原发性肺动脉肿瘤1例报道并文献复习

目的 探讨原发性肺动脉肿瘤的临床特点、诊断和治疗方法.方法 报道我院201 1年收治的1例原发性肺动脉肿瘤患者临床特征、诊疗经过及随访结果,并结合文献进行回顾性分析.结果 患者男性,47岁,有进行性活动时气短症状,增强CT示主肺动脉低密度肿块影并累及双侧肺动脉干,诊断为肺动脉恶性肿瘤.由于肿块位置特殊,未能行穿刺取病理及手术切除,予多西他赛＋奈达铂化疗同时联合放疗和中医药等综合治疗措施,治疗后症状明显好转.25个月后发现腹腔肿物,术后病理显示梭形细胞恶性肿瘤,考虑可能为肺动脉肿瘤转移.患者随访至2014年6月仍存活,且生存状态良好.结论 原发性肺动脉肿瘤十分少见,极易误诊为肺栓塞.CT等影像学检查可提高早期诊断率,确诊依赖于组织病理学诊断.化疗、放疗等综合治疗有显著疗效.     

Embolisation of a post-traumatic superior gluteal artery aneurysm: case report

Pseudoaneurysms of the superior gluteal artery are a rare complication of trauma. They can be diagnosed by Doppler ultrasound, computed tomography or magnetic resonance imaging. Angiography, however, is needed for definitive diagnosis. Transcatheter embolisation is now regarded as the treatment of choice. We present a case of superior gluteal artery pseudo-aneurysm following minor blunt trauma. The patient was successfully treated by transcatheter embolisation and aspiration.     

Blunt ureteral injury with associated aortic dissection: a case report

Ureteral injury from blunt abdominal trauma is very uncommon and is reported most often in children. We report a case mid-ureteral transection following blunt abdominal trauma that resulted in nephrectomy. There was also an associated aortic dissection. The pathophysiology, epidemiology, diagnosis, and treatment of blunt ureteral injury are also discussed.     

42岁男性主动脉弓离断1例报告

主动脉弓离断是一种罕见的、婴幼儿期死亡率高的严重复杂畸形,能长大成人更为罕见。一位42岁男性高血压患者,经主动脉CT血管造影检查证实,降主动脉起始部血管与主动脉弓中断,邻近脊柱旁、肋间及胸背部皮下软组织内见多个扭曲紊乱血管团,并于降主动脉起始水平见数支血管汇入降主动脉CT血管造影。经降压治疗后,症状好转出院。本研究报道给我们的启示:对年轻高血压患者要仔细听诊,一旦前胸背部听到杂音,及时行CTA检查,避免漏诊和误诊。     

Traumatic pseudoaneurysm from the aorta to the left common carotid artery presenting as widened mediastinum

Diagnosis of pseudoaneurysm of the aorta or its main branches is a challenge in patients with blunt chest trauma. Computed tomography helps to demonstrate intrathoracic hemorrhage and suspected great vascular injury when a chest radiograph reveals widening of the mediastinum. Aortic angiography remains the gold standard in the determination of the site, and severity of vascular injury for definitive surgical intervention. Timing of surgical repair is controversial. Delayed repair of traumatic pseudoaneurysm of the aorta after primary control of associate injuries decreases mortality significantly, thus improving prognosis. We report a case of successful repair of a traumatic pseudoaneurysm of the aortic arch with extension to the left common carotid artery in an 18-year-old female patient. The diagnosis, surgical approaches, and timing of operation are discussed along with case presentation.     

Clinics in diagnostic imaging (155). Incidental PDA with secondary pulmonary arterial hypertension.

We report the case of a 70-year-old man with an asymptomatic large patent ductus arteriosus (PDA) incidentally detected on triple-rule-out computed tomography (CT). CT clearly demonstrated a vascular structure connecting the descending thoracic aorta to the roof of the proximal left pulmonary artery, consistent with a PDA. Secondary pulmonary arterial hypertension was also evident on CT. The patient was eventually diagnosed with acute coronary syndrome and was successfully treated with coronary artery bypass graft surgery and concomitant patch closure of the PDA. This article aims to outline the imaging features of PDA and highlight the information provided by CT, which is crucial to treatment planning. The pathophysiology, clinical manifestations and closure options of PDA are also briefly discussed.     

