髂腰肌囊扩张的超声表现及鉴别诊断
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摘要
目的探讨髂腰肌囊扩张的超声表现及鉴别诊断,提高超声医师对本病的认识。方法回顾性分析经B超引导下穿刺抽吸和/或手术病理证实的30例髂腰肌囊扩张患者的超声表现。结果 30例髂腰肌囊扩张均发生于单侧,右侧21例,左侧9例,横径平均值为2.9cm(1.2~4.7cm),纵径平均值为5.7cm(3.8~7.5cm),其声像图表现为圆形,卵圆形囊性团块,囊壁薄,边界清晰,26例内透声良好,4例内见细密点状略强回声,其中2例可见条状分隔。18例腹股沟区可触及囊性肿物,21例可显示髋关节积液,18例可显示髂腰肌囊与髋关节积液相连通,3例可显示扩张髂腰肌囊向周围组织延伸。结论超声检查无创易行,便捷经济,准确可靠,可对髂腰肌囊扩张做出较为明确诊断,具有重要的诊断与鉴别诊断价值。
Objective To study the manifestations and differential diagnosis of ultrasound( US) on enlarged iliopsoas bursa,aimed at improving the awareness of this disease by ultrasonic physician. Methods US features of 30 patients with enlarged iliopsoas bursa,who were proved by aspiration of synovial fluid under ultrasound guidance or surgical operation-pathology,respectively,were analyzed retrospectively. Results All of those 30 enlarged iliopsoas bursas located in only one side,in whom 21 were located in the right side and 9 in the left side. The mean size of the iliopsoas bursae was 2. 9 cm,ranged from 1. 2 to 4. 7 cm in sagittal diameter and 5. 7 cm,ranged from 3. 8 to 7. 5 cm,in longitudinal diameter. All of them appeared as round,oval cystic,well-defined,thin-walled mass. 26 cases appeared homogeneously echo-free cystic lesion,4 cases exhibited the homogeneously texture,and 2 presented with strip separations. Palpable cystic masses of inguinal region were seen in 18 cases,hip joint effusions were seen in 21 cases,a communication between the iliopsoas bursa and the adjacent hip joint was seen in 18 cases,and the abdominal extension of the iliopsoas bursa was seen in 3 cases. Conclusion Since US is the most cost-effective,fast and easy-to-perform imaging technique,it can make a clear diagnosis of the enlarged iliopsoasbursa,which is of important clinical value.
Objective To study the manifestations and differential diagnosis of ultrasound( US) on enlarged iliopsoas bursa,aimed at improving the awareness of this disease by ultrasonic physician. Methods US features of 30 patients with enlarged iliopsoas bursa,who were proved by aspiration of synovial fluid under ultrasound guidance or surgical operation-pathology,respectively,were analyzed retrospectively. Results All of those 30 enlarged iliopsoas bursas located in only one side,in whom 21 were located in the right side and 9 in the left side. The mean size of the iliopsoas bursae was 2. 9 cm,ranged from 1. 2 to 4. 7 cm in sagittal diameter and 5. 7 cm,ranged from 3. 8 to 7. 5 cm,in longitudinal diameter. All of them appeared as round,oval cystic,well-defined,thin-walled mass. 26 cases appeared homogeneously echo-free cystic lesion,4 cases exhibited the homogeneously texture,and 2 presented with strip separations. Palpable cystic masses of inguinal region were seen in 18 cases,hip joint effusions were seen in 21 cases,a communication between the iliopsoas bursa and the adjacent hip joint was seen in 18 cases,and the abdominal extension of the iliopsoas bursa was seen in 3 cases. Conclusion Since US is the most cost-effective,fast and easy-to-perform imaging technique,it can make a clear diagnosis of the enlarged iliopsoasbursa,which is of important clinical value.
引文
[1]石景芳,何慧,桂季滔,等.髂腰肌囊扩张高频彩超误诊分析及其临床意义[J].医学影像学杂志,2017,27(3):573-575.
[2]Johnston CA,Wiley JP,Lindsay DM,et al.Iliopsoas bursitis and tendinitis[J].A review Sports Med,1998,525(3):271-283.
[3]Kozlov DB,Sonin AH.Iliopsoasbursitis:diagnosis by MRI[J].Comput Assist Tomogr,1998,22(5):625-628.
[4]刘吉华,徐爱德,汪敬群,等.髂腰肌囊扩张的影像学诊断[J].中华放射学杂志,2003,37(2):140-143.
[5]Blankenbaker DG,De Smet AA,Keene JS.Sonography of the iliopsoas tendon and injection of the iliopsoas bursa for diagnosis and management of the painful snapping hip[J].Skeletal Radiol,2006,35(8):565-571.
[6]Nunley RM,Wilson JM,Gilula L,et al.Iliopsoas bursa injections can be beneficial for pain after total hip arthroplasty[J].Clin Orthop Relat Res,2010,468(2):519-526.
