主动脉弓左侧先天性静脉异常的CT鉴别诊断

目的：分析41例主动脉弓左侧先天性静脉变异的CT表及鉴别诊断。方法：所有患者均有CT平扫，其中3例行增强扫描，5例另做MRI或超声检查确诊，6例做最大信号强度投影和表面遮盖法三维重建。结果：永存在上腔静脉24例，其中双上腔静脉23例，永存左上腔静脉并右上腔静脉缺如1例，异常左头臂静脉11例，其中6例合并主动脉畸形；左上叶的部分异常肺静脉引流4例，其中1例并双上腔静脉畸形；左头臂静脉与奇静脉异常连接2例，它们的共同表现是在主动态弓可见圆形或类圆形结影，但它们具有各自不同的血管行程，可加以区别。结论：熟悉这些少见的先天性异常有助于避免误诊，高质量的DT增强扫描这些先天性异常的诊断及鉴别诊断有重要价值。

Various anomalous veins left to aortic arch distinction based on CT findings

Objective To review the CT appearance of various anomalous mediastinal veins left to aortic arch and provide guideline for differentiating between them. Methods All 41 patients (26 men, 15 women; mean age 50.6) underwent CT scan and no one associated with congenital heart disease. 36 of which had the injection of IV contrast material. Others had chest MRI or ultrasound examination. Three-dimension (3D) and MIP reconstruction of the major mediastinal vascular structures were performed in 6 patients. All the CT scans were reviewed in order to observe the CT findings in each anomaly. Results Of the all cases, 24 cases had persistent left superior vena cava, of them, 23 cases with duplication of SVC, and 1 case with absent right SVC. Eleven cases had anomalous left brachiocephalic vein, and 6 of 11 cases were associated with various anomalous aortic arches. Four patients had partial anomalous pulmonary venous drainage of the left upper lobe. Two cases had left brachiocephalic vein continuation of the azygos vein. There were different CT findings among various types of venous anomalies, especially their courses below the aortic arch. Conclusion Contrast enhancement CT scan was valuable in the diagnoses of these anomalous veins. Careful analysis of the CT scans allowed the radiologist to avoid making wrong diagnosis.