髂腰肌囊积液的临床、CT诊断

目的 分析髂腰肌囊积液的CT表现，探讨其发病机制和鉴别诊断。资料与方法 回顾分析经手术或穿刺证实的34例髂腰肌囊积液的临床和CT资料。结果 34例髂腰肌囊积液中，30例伴有筋关节疾病，其中股骨头缺血坏死20例，类风湿性关节炎2例，筋关节退变5例，化脓性关节炎2例，滑膜骨软骨瘤病1例。临床表现为筋部疼痛、跛行、腹股沟区肿胀及下肢放射痛，8例腹股沟区可触及囊性肿物且有波动感。CT表现为单纯髂腰肌囊积液扩张26例，呈圆形、卵圆形及倒水滴状低密度影，其中8例增强扫描囊壁呈线样强化；髂腰肌囊积液扩张伴囊壁增厚6例；髂腰肌囊扩张囊壁呈斑点状或弧形钙化2例。结论CT扫描可显示扩张滑囊的范围、大小及形状，是正确诊断髂腰肌囊积液扩张的重要检查方法。

CT and Clinical Diagnosis of Dropsy in the Bursa of Iliopsoas Muscle

Objective To analyze CT findings of dropsy in the bursa of iliopsoas muscle, and to discuss its etiology, clinical diagnosis and differentiation.Materials and Methods Clinical manifestations and CT findings in 34 patients with dropsy in the bursa of iliopsoas muscle proved by surgery or aspiration biopsy were retrospectively analyzed.Results Of 34 patients, 30 were accompanied with hip disorders, including avascular necrosis of femoral head (n=20), rheumatoid arthritis (n=2), retrograde degeneration of hip (n=5), suppurative arthritis (n=2) and synovial osteochondromatosis (n=1). Clinical manifestation included hip pain, limping, swelling at inguinal region and radiating pain at lower extremity. Cystic mass with fluctuation feeling when touched at inguinal region was seen in 8 cases. On CT scans, the disorder was characterized by enlarged and hydropic bursa of iliopsoas muscle in 26 cases, presenting as a round, oval or reversed water drop shaped low density shadow, of which linear calcification of the cystic wall on enhanced scans was present in 8. Thickened bursal wall was accompanied in 6 cases, and punctate or arc shaped calcification in 2 cases. Conclusion CT scans can demonstrate the extent, size and shape of the enlarged iliopsoas bursa, thus, it is an useful means in the diagnosis of dropsy in the bursa of iliopsoas muscle.