膈肌支气管源性囊肿误诊为肺囊肿一例

支气管源性囊肿为一种先天性病变,发生于膈肌罕见。该文报道1例膈肌支气管源性囊肿被误诊为肺囊肿的患者。其为46岁女性,因行胸部CT检查发现胸腔内肿块入院,结合MRI结果,术前诊断为右下肺囊肿,排除手术禁忌证后于胸腔镜下切除囊肿,术中发现囊肿发生于膈肌,与右下肺组织分界清晰,最终病理诊断为膈肌支气管源性囊肿。术后随访半年,患者情况良好。     

First-trimester diagnosis of fetal hepatic cyst.

Fetal intra-abdominal cysts seen on antenatal sonography pose a diagnostic problem as they may have many etiological origins. We present a case of a hepatic cyst measuring 11 x 7 x 7 mm that was diagnosed at 13 weeks' gestation by transvaginal sonography. The cyst increased in proportion with the growth of the fetus. Ultrasound-guided needle aspiration of the cyst at 22 weeks' gestation helped to clearly identify the formerly displaced gall bladder and demonstrated the intrahepatic location of the cyst. The aspirated fluid was identified as bile. After aspiration the fluid reaccumulated rapidly. Shortly prior to delivery the cyst measured 75 x 44 x 46 mm. At 39 weeks of gestation a female infant was delivered by forceps (3610 g; Apgar 9/10/10 at 1, 5 and 10 min, respectively). Increasing cyst size and concomitant feeding problems prompted surgery on the 14th day postpartum. A large hepatic cyst was partially excised and marsupialized, confirming the prenatal diagnosis. The postoperative course was complicated by cholangitis, septicemia and recurrence of the cyst. Therefore Roux-en-Y hepatojejunostomy was performed in the second month of life. The postoperative period was uneventful and the child was doing well at the time of writing.     

Lymphoepithelial cyst of the hypopharynx

A rare case of lymphoepithelial cyst formed in the piriform sinus of the hypopharynx is reported. Histopathological examination revealed a lymphoepithelial cyst. It was removed by laryngomicrosurgical technique using a side-opened direct laryngoscope. Because this cyst was wide-based on the antero-medial region in the right piriform sinus of the hypopharynx, the mucous membrane around the cyst was incised electrosurgically and then detached to facilitate removal. In this paper, we describe our surgical procedure for removing the cyst in this case and discuss the possible causes of the disease.     

肾盂源性囊肿非血管超声造影诊断的方法及意义

目的 探讨非血管超声造影对剔除肾盂源性囊肿,提高肾囊肿无水乙醇硬化治疗安全性的积极意义.方法 制订纳入标准后对接受超声引导下肾囊肿穿刺无水乙醇硬化治疗的23例患者进行囊肿腔内注射Sono Vue造影剂,以造影剂从囊肿腔内逸出进入同侧肾集合系统内为肾盂源性囊肿的诊断依据,将之剔除出硬化治疗行列.结果 从23例患者中检出3例肾盂源性囊肿,中止硬化治疗;证实4例因形态怪异而疑为肾盂源性囊肿的患者仍为单纯性肾囊肿,继续硬化治疗.结论 囊肿腔超声造影可以有效地鉴别单纯性肾囊肿和肾盂源性囊肿,提高肾囊肿穿刺硬化治疗的安全性.     

肾盂源性囊肿非血管超声造影诊断的方法及意义

目的 探讨非血管超声造影对剔除肾盂源性囊肿,提高肾囊肿无水乙醇硬化治疗安全性的积极意义.方法 制订纳入标准后对接受超声引导下肾囊肿穿刺无水乙醇硬化治疗的23例患者进行囊肿腔内注射Sono Vue造影剂,以造影剂从囊肿腔内逸出进入同侧肾集合系统内为肾盂源性囊肿的诊断依据,将之剔除出硬化治疗行列.结果 从23例患者中检出3例肾盂源性囊肿,中止硬化治疗;证实4例因形态怪异而疑为肾盂源性囊肿的患者仍为单纯性肾囊肿,继续硬化治疗.结论 囊肿腔超声造影可以有效地鉴别单纯性肾囊肿和肾盂源性囊肿,提高肾囊肿穿刺硬化治疗的安全性.     