宝石CT对肺动脉栓塞后患者肺实质血流灌注的定量分析

目的 观察急性肺栓塞(PE)患者抗凝治疗前后肺动脉充盈缺损形态和肺实质灌注的变化与临床表现的相关性.方法 2009年12月至2010年3月上海仁济医院血管外科收治的23例急性血栓栓塞症(VTE)患者应用宝石CT(GE Discovery 750 HD CT)动态观察动脉血栓形成部位、范围、形态,通过冠状位、矢状位、轴位观察灌注缺损,并和肺动脉期成像对照.原始数据采用能量成像系统和CT增强软件处理.结果 23例VTE患者中,14例经宝石CT证实PE,抗凝治疗前,相应肺实质灌注缺损区域的碘含量值(-1.09±2.95)mg/ml,灌注正常区碘含量值(1.67±0.93)mg/ml,两者的数值差异有统计学意义(t=3.82,P＜0.05).抗凝治疗3个月后CT复查原肺实质灌注缺损区域的碘含量值(1.21±0.34)mg/ml,较治疗前有明显提高(t=1.34,P＜0.05);PE患者段或亚段分布的灌注缺损区的碘含量值与肺栓塞临床可能性评分值呈负相关(r =0.78,P＜0.05),肺实质血流动力学的变化与肺栓塞临床表现的严重程度密切相关.结论 宝石CT能量成像技术可以分析分离的造影剂碘物质在肺实质的分布,有助于定量评价肺动脉栓塞后肺实质血流灌注的变化和临床疗效.     

Low velocity traumatic dissection of the internal carotid artery presenting as a stroke after a slash injury

Low velocity traumatic dissection of the carotid artery is an infrequent but serious complication of blunt cranio-cervical injury. A 25-year-old man was hit by a blunt sickle over his chest and left side of his neck, and sustained open wounds over zone II of the neck. At that time, he had no neurological deficits and the wounds were sutured primarily. On the sixth day, while he was undergoing a change of dressing for the wounds, he suddenly became unconscious, and on recovery hours later, he was aphasic. Computed tomography showed a left posterior fronto-temporal ischaemic infarct in the territory of the middle cerebral artery. Colour Doppler ultrasonography showed an intimal tear and thrombus in the left common carotid artery. We discuss the possible mechanism of neurological deficits and also emphasise that in any patient with blunt injury to the neck, new neurological deficits should prompt us to suspect carotid artery injuries.     

Grading system modification and management of blunt aortic injury

Background The traditional approach to blunt aortic injury (BAI) has been emergent intervention.This study aimed to utilize a modified imaging grading system that may allow us to categorize these injur...     

MIP、MPR及VRT计算机图像后处理技术对肺动脉栓塞诊断的应用研究

目的 比较16层螺旋CT图像后处理中不同层厚的MIP、MPR、VRT重组图像对于肺动脉栓子的检出率.方法 对于42例临床拟诊为肺动脉栓塞的患者,利用原始数据分别行1 mm、2mm、5 mm、10 mm MIP、2 mm MPR及VRT重建图像重建.显示叶、段、亚段肺动脉内有无栓子,并行χ2检验.结果 32例患者显示肺动脉栓塞91支,其中肺动脉主干11支、肺叶动脉29支、肺段动脉29支、肺亚段动脉22支.对于肺动脉主干及肺叶动脉栓塞的检出,6组图像检出结果 无明显差异.对于肺段及亚段肺动脉栓塞的检出,1mm、2mm MIP、2 mm MPR组检出率明显高于5mm、10 mm MIP组及VRT组;2 mm MIP组与1 mm MIP、2 mm MPR组在统计学上没有显著差异（P值分别为0.443,1.000）.2 mm MIP组与5 mm、10 mm MIP及VRT组在统计学上有显著差异（P值分别为0.004,0.001,0.000）.结论 多层螺旋CT,2mm层厚MIP重建图像能明显提高段、亚段肺动脉栓子的显示率,又能减少图像数目,有重要的应用价值.     

