婴幼儿胸壁错构瘤的影像诊断

目的：探讨婴幼儿胸壁错构瘤（MHCW）的临床影像特征。方法：回顾性分析2例病理确诊为MHCW婴儿的临床影像资料。2例患儿临床表现为发热、咳嗽,均行胸部X线正侧位片及CT增强扫描。结果：2例患儿胸片均表现为左侧胸腔类圆形密度不均肿块,受累肋骨受压变形。CT显示肿物源自肋骨,境界清晰,内见高密度钙化样密度影,中心肋骨膨胀变形,增强后肿物部分区域轻度强化。结论：MHCW的影像表现具有一定特征性,确诊需依靠组织病理学检查。     

Mesenchymal hamartoma of the chest wall in infants and children: a clinicopathological study of five patients

Mesenchymal hamartoma of chest-wall is a rare benign lesion that has varied histological characteristics and usually occurs during early infancy. We report the histological characteristics of mesenchymal hamartoma found in five patients aged respectively 25 days, 5 months, 8 months, and 4 and 8 years at presentation. Two patients presented with respiratory distress, two with an asymptomatic chest-wall mass, and one with a deformity of the left chest wall. Surgical resection was performed on four patients and a biopsy only in one patient. Overall, the tumors were well delineated, lobulated, tan to reddish in color, and on section showed bloodfilled cystic spaces with interspersed small islands of cartilage and fibrous tissue. Histological analyses demonstrated mixtures of bone trabeculae with spindle-cell stroma, chondroblast-like proliferation, mature and immature hyaline cartilage, and aneurysmal bone cyst formation. All patients are alive and well without evidence of disease. Despite the alarming clinical and histologic presentation, mesenchymal hamartoma of the chest wall is a non-neoplastic benign lesion.     

肝脏间叶性错构瘤的CT诊断价值

【摘要1目的分析肝脏间叶性错构瘤的CT表现,以增加对本病CT表现的认识,提高其诊断正确率。方法搜集已行CT检查并获得病理证实的3例肝脏间叶性错构瘤的CT图像及临床资料,分析并总结其CT表现。结果瘤体最大径分别为7．7cm、10．7cm、16．3cm,表现为肝内囊实性肿块,内见多个囊腔及分隔,增强后病灶囊性部分无强化,实性部分及分隔早期呈轻中度强化,延迟期密度进一步升高。结论肝脏间叶性错构瘤具有一定的特征性,认真分析其影像表现并结合患儿临床特征,术前大多能做出正确诊断。     

Radiological spectrum of hepatic mesenchymal hamartoma in children.

OBJECTIVE: A hepatic mesenchymal hamartoma is an uncommon benign tumor in children and little is known about the spectrum of its radiological features. The purpose of this study is to describe the spectrum of radiological features of a hepatic mesenchymal hamartoma in children. MATERIALS AND METHODS: Thirteen children with a pathologically confirmed hepatic mesenchymal hamartoma (M:F = 7:6; mean age, 3 years 2 months) were included in our study. Ultrasonography (US) was performed in nine patients including color and power Doppler US (n = 7). CT scans were performed in all patients. We evaluated the imaging findings of the hepatic mesenchymal hamartomas and the corresponding pathological features. RESULTS: Each patient had a single tumor (mean diameter: 13 cm [1.8-20 cm]). On CT and/or US, four patients (31%) had a "multiseptated cystic tumor", five patients (38%) had a "mixed solid and cystic tumor", and four patients (31%) had a "solid tumor." The septa of the cystic portion were thin in the multiseptated cystic tumors and irregularly thick in the mixed solid and cystic tumors as seen on US. On a post-contrast CT scan, solid portions or thick septa of the tumors showed heterogeneous enhancement. The amount of hepatocytes was significantly different among the three tumor groups according to the imaging spectrum (p = 0.042). CONCLUSION: A hepatic mesenchymal hamartoma in children can show a wide spectrum of radiological features, from a multiseptated cystic tumor to a mixed solid and cystic tumor, and even a solid tumor.     