Intracystic hemorrhage in a non-endometriotic mullerian vaginal cyst

The commonest type of simple vaginal cyst is the Mullerian cyst. These are typically lined by columnar epithelium and contain serous or mucinous fluid. If blood is found in the cyst, the source is usually due to the presence of endometrial elements in the cyst wall. The cyst is then termed an endometriotic cyst. In this case report, we have described a woman with a symptomatic 3 cm upper vaginal cyst who underwent surgical excision of the cyst. The cyst cavity was found to be full of old dark blood and mucous, however the wall contained no endometrial tissue and was lined by columnar epithelium which stained positive for mucous with mucicarmine. No cause for the intracystic hemorrhage was identified. We conclude that intracystic hemorrhage can occur in a simple Mullerian vaginal cyst in the absence of endometrial components.     

MR findings in pericardial hydatid cyst

Pericardial hydatid cyst is rare. We present a 32-year-old man with a pericardial hydatid cyst. Chest x-ray film showed a spherical mass located left mediastinum. A pericardial cyst with low signal intensity was noted on T1 weighted magnetic resonance (MR) images. The cyst had high signal intensity, but signal intensity of folded parasitic membranes in the cyst were seen lower intensity on T2 weighted MR images. Based on these MR findings, pericardial hydatid cyst was diagnosed. The patient underwent surgical removal of the cyst. Histologic study of the cyst confirmed hydatid cyst diagnosis.     

Report of a case of video-assisted thoracoscopic resection of bronchogenic cyst developed in the aorto-pulmonary window

We report the case of a 28-years-old male with a bronchogenic cyst developed in the aorto-pulmonary window. Left video-assisted thoracoscopy was performed and the cyst was removed intact and completely. Operative time was 48 minutes. The postoperative course was uneventful and the patient was discharged on the third postoperative day. We believe that an uncomplicated mediastinal bronchogenic cyst can be successfully approached by video-assisted thoracoscopy. In the case of an intraparenchymal or complicated cyst, thoracoscopic resection can be technically difficult and hazardous, and open approach is preferable.     

彩色多普勒超声诊断卵巢囊肿蒂扭转的临床价值

目的探究彩色多普勒超声(CDFI)诊断卵巢囊肿蒂扭转的临床价值,以期为临床治疗提供参考依据。方法以2017年2月至2020年2月46例收治的疑似卵巢囊肿蒂扭转患者作为研究对象,患者均接受CDFI以及病理检查,并对检查结果进行分析。结果46例疑似卵巢囊肿蒂扭转患者的麻花状绳状、血管蒂类型检出率为47.83%,盆腔游离液性暗区检出率为52.17%,囊肿直径≤8 cm的检出率为78.26%,囊壁厚度>0.85 cm检出率为50.00%,囊性肿块检出率为80.43%。疑似卵巢囊肿蒂扭转患者经CDFI检查的卵巢黏液性腺囊瘤、卵巢浆液囊腺瘤、卵巢囊性畸胎瘤、卵巢黄体囊肿、卵巢巧克力囊肿、单纯卵巢囊肿检出率与病理诊断结果比较,差异无统计学意义(P>0.05)。CDFI诊断卵巢囊肿蒂扭转的灵敏度为90.91%,特异度为100.00%,准确度为91.30%。结论CDFI应用在卵巢囊肿蒂扭转患者的诊断中,有着较高的灵敏度、特异度、准确度,可较好地检出疾病,且可鉴别诊断疾病的具体类型,为患者疾病的确诊以及治疗方案的制定提供参考依据。     

Endoscopic fenestration of pseudo cyst in acute pancreatitis

We report a case of pseudo cyst accompanied by acute pancreatitis which was successfully treated by endoscopic cyst-gastrostomy. It had been enlarged recurrently after twice simple needle aspiration under ultrasonic monitoring. Because of the infection of the cyst, rapid and complete drainage was needed. Upper gastro-intestinal endoscopy showed a large bulge of the stomach which was compressed by paragastric pancreatic cyst. Endoscopic ultrasonography revealed that the cyst wall was attached hard with the stomach and there was no vessels between them. Endoscopic fenestration of the bulge was created using papillotome and diathermic snare. The drainage was effective and cyst was decompressed rapidly. The fenestration was closed after the cyst was diminished. Recently the endoscopic cyst-gastrostomy made by cutting linearly or inserting catheter have been reported, however, these treatments sometimes resulted in infection and relapse because of the quick closure of the fistula. When the bulge is large and endoscopic ultrasonogram revealed low bleeding risk, the fenestration may be advisable for effective drainage of longer duration without infection.     

