食管黏膜下血肿的多层螺旋CT诊断
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摘要
目的分析食管黏膜下血肿的CT表现,提高对该病的认识。方法回顾性分析16例食管黏膜下血肿患者的临床及影像资料,总结其CT表现特征。结果病灶部位:食管上段1例,食管颈段+胸上段2例,食管颈段+胸中上段1例,食管胸中下段4例,食管颈段+胸上中下段8例。食管管壁增厚的形态:结节状增厚1例,同心圆状增厚2例,偏心性增厚10例,同心圆状+偏心性增厚3例;3例病灶内见气泡影;病变段管腔闭塞或呈圆形、新月形、斑点状气体影,适度扩张者病灶腔内缘一般光滑;4例累及胸中下段者其上方食管扩张不明显,管腔扩张程度与病灶的厚度不成比例。除1例合并纵隔血肿外,其余15例病灶外缘清楚。平扫呈高密度(CT值为35～69 HU),高于自身胸主动脉密度,增强扫描无强化。其中5例伴有胸腔积液,1例伴有纵隔血肿。结论 CT能很好的显示食管黏膜下血肿的特征,可作为诊断及随访的首选方法。
Objective To analyze the CT features of esophageal submucosal hematoma,and to improve the understanding of the disease. Methods The data of 16 patients with esophageal submucosal hematoma were analyzed retrospectively,and their CT features were summarized. Results Lesion location: 1 case of upper thoracic segment of esophagus,2 cases of cervical and upper thoracic esophagus,1 case of cervical and upper thoracic esophagus,4 cases in the middle and lower thoracic segment of esophagus,8 cases involving the whole esophagus. The shape of the esophageal wall thickening: nodular thickening in 1 case,concentric circular thickening in 2 cases,eccentric thickening in 10 cases,concentric and eccentric thickening in 3 cases; 3 cases of cases of gas bubbles in the lesion; The luminal segment of the lesion was occluded or round, crescent-shaped, and speckled. The inner edge of the lesion was generally smooth. The upper esophageal dilatation of the 4 cases involving the lower thoracic segment was not obvious, and the degree of lumen dilatation and lesions were not obvious. Except for 1 case with mediastinal hematoma,the external margin of the lesion was clear in 15 cases. Plain CT scan showed a high density(CT value is 35 ～ 69 HU),higher than the thoracic aortic density,enhanced scan without enhancement. Among them,5 cases were accompanied with pleural effusion and 1 case with mediastinal hematoma. Conclusion CT can display well the characteristics of esophageal submucosal hematoma,which can be used as the first choice for diagnosis and follow-up.
Objective To analyze the CT features of esophageal submucosal hematoma,and to improve the understanding of the disease. Methods The data of 16 patients with esophageal submucosal hematoma were analyzed retrospectively,and their CT features were summarized. Results Lesion location: 1 case of upper thoracic segment of esophagus,2 cases of cervical and upper thoracic esophagus,1 case of cervical and upper thoracic esophagus,4 cases in the middle and lower thoracic segment of esophagus,8 cases involving the whole esophagus. The shape of the esophageal wall thickening: nodular thickening in 1 case,concentric circular thickening in 2 cases,eccentric thickening in 10 cases,concentric and eccentric thickening in 3 cases; 3 cases of cases of gas bubbles in the lesion; The luminal segment of the lesion was occluded or round, crescent-shaped, and speckled. The inner edge of the lesion was generally smooth. The upper esophageal dilatation of the 4 cases involving the lower thoracic segment was not obvious, and the degree of lumen dilatation and lesions were not obvious. Except for 1 case with mediastinal hematoma,the external margin of the lesion was clear in 15 cases. Plain CT scan showed a high density(CT value is 35 ～ 69 HU),higher than the thoracic aortic density,enhanced scan without enhancement. Among them,5 cases were accompanied with pleural effusion and 1 case with mediastinal hematoma. Conclusion CT can display well the characteristics of esophageal submucosal hematoma,which can be used as the first choice for diagnosis and follow-up.
引文
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10 Syed TA,Salem G,Fazili J.Spontaneous Intramural Esophageal Hematoma[J].Clinical Gastroenterology and Hepatology,2017,4:27-27.
11冯聪,杨蕾娟,陈力,等.自发性食管血肿1例[J].临床急诊杂志,2011,12:418-419.
12 Tong M,Hung WK,Law S,et al.Esophageal hematoma[J].Dis E-sophagus,2006,19:200-202.
2张伟.食管血肿的研究现状[J].临床消化病杂志,2015,27:57-59.
3 Cullen SN,Mc Intyre AS.Dissecting intramural haematoma of the oesophagus[J].Eur J Gastroenterol Hepatol,2000,12:1151-1162.
4朱国玲,王巍峰,范开春,等.胃镜联合超声胃镜诊断食管、胃底黏膜下血肿例及文献复习[J].军医进修学院学报,2012,33:897-899.
5张爱伟,周海生,贾国葆,等.食管黏膜下血肿的CT检查特征[J].中华消化外科杂志,2014,13:654-657.
6 Restrepo CS,Lemos DF,Ocazionez D,et al.Intramural hematoma of the esophagus:a pictorial essay[J].Emerg Radiol,2008,15:13-22.
7梁明柱,李坤炜,王勇,等.自发性食管粘膜下血肿二例[J].临床放射学杂志,2008,27:140-140.
8 Fadoo F,Ruiz DE,Dawn SK,et al.Helical CT esophagography for the evaluation of suspected esophageal perforation or rupture[J].AJR,2004,182:1177-1179.
9吕金纯,陈浩.食管壁内血肿的CT检查和诊断[J].中国基层医药,2016,23:146-148.
10 Syed TA,Salem G,Fazili J.Spontaneous Intramural Esophageal Hematoma[J].Clinical Gastroenterology and Hepatology,2017,4:27-27.
11冯聪,杨蕾娟,陈力,等.自发性食管血肿1例[J].临床急诊杂志,2011,12:418-419.
12 Tong M,Hung WK,Law S,et al.Esophageal hematoma[J].Dis E-sophagus,2006,19:200-202.