Macrocystic lymphatic malformation of the chest wall and axilla: A case report in a 45-year-old man

Lymphatic malformations (LMs) are rare, with more than 90% occurring during childhood. Most LMs are located in the head, neck and axilla. LMs in chest wall are extremely rare, particularly in adults. This report describes a 45-year-old man with a large macrocystic LM in the right anterior chest wall. Computed tomography showed a ∼15 cm sized, well-defined, homogeneous and hypoattenuated mass without enhancement in the right anterior chest wall. On ultrasonography (US), the mass was circumscribed and anechoic, with internal septations and posterior acoustic enhancement. Following surgical excision, the mass was diagnosed as a macrocystic LM.     

胸壁结核的超声影像表现及其临床应用价值

目的:探讨胸壁结核的影像学表现及其临床应用价值。方法:回顾分析64例胸壁结核的超声影像图。结果:胸壁结核的影像学表现主要为实性低回声型、液性暗区型、混合回声型,部分伴窦道形成,其较具特征性改变是图像呈"哑铃"形。结论:胸壁结核超声图像有其特征,超声检查可确定病变的范围、性质,是术前常规检查,对诊断及治疗均有重要的临床价值。     

胸壁结核的超声诊断(51例分析)

目的 探讨胸壁结核的超声表现及其诊断价值。方法 回顾分析经手术、穿刺病理检查证实的51例胸壁结核患者的超声表现特征。结果 本组51例胸壁结核超声表现，圆形或椭圆形实质性回声18例，且沿肋间软组织分布，其中，低回声型5例。弱而不均质回声，且内部兼有斑点状强回声13例，5例病灶周边可见点线状血流分布。病灶表现为液性暗区者33例，其中，20例肋间组织间呈现哑铃型液性暗区。与病理对照，超声正确诊断49例（96.2%），误诊2例（3.8%）。结论 胸壁结核的超声表现有其特征的改变。超声检查可反映胸壁结核病灶大小、范围、内部结构以及与周围的关系，并为临床制定治疗方案提供依据。     

Loop arteriovenous graft of the chest wall as a viable option for dialysis

The search for a reliable, complication-free vascular access is crucial among dialysis patients. The creation of a long-term access site for hemodialysis is dependent on several factors that mandate forming a life-plan for dialysis access, with upper extremity vascular access being the preferred route. However, complications including poor maturation, venous anastomosis lesions, and thrombosis are all associated with poor survival of these accesses. As a result, numerous patients within the dialysis population have exhausted access sites in the upper and lower extremities, requiring the search for other access options including chest wall arteriovenous graft (AVG). However, limited data is available about the outcomes of these chest wall grafts. Here, we describe two 62-year-old female dialysis patients who exhausted other dialysis access sites and subsequently underwent arteriovenous loop graft of the chest wall that connected the axillary artery with the ipsilateral axillary vein. These AVGs remained functional during the follow up period. This report highlights the viability of chest wall AVG access in the unique subset of hemodialysis patients who exhausted all other access sites.     

胸壁肿块的CT诊断

目的分析胸壁肿块的CT表现,提高其诊断水平。方法 30例临床证实的胸壁肿块患者均经CT平扫,10例又经增强扫描。对所有患者的CT表现进行了回顾性分析。结果在CT像上,胸壁结核(5例)表现为胸壁内软组织密度肿块影;细菌性脓肿(4例),表现为局限性软组织肿块影,密度不均匀;脂肪瘤(4例)表现为胸壁内局限性脂肪密度肿块影;神经源性肿瘤(5例)表现为胸壁内密度均匀、边界清楚的软组织肿块影;血管瘤(1例)表现为左侧胸壁散在条状迂曲的软组织密度肿块影,增强后明显强化;胸膜间皮瘤(3例),其中良性者(2例)表现为局限性胸膜增厚,恶性者(1例)表现为弥漫性胸膜增厚伴胸腔积液;胸膜转移瘤(3例)表现为胸膜结节状增厚;肋骨转移瘤(4例)表现为胸膜结节状增厚;Askin瘤(1例)表现为右侧胸壁内及胸膜处软组织肿块影伴邻近肋骨骨质破坏。结论 CT对胸壁肿块的定位及良、恶性鉴别具有重要价值,尤其64排螺旋CT及其后处理技术更有利于其诊断与鉴别诊断。     