Complete laparoscopic choledochal cyst excision and hepaticojejunostomy with laparoscopic Roux-Y reconstruction using a 5-mm stapler: A case of a 2-month-old infant

Laparoscopic choledochal cyst excision and hepaticojejunostomy for choledochal in children is performed only at particular institutions because of the technical difficulty. Although choledochal cyst excision and hepaticojejunostomy are feasible, the small working space of infants makes intraabdominal Roux-Y reconstruction technically challenging. A 2-month-old girl diagnosed with a choledochal cyst underwent complete laparoscopic choledochal cyst excision and hepaticojejunostomy, including intraabdominal Roux-Y reconstruction with a 5-mm stapler. After cyst excision, Roux-Y reconstruction was performed in the intraabdominal cavity. Jejunojejunostomy was performed in a side-to-side fashion using a 5-mm stapler, and the entry hole was closed laparoscopically by hand-sewing, along with the mesentery defect. All procedures were performed by laparoscopic surgery. The postoperative course was uneventful, and the patient showed a quick recovery. Using small-diameter instruments, completely laparoscopic procedures for choledochal cyst are feasible.     

支气管囊肿的CT表现及特征

目的 探讨支气管囊肿的CT征象及诊断价值。方法收集20例经手术病理证实的CT影像，进行回顾性分析。结果 20例支气管囊肿，纵隔内10例，肺内9例，膈肌1例；单发病灶16例，多发病灶4例；含液囊肿8例，含气液囊肿7例，含气囊肿2例，实质性囊肿3例，单房囊肿15例，多房囊肿5例；薄壁囊肿14例，厚壁囊肿6例；8例病灶作了平扫与增强对照，表现为囊液无强化，囊壁有均匀强化；7例病灶合并感染，6例支气管囊肿压迫相邻气管地气管及血管；CT正确诊断为支气管囊肿17例，正确率85%。结论 纵隔型及肺内型支气管囊肿有特征性CT表现，CT诊断价值大，异位型支气管囊肿缺乏特征性CT表现，仅借助CT诊断有一定困难。     

二维和彩色多普勒超声诊断颈部囊性包块及误诊原因分析

本文报告87例颈部囊性包块二维超声和彩色多普勒血流显像(CDFI)情况。并对其在囊实性判断、定位、病因等方面出现错误的原因分析。正确率79.4%(69/87)。错误率20.6%(18/87)。囊实性判断错误主要是将囊肿内浓稠的液体误为实性包块。定位错误主要是对疾病的解剖位置不熟悉。病因错误主要是将腮裂囊肿、海绵状血管瘤、表皮样囊肿中的气体、血栓、纤维组织机化、钙化及炎症误诊为淋巴结结核。认为二维超声结合CDFI有助于提高颈部囊性包块的诊断准确性。     

Quantification of pepsinogen C and prostaglandin D synthase in breast cyst fluid and their potential utility for cyst type classification

OBJECTIVE: To quantify pepsinogen C (PEPC) and prostaglandin D synthase (PGDS) in breast cyst fluid and examine if these two parameters can be used for breast cyst type classification. DESIGN AND METHODS: We quantified PEPC and PGDS in 92 and 50 breast cyst fluids, respectively, using previously established immunofluorometric procedures. We then examined if the levels of PEPC or PGDS correlate with the type of cyst or with other clinicopathological variables. RESULTS: Quantitative analysis of the breast cyst fluids indicated that PEPC is present in all cyst fluids at various concentrations ranging from 3 to 31,000 ng/mL. PGDS positivity was confined to 30% of the cyst fluids. PEPC and PGDS levels were correlated with the breast cyst fluid cation ratio and were associated with the type of the cyst. Increased PEPC levels in breast cyst fluids were significantly correlated with a > or = 1.5 K+/Na+ ratio and were associated with the secretory/apocrine type of cyst (Type I) (p = 0.011). Immunoreactive PGDS levels were highly correlated with a low cation ratio and were associated with the transudative/flattened type of breast cyst (Type II) (p = 0.0003). A weak association was observed between PEPC levels in breast cyst fluid and menopausal status (p = 0.093). No significant associations were observed for either PEPC or PGDS concentration in breast cyst fluid and number of cysts, recurrence of the disease, family history of breast cancer, number of children, abortion, and breast feeding. CONCLUSIONS: Quantification of PEPC and PGDS in breast cyst fluid may be useful in the subclassification of cyst type in patients with gross cystic disease.     

Transient fetal sternal dermal cyst: report of 2 cases and literature review.

OBJECTIVE: The purpose of this series was to describe the prenatal diagnosis and pregnancy outcome of fetuses affected by a transient idiopathic fetal sternal cyst. METHODS: Two fetuses had the diagnosis of an isolated presternal cyst at routine sonography at 15 weeks. A follow-up sonographic examination was done, and the neonates were examined after birth. RESULTS: In both cases, the cyst disappeared at 20 weeks' gestation, and both fetuses had only a small dimple at the location of the cyst. CONCLUSIONS: An isolated presternal cyst is an extremely rare finding. It should be followed sonographically, and if it disappears within a few weeks, the diagnosis of a dermal inclusion cyst should be suspected. Parents can be informed to anticipate a small depression on the neonate's chest.     

