儿童主动脉憩室的CT影像学表现
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摘要
目的:分析和总结儿童主动脉憩室的CT影像学特点。方法:回顾性分析2013年1月-2017年5月本院87例主动脉憩室患儿的CT资料,所有患者均行多层CT检查,其中26例进行了手术治疗。结果:87例中Kommerell憩室47例(连接处狭窄26例),导管憩室40例。按主动脉弓及憩室位置分型:(1)右位主动脉弓伴憩室75例,其中憩室位于气管右侧67例(右弓右降)、左侧8例(右弓左降);(2)左弓伴憩室9例,其中右侧憩室1例(左弓右降)、左侧憩室8例(左弓左降);(3)双主动脉弓一侧闭锁伴憩室3例。憩室直径4.8~12.1mm。所有右弓、双弓及左弓右降伴右侧憩室的患者均有不同程度气道受压推移、变窄,同时伴食道受压向前、局部含气消失者32例。左弓左降伴憩室的患者无明显气管受压表现。43例患者合并其它异常,包括心血管异常31例、支气管肺发育异常5例、骨骼异常8例、占位4例、消化道畸形和膈疝各1例。结论:儿童主动脉憩室可有多种表现,与成人患者间有一定差异,CT检查可准确诊断本病。
Objective:To explore the CT imaging features of congenital aortic diverticulum(AD)in children,and to improve the CT diagnostic accuracy of this diseases.Methods:CT images of 87 patients with congenital AD in our hospital from Janauary 2013 to May 2015 were retrospectively analyzed.All children underwent MSCT scan,and 26 cases underwent surgical operation.Results:There were 47 cases of Kommerell diverticulum(KD),with stenosis at the junction in 26 cases,and 40 cases of ductus diverticulum(DD).According to the position of the aortic arch and diverticulum,there were three types:(1)right-sided aortic arch with diverticulum in 75 cases.The diverticulum was located on the right side of the trachea in 67 cases(right-sided aortic arch and right descending aorta),on the left side of the trachea in 8 cases(right-sided aortic arch and left descending aorta).(2)left-sided aortic arch with diverticulum in 9 cases,including right side diverticulum in one case(left-sided aortic arch and right descending aorta),left side diverticulum in 8 cases(left-sided aortic arch and left descending aorta).(3)double aortic arch with one side atresia and associated with diverticulum in 3 cases.Diverticula diameter was 4.8~12.1 mm.All patients had different degrees of airway compression and narrowing,and 32 cases had esophageal compression and disappearance of local gas,except the cases with left-sided aortic arch,left descending aorta and divertuculum.There were 43 cases with other anomaly,including 31 cases of cardiovascular anomaly,5 cases of bronchopulmonary dysplasia,8 cases of bone abnormalities,4 cases of space-occupying lesions,one case of digestive tract malformation,and one case of diaphragmatic hernia.Conclusion:Aortic diverticulum in children can have a variety of manifestations,which are quite different from those of adults.CT can accurately diagnose this diseases.
Objective:To explore the CT imaging features of congenital aortic diverticulum(AD)in children,and to improve the CT diagnostic accuracy of this diseases.Methods:CT images of 87 patients with congenital AD in our hospital from Janauary 2013 to May 2015 were retrospectively analyzed.All children underwent MSCT scan,and 26 cases underwent surgical operation.Results:There were 47 cases of Kommerell diverticulum(KD),with stenosis at the junction in 26 cases,and 40 cases of ductus diverticulum(DD).According to the position of the aortic arch and diverticulum,there were three types:(1)right-sided aortic arch with diverticulum in 75 cases.The diverticulum was located on the right side of the trachea in 67 cases(right-sided aortic arch and right descending aorta),on the left side of the trachea in 8 cases(right-sided aortic arch and left descending aorta).(2)left-sided aortic arch with diverticulum in 9 cases,including right side diverticulum in one case(left-sided aortic arch and right descending aorta),left side diverticulum in 8 cases(left-sided aortic arch and left descending aorta).(3)double aortic arch with one side atresia and associated with diverticulum in 3 cases.Diverticula diameter was 4.8~12.1 mm.All patients had different degrees of airway compression and narrowing,and 32 cases had esophageal compression and disappearance of local gas,except the cases with left-sided aortic arch,left descending aorta and divertuculum.There were 43 cases with other anomaly,including 31 cases of cardiovascular anomaly,5 cases of bronchopulmonary dysplasia,8 cases of bone abnormalities,4 cases of space-occupying lesions,one case of digestive tract malformation,and one case of diaphragmatic hernia.Conclusion:Aortic diverticulum in children can have a variety of manifestations,which are quite different from those of adults.CT can accurately diagnose this diseases.
引文
[1]Tanaka A,Milner R,Ota T.Kommerell's diverticulum in the current era:a comprehensive review[J].Gen Thorac Cardiovasc Surg,2015,63(5):245-259.
[2]Fisher RG,Whigham CJ,Trinh T.Diverticula of Kommerell and aberrant subclavian arteries complicated by aneurysms[J].Cardiovasc Interv Radiol,2005,28(5):553-560.
[3]Backer CL,Russell HM,Wurlitzer KC,et al.Primary resection of Kommerell diverticulum and left subclavian artery transfer[J].Ann Thorac Surg,2012,94(5):1612-1617.
[4]Cina CS,Althani H,Pasenau J,et al.Kommerell's diverticulum and right-sided aortic arch:a cohort study and review of the literature[J].J Vascul Surg,2004,39(1):131-139.
[5]Salomonowitz E,Edwards JE,Hunter DW,et al.The three types of aortic diverticula[J].AJR,1984,142(4):673-679.