[7]Agten CA,Rosskopf AB,Zingg PO,et al.Outcomes after fluoroscopy-guided iliopsoas bursa injection for suspected iliopsoastendinopathy[J].Eur Radiol,2015,25(3):865-871.
[8]Yoon TR,Song EK,Chung JY,et al.Femoral neuropathy caused by enlarged iliopsoas bursa associated with osteonecrosis of femoral head:a case report[J].Acta Orthop Scand,2000,71(2):322-324.
[9]杨志远,黄伟,余东,等.髂腰肌滑囊扩张的临床特点和影像学表现[J].中国临床医学影像杂志,2011,21(1):56-58.
[10]Matsumoto T,Juji T,Mori T.Enlarged psoas muscle and bursitis associated with a rapidly destructive hip in a patient with rheumatoid arthritis[J].Mod Rheumatol,2006,16(1):52-54.
[11]胡卫东,张卫红,王秀荣,等.髂腰肌囊扩张影像学表现及其相关因素分析[J].广东医学,2016,(12):1857-1858.
[12]杜玉清,孔祥泉,刘吉华,髂腰肌囊积液的临床、CT诊断[J].临床放射学杂志,2003,22(4):311-313.
[13]刘春红,马大庆,徐爱德,等.股骨头缺血坏死并髂腰肌囊扩张的影像学表现[J].临床放射学杂志,2004,23(6):495-497.
[14]Monaghan N,Nwawka OK,Wyss JF.Giant iliopsoas bursa presenting as a large pulsatile groin mass[J].P M R,2014,6(9):857-859.
[15]曾禹莉,王贵良.髂腰肌囊扩张的影像诊断与鉴别诊断[J].中国医疗前沿,2013,7(14):92-93.
[16]Walter HS,Martin M.Female hydrocele(cyst of the canal of Nuck)[J].Ultrasound Med,2004,23(5):429-432.
[2]Johnston CA,Wiley JP,Lindsay DM,et al.Iliopsoas bursitis and tendinitis[J].A review Sports Med,1998,525(3):271-283.
[3]Kozlov DB,Sonin AH.Iliopsoasbursitis:diagnosis by MRI[J].Comput Assist Tomogr,1998,22(5):625-628.
[4]刘吉华,徐爱德,汪敬群,等.髂腰肌囊扩张的影像学诊断[J].中华放射学杂志,2003,37(2):140-143.
[5]Blankenbaker DG,De Smet AA,Keene JS.Sonography of the iliopsoas tendon and injection of the iliopsoas bursa for diagnosis and management of the painful snapping hip[J].Skeletal Radiol,2006,35(8):565-571.
[6]Nunley RM,Wilson JM,Gilula L,et al.Iliopsoas bursa injections can be beneficial for pain after total hip arthroplasty[J].Clin Orthop Relat Res,2010,468(2):519-526.
[7]Agten CA,Rosskopf AB,Zingg PO,et al.Outcomes after fluoroscopy-guided iliopsoas bursa injection for suspected iliopsoastendinopathy[J].Eur Radiol,2015,25(3):865-871.
[8]Yoon TR,Song EK,Chung JY,et al.Femoral neuropathy caused by enlarged iliopsoas bursa associated with osteonecrosis of femoral head:a case report[J].Acta Orthop Scand,2000,71(2):322-324.
[9]杨志远,黄伟,余东,等.髂腰肌滑囊扩张的临床特点和影像学表现[J].中国临床医学影像杂志,2011,21(1):56-58.
[10]Matsumoto T,Juji T,Mori T.Enlarged psoas muscle and bursitis associated with a rapidly destructive hip in a patient with rheumatoid arthritis[J].Mod Rheumatol,2006,16(1):52-54.
[11]胡卫东,张卫红,王秀荣,等.髂腰肌囊扩张影像学表现及其相关因素分析[J].广东医学,2016,(12):1857-1858.
[12]杜玉清,孔祥泉,刘吉华,髂腰肌囊积液的临床、CT诊断[J].临床放射学杂志,2003,22(4):311-313.
[13]刘春红,马大庆,徐爱德,等.股骨头缺血坏死并髂腰肌囊扩张的影像学表现[J].临床放射学杂志,2004,23(6):495-497.
[14]Monaghan N,Nwawka OK,Wyss JF.Giant iliopsoas bursa presenting as a large pulsatile groin mass[J].P M R,2014,6(9):857-859.
[15]曾禹莉,王贵良.髂腰肌囊扩张的影像诊断与鉴别诊断[J].中国医疗前沿,2013,7(14):92-93.
[16]Walter HS,Martin M.Female hydrocele(cyst of the canal of Nuck)[J].Ultrasound Med,2004,23(5):429-432.