门静脉血栓的CT表现及鉴别诊断  

CT appearance and differential diagnosis of thrombus in portal vein

作　　者：吴恒[1] 寿毅[2] 

机构地区：[1]上海市江湾医院放射科,200434 [2]第二军医大学附属东方肝胆外科医院放射科

出　　处：《上海医学影像》2004年第4期296-298,共3页Shanghai Medical Imaging

摘　　要：目的探讨门静脉系统血栓的CT影像表现。方法对18例经临床及病理证实的门脉栓塞的患者进行螺旋CT扫描检查,分析门脉血栓影像特点。结果18例门脉血栓中,栓子发生于主干15例,右支10例,左支7例,脾静脉6例,肠系膜上静脉4例;栓子出现高密度5例,等密度8例,低密度2例;栓子为部分偏心栓塞13例,呈现小条状、柴捆状;出现受累管腔扩张2例,附栓管壁均连续光滑、无外突结节,无1例出现管壁强化;出现食管胃丛及脾丛侧支循环10例,胆管丛及胆囊丛侧支循环2例;无1例出现动-门脉瘘。结论门脉血栓在栓塞的位置、栓子的表现、附栓管腔的情况及肝外侧支循环等方面都有不同于癌栓的特征性表现,结合病史和CT表现可以对门脉栓塞的定性作出更准确的诊断。Objective To study the CT images of thrombus in portal vein and describe its features and summarize further discrimination with cancer embolus. Methods 18 cases confirmed by autopsy and therapy were examined with CT, and analysis its traits in CT images. Results In 18 cases of thrombus embolism, 15 cases occurred in trunk vein, 10 cases in right branch, 7cases in left branch, 6 cases in splenic vein and 4 cases in superior mesenteric vein; 5 cases showed high-dense in thrombus and 8 cases appear iso-dense and 2 cases in low-dense; 13 benign embolism cases presented partial filling defect, which was described as stripe and bundles in contrasted vein; All cases with thrombus showed smooth and successive in involved vein wall; 5 cases of thrombus lead to dilation of the involved vein; 10 cases displayed collateral circulation in esophagogastric and splenic vein, whereas 2 cases displayed pericholecystic and pericholedochal collateral branches; no cases visualized A-P shunt in all thrombus embolism. Conclusions There are great differentiation in some aspects such as embolus' position and shapes, involved vein and collateral circulation between benign and malignant embolism and so on. All above mentioned will be the great help to improve the accurate diagnosis of the portal vein embolism.

关 键 词：门脉 栓子 门静脉血栓 栓塞 侧支循环 CT表现 鉴别诊断 影像特点 肠系膜上静脉 螺旋CT扫描 

分 类 号：R657[医药卫生—外科学] R743[医药卫生—临床医学]