超声心动图在Berry综合征诊治中的应用

目的探讨超声心动图在Berry综合征诊治中的应用价值。方法对6例诊断为Berry综合征患儿的临床及影像学资料进行回顾性分析。结果 6例Berry综合征患儿经超声心动图检查确诊5例,疑诊1例。其中5例经CT检查和(或)手术证实,1例与CT检查及手术结果不符,表现为B型主动脉弓离断。4例手术患儿术后超声心动图示主动脉与肺动脉间隔回声连续,未见残余分流;右肺动脉与主肺动脉连接,血流通畅;主动脉弓降部连续,血流通畅。结论应用超声心动图可对Berry综合征进行早期诊断、手术效果评价,操作简便易行,可重复性强,对患者的预后随访有重要意义。     

CT在肝脏钝性损伤非手术治疗中的意义

目的评价腹部CT在肝脏钝性损伤非手术治疗中的意义。方法回顾性分析我科近三年来收治的84例肝外伤非手术治疗患者的临床资料。结果本组患者均经腹部CT明确诊断。CT分级：Ⅰ级32例,Ⅱ级27例,Ⅲ级17例,Ⅳ级6例,Ⅴ级2例。非手术治疗期间行CT检查,发现胆痿、肝周脓肿各1例,延迟性出血2例,非手术治疗成功率为96．3％。结论CT是首选的肝脏损伤的检查方法;CT有助于辨别肝损伤的确切程度、定量分析腹腔积血量,还有助于对肝脏钝性损伤并发症的诊断;CT对于腹部其他脏器损伤的诊断及鉴别诊断亦有参考价值。     

Dislocation of the penis: a rare complication after traumatic pelvic injury

Traumatic injury to the male external genitalia is frequently encountered, but acute traumatic dislocation of the penile structure is extremely rare, with only a few reports found in the literature. We herein report the case of a 21-year-old man who sustained blunt trauma to the pelvis following a motor vehicle accident, and had features suspicious of penile dislocation. With the use of computed tomography and bedside ultrasonography, a diagnosis of penile dislocation was made, which was subsequently confirmed intraoperatively. Immediate surgical intervention via gentle manipulation of the penile tissue back to its native position was performed in order to restore normal anatomy. The exact mechanism of penile dislocation is not known. However, circumferential laceration around the foreskin causing degloving injury of the penis is suggested in our patient.     

多层螺旋CT肺动脉造影诊断肺栓塞及鉴别诊断

目的探讨多层螺旋CT肺动脉造影（MSCTPA）诊断肺栓塞及鉴别诊断。方法对36例MSCTPA检查的肺栓塞患者分别行1．25mm层厚横断面及MPR重建,由两位有经验的影像科医师记录显示清楚的叶、段、亚段及第5级肺动脉内有无栓子。结果右肺动脉干单发栓子1例,肺动脉干、叶、段多发栓子9例,肺动脉干、叶、段、亚段多发栓子4例,叶、段肺动脉多发栓子11例,叶、段、亚段肺动脉多发栓予4例,仅肺段动脉多发栓子2例,段、亚段肺动脉多发栓子3例,段、亚段、5级肺动脉多发栓子1例,仅亚段肺动脉多发栓子1例。结论16层螺旋CT明显地提高了肺小血管和血管内栓子的显示率,特别是对下肺动脉较粗亚段及第5级肺动脉栓子的显示更确切,但在诊断中应注意与原发性肺动脉肿瘤等其他疾病相鉴别。     

16层螺旋CT肺动脉造影诊断肺栓塞的价值

目的探讨16层螺旋CT肺动脉造影在肺栓塞（PE）诊断中的应用价值。方法对2012年3月至2013年4月经我院初步诊断为PE的患者43例行多层螺旋CT肺动脉造影（MscTPA）检查,将所获原始图片传输至工作站进行图片后处理,重建的方法分别为容积再现（VR）、多平面重建（MPR）和最大密度投影（MIP）。结果29例患者发现PE,病灶部位位于两侧21例,位于右侧5例,位于左侧3例。病变共累及324支肺动脉,其中肺动脉干7支,左、右肺动脉26支,叶动脉68支,段动脉178支,亚段动脉45支。直接征象为充盈缺损和血管截断征,间接征象为肺梗死、胸腔积液、肺动脉高压等。结论MSCTPA在PE的诊断中能清楚地显示PE的特点和受累部位,具有无创、安全和方便的特点,建议在临床上进一步推广应用。     