胸壁结核的CT诊断和分型

目的总结分析31例胸壁结核(不包括胸椎结核)的CT征象并探讨其CT分型,以提高对该病的认识和诊断能力。方法收集经手术或穿刺病理证实的31例胸壁结核患者的资料,回顾性总结分析CT影像特征。结果按照病变的CT表现分为4型,Ⅰ型:胸膜结核球,12例;Ⅱ型:肋骨或胸骨结核,7例;Ⅲ型:胸壁前部结核性脓肿,8例;Ⅳ型:全胸壁结核,4例。结论CT能清楚显示胸壁结核的累及范围和密度变化,有利于病变定性和鉴别诊断,并能够准确地提供分型。     

Design and production of wax compensators for electron treatments of the chest wall

The primary aim of electron treatment planning for the post mastectomy chest wall is to encompass the volume between the skin surface and the lung-rib interface while limiting dose to the lung. Electron energies for treatment of the chest wall are chosen based on the thickness of tissue between these two areas. Surgical defects or surface irregularities often result in differing thicknesses of tissue across the treatment volume, and patient-specific compensation is necessary to achieve the desired dose distribution. This is true whether the treatment plan is designed using fixed or rotational electrons to treat the chest wall. These clinical requirements are often met using custom shaped wax of varying thickness which conforms to the chest surface. This paper will discuss the treatment planning process used to design these compensators, creation and use of an exact duplicate of the patient's chest wall to aid in the production of these compensators, the production process itself, and verification of the completed compensator.     

CT检查在胸壁肿物诊断中的应用价值

目的：探讨CT检查技术在胸壁肿物诊断中的应用价值。方法：回顾性分析和总结38例经手术病理和临床证实的胸壁肿物的CT表现，按病变的起源分为来源于胸壁软组织的Ⅰ型肿物和来源于胸壁骨性结构的Ⅱ型肿物。结果：Ⅰ型23例(60．5％)，包括脂肪瘤7例，结核5例，脓肿4例，纤维瘤3例，转移瘤3例，恶性纤维组织细胞瘤1例，其中以脂肪瘤和胸壁结核较有特点；Ⅱ型15例(39．5％)，包括软骨肉瘤3例，骨软骨瘤3例，骨纤维异常增殖症3例，骨转移瘤6例，CT具有很高的诊断准确率。结论：CT检查图像清晰无重叠，组织密度分辨率高，在各类胸壁肿物的影像学诊断中处于十分重要的地位。     

婴幼儿胸壁间叶性错构瘤1例

患者2岁。自述外伤后右肩及上背部疼痛11天。查体。患儿精神好，活动自如．右胸背部上方饱满。但无压痛、红肿等异常体征。听诊，右肺呼吸音低。     

Splenic hamartoma: a case report

Splenic hamartomas are rare benign tumours composed of an abnormal mixture of normal components of the spleen. Generally asymptomatic, they are in most insances discovered as incidental findings at laparotomy or autopsy. We report a case in which sonography disclosed a heterogenous splenic mass, partially cystic, with some echogenic foci thought to represent calcification. CT was unremarkable, d detecting a spontaneously isodense mass with a small peripheral calcification. Scintigraphy performed with sulphur colloids demonstrated an area of increase uptake. MRI disclosed a slightly hypointense mass on T1-weighted spin-echo images which was predominantly hypointense with a more isointense central area on long TR/TE images. On gadolinium-enhanced T1-weighted images the mass displayed a heterogenous hyperintensity with prolonged enhancement. Biopsy was inconclusive and the final diagnosis was achieved only with splenectomy. Correspondence to: P. O. Pinto     

