酷似纵隔肿块的食道静脉曲张的影像学诊断(1)
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2010年9月1日
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【摘要】目的:探讨酷似纵隔肿块的食道周围型静脉曲张的影像诊断。方法:自2005-2007年我院18例酷似纵隔肿块的食道静脉曲张在CT或MRI检查中诊断为食道静脉曲张,其中11例最终经手术或DSA证实为食道静脉曲张。回顾性分析此18例患者的影像学表现。结果:18例患者DR检查均见大小不等的后下纵隔肿块,增强CT或MRI检查中表现为静脉期食管壁及食管周围显著强化的迂曲血管团。11例患者中病变的CT或MRI表现与DSA或纵隔手术表现完全相符合,并可清楚显示流入和流出血管。结论:CT及MRI检查可正确诊断酷似纵隔肿块的食道静脉曲张,避免盲目活检造成的致命性出血。
【关键词】门静脉;食道;静脉曲张;肿块;CT;MRI;DR
doi:10.3969/j.issn.1006-1959.2010.09.426文章编号:1006-1959(2010)-09-2646-02
Dentification of Esophageal Varices Similar to Mediastinal mass: imaging diagnosisDONG Yun-xu,QIN Jie,MENG Xiao-chun,ZHANG Jian-shenDepartment of Radiology,the Third Affiliated Hospital,Sun Yat-sen University,Guangzhou 510630,China
【Abstract】Objective:To analyze the imaging diagnosis of esophageal varices similar to mediastinal mass.Methods:From 2005 to 2007,high-density mass-like shadow in mediastinal space,which was detected in DR examinations,was diagnosed as esophageal varices by CT or MRI examinations in 18 patients.Among them,11 patients were finally confirmed by DSA or mediastinal operation.The imaging features of these 18 patients were retrospectively analyzed.Results:All patients presented high-density mass-like shadow in posterior inferior mediastinum in DR images with different sizes.In contrast-enhanced CT or MRI examinations,all these lesions appeared as remarkably dilated tortuous blood vessels in or around esophageal wall with significant enhancement in portal venous phase,which connected with the portal venous branches.In CT or MRI examinations,the flow-in and flow-out vessels were clearly depicted in all of them.The manifestations of the varices presented in CT or MRI examinations were finally confirmed in DSA or mediastinal operations in 11 patients.Conclusion:Esophageal varices similar to mediastinal mass can be correctly identified by un-invasive CT or MRI examination and avoided fetal bleeding due to blinded biopsy.
【Key words】Esophageal varices;Mediastinal mass;Computed tomography;Magnatic Resonance Imaging;CT;MRI;DR
食道胃底静脉曲张作为门静脉高压的表现之一,诊断并不困难,上消化道内镜或钡餐可直接或间接的观察到粘膜面扩张迂曲的血管,这已有众多的文献描述并为人们所熟知,本文不再赘述,而表现为酷似纵隔肿块的食道周围型静脉曲张的影像诊断文献报告基少,偶可引起误诊(迷惑),本文重点探讨这一较少见的静脉曲张类型。
1.资料与方法
1.1一般资料:本组18例,男12例,女6例,年龄25-72岁,平均48岁。所有病例均有慢性乙肝病史,病程15-30年,18均有肝硬化,有5例合并有原发性肝癌,11例有反复上消化道出血。本组病例均无明显的吞咽困难。
1.2检查方法:常规照片采用GEDR设备,常规摄后前位及左侧位片;本组病例在明确诊断之前均行胸部螺旋CT(GElightspeedCT/i)或MRI(GEsigna/I1 ......
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