1例罕见的儿童损伤：外伤性幽门前横断

本文介绍1例14岁女孩的诊断和治疗经过。该患者在汽车交通事故后发生单纯的外伤性幽门前横断。腹部CT扫描适合于对气腹伴中空黏性性损伤的诊断。经过对这种罕见外伤的快速诊断和外科修补,患者恢复良好。1例罕见的儿童损伤:外伤性幽门前横断@Whyte L.H. @Soundappan S.V.S.$De     

钝性膈肌破裂的CT征象

目的探讨CT对钝性膈肌破裂的诊断价值。方法对2007年4月至至2012年11月在我院住院,并经临床及手术证实的16例钝性创伤性膈肌破裂病人的CT图像进行回顾性分析。其中右侧膈肌破裂13例,左侧膈肌破裂3例,未见双侧膈肌同时破裂病例。结果钝性膈肌破裂的征象包括膈肌不连续6例,部分膈肌不能辨认4例,膈肌增厚4例,腹腔脏器疝入胸腔10例,狭颈征5例,内脏坠落征9例,肋膈窦闭塞征6例,同时出现的胸腹腔积血4例,无上述阳性CT征象2例。结论钝性膈肌损伤临床表现隐匿,除非发生膈疝,影像表现不典型。正确认识膈肌破裂CT征象,是提高膈肌破裂CT诊断率的前提。     

Clinics in diagnostic imaging (152). Right lower lobe segmental pulmonary embolus.

A 56-year-old man presented to the Accident and Emergency Department with pleuritic chest pain of sudden onset. He gave a history of short-distance air travel ten days earlier. Chest radiograph showed a peripheral-based opacity in the right lower zone, which was not seen in a previous study done three months ago, suggestive of Hampton’s hump. The D-dimer level was raised. Computed tomography pulmonary angiography confirmed the diagnosis of pulmonary embolism in a right lower lobe segmental branch, with adjacent collapsed lung, consistent with lung infarction. The patient was started on heparin injection with significant relief of his symptoms. The clinical and imaging features of pulmonary embolism are described, with emphasis on the historical radiographic signs and the current dual-energy computed tomography innovations.     

Multiple cardiovascular injuries and motor vehicle accidents.

A patient sustained blunt chest trauma in a motor vehicle accident. Cardiovascular trauma was initially obscured by more obvious orthopedic injuries. Thoracic aortic transection with false aneurysm formation was discovered incidentally during cardiac catheterization for traumatic tricuspid insufficiency. Successful repair of both lesions was subseqeuntly performed. This case demonstrates the difficulty in recognizing cardiovascular trauma in survivors of motor vehicle accidents and emphasizes the need for an aggressive diagnostic approach with consideration of coexisting injuries in patients who have sustained blunt chest trauma.     

多层螺旋CT数据重建在主动脉壁内血肿中的临床应用价值

为探讨多层螺旋CT数据重建在主动脉壁内血肿中的临床应用价值,收集主动脉壁内血肿病例11例,采用16层螺旋CT扫描机进行平扫、增强扫描,将增强扫描数据薄层重建后进行MPR、CPR、MIP、VR等后处理。结果发现,11例患者中StanfordA型2例、B型9例。平扫增厚主动脉壁呈高密度10例。等密度1例,增强扫描所有患者增厚主动脉壁均未见明显强化,主动脉内膜小渗漏孔1例。合并主动脉溃疡6例,主动脉瘤样扩张1例。由此可知,多层螺旋CT检查能够清晰显示主动脉壁内血肿的范围、并发症、合并症,可以作为临床诊断、鉴别主动脉壁内血肿的首选检查。