成人腹型过敏性紫癫的胃肠道CT表现
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摘要
目的探讨成人腹型过敏性紫癫的临床特征及CT表现。方法回顾性分析经临床确诊的9例成人腹型过敏性紫癫患者的临床资料及CT表现。结果 9例均有不同部位的皮肤紫癜及不同程度的消化道症状,其中3例伴肾脏损害,1例伴肾脏及关节损害。所有病例肠壁和(或)胃壁增厚或浅溃疡形成,周围脂肪间隙模糊。CT表现为肠壁多环形增厚,分层样("靶征")改变,增强扫描轻度或中度强化(占7例)。9例均有腹痛,部位不定,可持续隐痛、胀痛,或阵发性绞痛,部分还伴有腹胀、腹泻、呕吐等症状;CT图像上病灶多发者7例,单发者2例,4例累及胃及十二指肠,6例累及空回肠,5例累及结肠,4例累及回盲部,2例累及直肠;1例伴肠梗阻,6例腹腔或腹膜后淋巴结肿大,4例腹盆腔积液。结论成人腹型过敏性紫癫的CT表现虽缺乏一定的特异性,但可较全面的显示病灶的部位、范围及程度,结合临床资料可为临床明确诊断提供重要依据。
Objective To analyze the clinical features and CT signs of adult abdominal type allergic purpura. Methods CT findings of 9 patients with clinically proved adult abdominal type allergic purpura were retrospectively analyzed.Results All the patients had purpura of different parts and alimentary symptoms. Of the 9 cases,kidney injury was seen in 3 and both joint and kidney damage in 1. The diseased intestinal wall or gastric wall showed thickening or superficial ulceration in all cases. The fatty space surrounding the bowel was blurry. The diseased bowel wall showed " double loop" sign and slightly or moderately enhanced after the injection of contrast-enhanced medium in 7 cases. All patients had abdominal pain with continuous pain or clonic angina in different parts. In addition,there were some symptoms such as abdominal distension,diarrhea,vomiting and so on. In pretreatment CT scan,single segment bowel involvement was found in 2 cases,multisegmental bowel involvement in 7 cases. Of all lesions,stomach and duodenum were found in 4 cases,jejunoileum in 6 cases,colon in 5 cases,ileocecum in 4 cases,rectum in 2 cases. Intestinal obstruction was found in 1 case. Peritoneal and retroperitoneal lymphadenectasis were found in 6 cases,pyoperitoneum in 4 cases. Conclusion While lacking specificity,the CT signs can display fully the location,range and extent of the lesions. Combined with clinical data,CT can provide important information for clinical diagnosis of adult abdominal type allergic purpura.
Objective To analyze the clinical features and CT signs of adult abdominal type allergic purpura. Methods CT findings of 9 patients with clinically proved adult abdominal type allergic purpura were retrospectively analyzed.Results All the patients had purpura of different parts and alimentary symptoms. Of the 9 cases,kidney injury was seen in 3 and both joint and kidney damage in 1. The diseased intestinal wall or gastric wall showed thickening or superficial ulceration in all cases. The fatty space surrounding the bowel was blurry. The diseased bowel wall showed " double loop" sign and slightly or moderately enhanced after the injection of contrast-enhanced medium in 7 cases. All patients had abdominal pain with continuous pain or clonic angina in different parts. In addition,there were some symptoms such as abdominal distension,diarrhea,vomiting and so on. In pretreatment CT scan,single segment bowel involvement was found in 2 cases,multisegmental bowel involvement in 7 cases. Of all lesions,stomach and duodenum were found in 4 cases,jejunoileum in 6 cases,colon in 5 cases,ileocecum in 4 cases,rectum in 2 cases. Intestinal obstruction was found in 1 case. Peritoneal and retroperitoneal lymphadenectasis were found in 6 cases,pyoperitoneum in 4 cases. Conclusion While lacking specificity,the CT signs can display fully the location,range and extent of the lesions. Combined with clinical data,CT can provide important information for clinical diagnosis of adult abdominal type allergic purpura.
