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目的总结胃肠道管壁弥漫血管瘤的CT表现,增强对本病影像表现的认识。方法回顾性分析2012年4-11月于我院就诊的4例胃肠道管壁弥漫血管瘤患者的临床资料及影像表现。3例行常规腹部平扫+增强CT扫描,1例因下消化道出血行盆腔平扫+增强CT扫描。结果 4例患者,男性3例,年龄分别为16、30、42岁;女性1例,年龄33岁。3例自出生后反复无痛性血便,1例血便1月余。CT显示病变累及胃壁和多节段肠壁,表现为较长节段管壁环形不规则增厚,局部合并管腔狭窄;病变内均可见多个点状或结节状钙化影。增强扫描常规动脉期、门静脉期病变无明显强化,延迟90~120 s,病变渐进性强化,CT值升高20~30 HU。1例在延迟50 min后扫描,病变呈中度均匀强化,CT值约60 HU。病变邻近动脉血管均未见异常。3例引流至门静脉,1例经腹部皮下迂曲静脉引流,其中2例引流静脉粗大。2例门脉正常结构消失,显示门静脉海绵样变。结论对自幼血便或长期反复血便者,应注意胃肠道管壁弥漫血管瘤的可能,CT表现具有特征性,结合临床病史可做出正确诊断。
Objective To summarize the CT manifestations of diffuse hemangiomas in gastrointestinal wall and to enhance the understanding of the imaging manifestations of the disease. Methods The clinical data and imaging findings of 4 patients with diffuse hemangiomas of gastrointestinal wall in our hospital from April to November in 2012 were analyzed retrospectively. In 3 cases, routine abdominal plain scan and enhanced CT scan were performed, and pelvic plain scan and enhanced CT scan in 1 case due to lower gastrointestinal bleeding. Results 4 patients, 3 males, the age were 16,30,42 years old; 1 female, aged 33 years. 3 cases of repeated painless hematochezia since birth, 1 case of bloody stool more than 1 month. CT showed lesions involving the stomach wall and multi-segment bowel wall, showing a long segment of the ring wall irregular thickening, local consolidation of stenosis; lesions can be seen within a number of punctate or nodular calcification. During the routine arterial phase with enhanced scanning, there was no obvious enhancement in the portal venous phase. The delay was 90-120 s. The lesion was progressive enhancement and the CT value was increased by 20-30 HU. One patient underwent a delayed scan for 50 min. The lesions were moderately and uniformly enhanced with a CT value of about 60 HU. No abnormalities were found in adjacent arteries of the lesion. 3 cases of drainage to the portal vein, 1 case of subcutaneous tortuous venous drainage, of which 2 cases of drained veins. Two cases of portal vein disappeared normal structure, showing spontaneous portal vein changes. CONCLUSIONS: Since childhood hematuria or long-term repeated bloody stools, attention should be paid to the possibility of diffuse hemangiomas in the gastrointestinal wall. The CT findings are characteristic and combined with clinical history can make a correct diagnosis.