苗勒管囊肿与射精管囊肿的超声表现

目的 探讨经直肠检查苗勒管囊肿与射精管囊肿的超声表现。方法 对34例经直肠超声检查发现患有位于精阜后上方单发囊肿的患者，行经直肠超声引导下囊肿穿刺抽液及对囊肿液行病理检查，含精子的为射精管囊肿，不含精子的为苗勒管囊肿，并比较分析两者超声图像的差异。结果 经穿刺抽液病理检查确诊27例为苗勒管囊肿，7例为射精管囊肿，两者超声图像无明显特征性差异。结论 经直肠超声图像很难鉴别苗勒管囊肿与射精管囊肿，经直肠超声引导下囊肿穿刺抽出液病理检查才是鉴别两者的唯一标准。     

腹腔镜肾囊肿切除术两种不同入路的比较

目的 比较腹腔镜两种入路肾囊肿切除术的优越性。方法 采用经腹腔与后腹腔腹腔镜行肾囊肿25例，其中经腹腔径路8例，腹膜后路径17例。结果 经腹腔路径平均需时80min，术后1例不全肠梗阻。腹膜后路径需时110min，术后皮下气肿2例，两组病例平均住院时间4d，术后恢复快。结论 两种入路腹腔镜肾囊肿切除术在住院时间、体力恢复无明显差别，后腹腔入路术后疼痛发生率、肠功能恢复方面明显优于腹腔入路。     

超声包裹征预测附件囊性包块蒂扭转的价值

目的探讨超声"包裹征"预测附件囊性包块蒂扭转的应用价值。方法回顾性分析193例因急性下腹痛就诊且超声检查存在附件囊性包块女性患者的超声图像,以手术结果为金标准确定附件扭转组131例,非扭转组62例,比较两组间超声包裹征的出现率,计算包裹征预测附件囊性包块蒂扭转的诊断效能。结果 (1)包裹征对应病理表现为扭转后输卵管及囊壁组织的广泛梗死水肿,半包绕扭转蒂部远端的囊肿;(2)扭转组131例中,出现包裹征共36例(27.5%),非扭转组中62例中出现1例(1.6%)包裹征,两组间差异具有统计学意义(P<0.001)。包裹征诊断附件囊性包块蒂扭转灵敏度、特异度和准确度分别为27.5%、98.4%、50.3%。当囊性包块最大长径<75.5mm时,包裹征诊断附件囊肿蒂扭转灵敏度、特异度和准确度分别为51.9%、97.6%、71.6%。结论超声包裹征预测附件囊性包块蒂扭转中具有高特异度。对于因下腹痛来诊女性患者,当合并包裹征时,应敢于提出疑似扭转的诊断。     

腹腔镜在治疗肾及肾上腺囊肿中的临床应用

目的 :探讨应用腹腔镜治疗肾及肾上腺囊肿的有效性。方法 :选择 12例直径 >5cm的肾囊肿 ,3例直径 >4 8cm的肾上腺囊肿 ,应用腹腔镜经腹腔途径切除治疗。结果 :15例肾及肾上腺囊肿均一次切除 ,手术时间肾囊肿组平均 70min ,肾上腺囊肿组平均 90min。术后平均住院 5 2d ,均治愈出院 ,平均随访 12 4个月 ,均无复发。结论 :腹腔镜治疗肾及肾上腺囊肿 ,损伤小、恢复快、疗效好 ,治疗彻底 ,临床可广泛应用     

经阴道彩色多普勒超声对胎囊型输卵管妊娠的诊断价值

目的　探讨经阴道彩色多普勒超声对胎囊型输卵管妊娠的诊断价值。方法　对经阴道超声诊断的 3 2例胎囊型输卵管妊娠的二维及彩色多普勒声像图改变进行总结分析。结果　 3 2例异位胎囊的特征为 :单侧附件区厚壁型囊性物 ,囊壁厚度均匀一致 ,约 2 .5～ 4.0mm ,回声强而均匀 ,囊内为液性暗区。与卵巢分界清。CDFI:囊性物周围血流丰富 ,似“花环样”包绕胎囊。PD :“花环样”血流处可录及低阻型滋养动脉频谱 ,舒张期血流丰富 ,RI平均为 0 .45± 0 .0 4。结论　经阴道彩色多普勒超声在诊断胎囊型输卵管妊娠中具有较强优势 ,结合血尿妊娠试验能为临床早期治疗提供可靠的诊断依据。