-surgical therapy of varicocele

A new method of non-surgical treatment of varicocele syndrome is described: it consists in sclerotherapy of spermatic vein by trans-femoral percutaneous catheterization with balloon-catheters. In 8 cases venous thrombosis has been induced by direct electric clotting. The techniques and a 6 months follow-up are discussed. It is pointed out that this procedure should be considered as the method of choice for tubular lesions and sub-fertility prophylaxis in young people and in childhood.     

延迟性脾破裂误漏诊原因分析

目的探讨延迟性脾破裂误漏诊原因和预防措施.方法回顾性分析总结12例延迟性脾破裂中的诊断和误漏诊的经验与教训.结果本组延迟性脾破裂的误漏诊5例(41.66%).对多发伤与脾破裂并存可能认识不足,外伤史轻微或伤员隐瞒外伤史,缺乏腹痛-缓解-突然再腹痛的典型病史,缺乏“对冲性脾破裂”力学分析和整体化诊断思路等为其误漏诊的主要原因.结论详细的外伤史和全面系统检查,重视腹以外多发伤掩盖腹内脏器伤及延迟性脾破裂可能.确立外伤-腹内脏器伤-脾破裂整体化诊断思路.不间断地辅以B超检查脾形态学变化和腹内有无积液,腹腔穿刺确定有无血腹、X线胸腹部检查观察左侧胸肋角和膈肌运动情况、必要时CT检查以尽早发现脾包膜下血肿,降低延迟性脾破裂误漏诊率.