引文
1 Liu LX,Zhu FQ,Lin H,et al.Clinical manifestations and endoscopic characteristics of adult abdominal type allergic purpura:An analysis of 26 cases[J].World Chinese Journal of Digestology,2013,21:2364-2366.
2 Reamy BV,Williams PM,Lindsay TJ.Henoch-Schonlein purpura[J].Am Fam Physician,2009,80:697-704.
3 Trapani S,Micheli A,Grisolia F,et al.Henoch Schonlein purpura in child-hood:epidemiological and clinical analysis of 150 cases over a5 -year period and review of literature[J].Semin Arthritis Rheum,2005,35:143-153.
4 程小杰,陆涤宇,等.多层螺旋CT对成人腹型过敏性紫癜的诊断及疗效评价[J].中国医学影像学杂志,2015,23:369-372.
5 闫喆,李欣,赵滨,等.儿童腹型过敏性紫癜的MSCT诊断及鉴别诊断[J].放射学实践,2013,28:735-738.
6 谢峥,韦炳能,黄庆宁.CT平扫对小儿腹型紫癜的诊断价值[J].影像诊断与介入放射学,2013,22:52-55.
7 Hokama A,Kishimoto K,Ihama Y,et al.Endoscopic and radiographic features of gastrointestinal involvement in vasculitis[J].World J Gastrointest Endosc,2012,4:50-56..
8 Chung DJ,Park YS,Huh KC,et al.Radiologic fingings of gastrointestinal complications in an adult patient with Henoch-Schonlein purpura[J].Am J Roentgenol,2006,187:396-398.
9 Kalyoncu M,Odemis E,Aynaci M,et al.An unusual varicella zoster infection complicated by purpura fulminans and multiorgan failure in a healthy infant[J].Scand J Infect Dis,2003,35:74-76.
10 Karagozian R,Turbide C,Szilagyi A.Henoch-Schonlein purpura presenting with ileal involvement in an adule[J].Dig Dis Sci,2004,49:1722-1726.
2 Reamy BV,Williams PM,Lindsay TJ.Henoch-Schonlein purpura[J].Am Fam Physician,2009,80:697-704.
3 Trapani S,Micheli A,Grisolia F,et al.Henoch Schonlein purpura in child-hood:epidemiological and clinical analysis of 150 cases over a5 -year period and review of literature[J].Semin Arthritis Rheum,2005,35:143-153.
4 程小杰,陆涤宇,等.多层螺旋CT对成人腹型过敏性紫癜的诊断及疗效评价[J].中国医学影像学杂志,2015,23:369-372.
5 闫喆,李欣,赵滨,等.儿童腹型过敏性紫癜的MSCT诊断及鉴别诊断[J].放射学实践,2013,28:735-738.
6 谢峥,韦炳能,黄庆宁.CT平扫对小儿腹型紫癜的诊断价值[J].影像诊断与介入放射学,2013,22:52-55.
7 Hokama A,Kishimoto K,Ihama Y,et al.Endoscopic and radiographic features of gastrointestinal involvement in vasculitis[J].World J Gastrointest Endosc,2012,4:50-56..
8 Chung DJ,Park YS,Huh KC,et al.Radiologic fingings of gastrointestinal complications in an adult patient with Henoch-Schonlein purpura[J].Am J Roentgenol,2006,187:396-398.
9 Kalyoncu M,Odemis E,Aynaci M,et al.An unusual varicella zoster infection complicated by purpura fulminans and multiorgan failure in a healthy infant[J].Scand J Infect Dis,2003,35:74-76.
10 Karagozian R,Turbide C,Szilagyi A.Henoch-Schonlein purpura presenting with ileal involvement in an adule[J].Dig Dis Sci,2004,49:1722-1726.