[6]Gould SW,Rigsby CK,Donnelly LF,et al.Useful signs for the assessment of vascular rings oncross-sectional imaging[J].Pediatr Radiol,2015,45(13):2004-2016.
[7]Backer CL,Hillman N,Mavroudis C,et al.Resection of Kommerell's diverticulum and and left subclavian artery transfer for recurrent symptoms after vascular ring division[J].Eur J Cardio Surg,2002,22(1):64-69.
[8]Backer CL,MongéMC,Popescu AR,et al.Vascular rings[J].Semin Pediatr Surg,2016,25(3):165-175.
[9]Sugimoto T,Takahashi T,Inui K,et al.Aneurysm of the ductus diverticulum in adults:the diagnostic value of three-dimensional computed tomographic scanning[J].Jpn J Thorac Cardiovasc Surg,2003,51(10):524-527.
[10]Kim KM,Cambria RP,Isselbacher EM,et al.Contemporary surgical approaches and outcomes in adults with kommerell diverticulum[J].Ann Thorac Surg,2014,98(4):1347-1354.
[11]Krishnan GS,Peter WG.Vascular ring:right aortic arch,mirror image branching with Kommerell's diverticulum[J].Heart Lung Circ,2010,19(1):56-57.
[12]Bhat VS,Raj V.Vascular ring with a Kommerell's diverticulum:neonatal presentation with oesophageal symptoms[J].Indian J Med Res,2014,140(1):152-153.
[13]邵剑波,郑楠楠,王芳,等.MSCTA对先天性血管环的诊断价值[J].放射学实践,2012,27(11):1260-1263.
[14]Gomes MM,Bernatz PE,Forth RJ.Arteriosclerotic aneurysm of an aberrant right subclavian artery[J].Dist Chest,1968,54(6):549-552.
[15]Luciano D,Mitchell J,Fraisse A,et al.Kommerell diverticulum should be removed in children with vascular ring and aberrant left subclavian artery[J].Ann Thorac Surg,2015,100(6):2293-2297.
[16]Wong HL,Liew CJY,Poh ACC.Saccular Kommerell aneurysm,apotential pitfall on MDCT imaging:a review of imaging features and potential mimics[J].Eur J Radiol Open,2017,11(4):89-94.
[17]Ichikawa T,Koizumi J,Tanno K,et al.Kommerell diverticulum in adults:evaluation of routine CT examinations[J].Tokai J Exp Clin Med,2016,41(2):65-69.
1mmHg=0.133kPa
[2]Fisher RG,Whigham CJ,Trinh T.Diverticula of Kommerell and aberrant subclavian arteries complicated by aneurysms[J].Cardiovasc Interv Radiol,2005,28(5):553-560.
[3]Backer CL,Russell HM,Wurlitzer KC,et al.Primary resection of Kommerell diverticulum and left subclavian artery transfer[J].Ann Thorac Surg,2012,94(5):1612-1617.
[4]Cina CS,Althani H,Pasenau J,et al.Kommerell's diverticulum and right-sided aortic arch:a cohort study and review of the literature[J].J Vascul Surg,2004,39(1):131-139.
[5]Salomonowitz E,Edwards JE,Hunter DW,et al.The three types of aortic diverticula[J].AJR,1984,142(4):673-679.
[6]Gould SW,Rigsby CK,Donnelly LF,et al.Useful signs for the assessment of vascular rings oncross-sectional imaging[J].Pediatr Radiol,2015,45(13):2004-2016.
[7]Backer CL,Hillman N,Mavroudis C,et al.Resection of Kommerell's diverticulum and and left subclavian artery transfer for recurrent symptoms after vascular ring division[J].Eur J Cardio Surg,2002,22(1):64-69.
[8]Backer CL,MongéMC,Popescu AR,et al.Vascular rings[J].Semin Pediatr Surg,2016,25(3):165-175.
[9]Sugimoto T,Takahashi T,Inui K,et al.Aneurysm of the ductus diverticulum in adults:the diagnostic value of three-dimensional computed tomographic scanning[J].Jpn J Thorac Cardiovasc Surg,2003,51(10):524-527.
[10]Kim KM,Cambria RP,Isselbacher EM,et al.Contemporary surgical approaches and outcomes in adults with kommerell diverticulum[J].Ann Thorac Surg,2014,98(4):1347-1354.
[11]Krishnan GS,Peter WG.Vascular ring:right aortic arch,mirror image branching with Kommerell's diverticulum[J].Heart Lung Circ,2010,19(1):56-57.
[12]Bhat VS,Raj V.Vascular ring with a Kommerell's diverticulum:neonatal presentation with oesophageal symptoms[J].Indian J Med Res,2014,140(1):152-153.
[13]邵剑波,郑楠楠,王芳,等.MSCTA对先天性血管环的诊断价值[J].放射学实践,2012,27(11):1260-1263.
[14]Gomes MM,Bernatz PE,Forth RJ.Arteriosclerotic aneurysm of an aberrant right subclavian artery[J].Dist Chest,1968,54(6):549-552.
[15]Luciano D,Mitchell J,Fraisse A,et al.Kommerell diverticulum should be removed in children with vascular ring and aberrant left subclavian artery[J].Ann Thorac Surg,2015,100(6):2293-2297.
[16]Wong HL,Liew CJY,Poh ACC.Saccular Kommerell aneurysm,apotential pitfall on MDCT imaging:a review of imaging features and potential mimics[J].Eur J Radiol Open,2017,11(4):89-94.
[17]Ichikawa T,Koizumi J,Tanno K,et al.Kommerell diverticulum in adults:evaluation of routine CT examinations[J].Tokai J Exp Clin Med,2016,41(2):65-69.
1mmHg=0.133kPa