Utility of CT scan for the diagnosis of chest wall tuberculosis

The objective of this study was to determine the utility of CT scan findings for the diagnosis of chest wall tuberculosis, excluding the spine. We reviewed 15 patients (13 Africans and 2 Indians) with chest wall tuberculosis, retrospectively. The radiologic examination consisted of a plain X-ray and a CT scan of the chest for each patient. The site of disease was the rib in 13 patients or the body of the sternum in 2 patients. One rib was involved in 11 patients, 2 contiguous ribs (one site) in 2 patients, and bilateral disease (two sites) was observed in the remaining patient. The 14 rib sites involved the posterior arc or costovertebral joint in 11 cases, the anterior arc in 2 cases, and the anterior and middle arc in 1 case. The CT scan findings were an abscess (n = 14) or a soft tissue mass (n = 2), osteolytic lesions (n = 13), periosteal reaction (n = 10), and sequestrum (n = 14). Bone sclerosis was observed only in 3 cases of rib involvement. The association of a soft tissue abscess, an osteolytic lesion, and sequestrum, especially in immigrants to France, suggests chest wall tuberculosis on CT scan. Received: 22 October 1998; Revision received: 11 January 1999; Accepted: 8 February 1999     

胸部X线摄影术与CT诊断胸壁结核的对照研究

目的评价胸部X线摄影术及CT在胸壁结核诊断中的价值。方法对21例经手术、穿刺活检证实的胸壁结核作了影像学分析，其中男8例，女13例，年龄在19—84岁，中位年龄34岁；全部病例均作了胸部X线摄影术和CT扫描，9例作了增强CT扫描。结果（1）胸部X线平片仅4例显示骨质破坏。（2）CT平扫则全部可见肋骨旁软组织肿块；16例边缘密度较高，中央密度较低，3例呈较高密度中有多发低密度，2例呈均匀较低密度。5例肋骨破坏，3例为膨胀性溶骨性骨破坏。增强扫描时8例肿块呈边缘强化。（3）21例CT所见的胸壁肿块，胸片均未能发现（X^2=42．000，P〈0．01）；4例CT上可见的4个纵隔及腋窝肿大淋巴结，胸片上均未能见到（X^2=4．421，P〈0．05）；2种影像学检查差异具有统计学意义。结论CT，特别是增强CT扫描是确诊本病的首选方法。     

Photodynamic therapy for chest wall recurrence from breast cancer

Breast cancer is common with over 230,000 new cases diagnosed each year in North America alone. While great strides have been made to achieve excellent cancer control and survival, a significant minority of patients fail locally. While initial salvage to regain disease control is of the utmost importance, it is not universally successful. This leads to a therapeutic quagmire. Additional surgery, radiation and chemo-hormonal therapy are possible, but they are usually highly morbid with low success rates. Photodynamic therapy appears to be an underutilized salvage modality for this unfortunate patient population. This report analyzes and reviews the role of photodynamic therapy for patients with chest wall re-recurrence from breast cancer.     

生物材料人工胸壁结构设计及其评价

目的 通过生物材料的筛选和优化组合及特殊工艺制备新型人工胸壁结构,并探讨其应用于大块胸壁缺损重建的可行性.方法 根据胸壁重建需要,筛选出适宜的可降解高分子生物材料,通过特殊工艺制成三种不同结构的人工胸壁(聚对二氧杂环己酮纤维网、甲壳素纤维增强聚已内酯板、甲壳素纤维增强聚已内酯肋条).建立犬大块胸壁缺损动物模型,应用所研制的人工材料进行动物实验,通过动态观察及组织学检查评价其效果.结果 聚对二氧杂环已酮网重建胸壁与组织结合良好,可有效减轻反常呼吸,网状材料24周内完全降解吸收,被自体再生组织取代,胸壁长期稳定性和胸廓外形满意.甲壳素纤维增强聚已内酯板重建胸壁可获得良好的胸壁固定,肋条可有效防止反常呼吸,同时具有更佳的组织相容性.甲壳素纤维增强聚已内酯材料植入24周无明显变化.结论 聚对二氧杂环已酮网及甲壳素纤维增强聚已内酯材料具有良好的组织相容性,可有效防止反常呼吸,在胸壁重建中各具特点,具有一定的临床应用价值.