颈胸交界区感染、积气性病变MDCT表现特征及其解剖、病理学基础  

Multi-detector CT features and anatomic and pathological basis of infection and air collection in cervico-thoracic juntion

作　　者：叶奕兰[1,2] 杨志刚 李媛[1] 陈静[1] 唐思诗[1] 文凌仪[1] 杨开清[3] 

机构地区：[1]四川大学华西医院放射科,成都610041 [2]解放军第四五二医院医学影像科,成都610021 [3]四川大学基础与法医学院人体解剖教研室,成都610041

出　　处：《放射学实践》2014年第8期924-928,共5页Radiologic Practice

基　　金：国家自然科学基金资助项目(30970820)

摘　　要：目的:明确颈胸交界区感染、积气病变的MDCT影像表现特点和规律,结合尸体断面解剖观察,探讨其影像学表现与解剖、病理学基础的相关性。方法:观察尸体断面标本11具(5例横断面、4例矢状面和2例冠状面),主要观察颈胸交界区组织结构的位置、形态特征,并结合经临床或病理证实的颈胸交界区感染、积气性病变84例的MDCT表现特点及规律,阐明影像学表现与解剖、病理学的相关性。结果:11例尸体断面解剖发现:咽后间隙、椎前间隙与上纵隔食管后间隙自然相通;椎前间隙向外下方经腋鞘与腋窝相连通;颈动脉鞘向下与上纵隔血管周围间隙相延续;颈部气管前间隙向下与上纵隔相通。84例患者的MDCT影像表现:咽后间隙感染可向下达后纵隔;椎前间隙感染可向下蔓延至后纵隔,向两侧蔓延至腋窝;颈动脉鞘感染可向下延伸至上纵隔;积气性病变可同时分布于纵隔、颈部、腋窝区。结论:MDCT能够详细反映颈胸交界区感染、积气病变的局部表现和向周围扩散的情况;尸体断面发现的解剖特点决定了此区域病灶的优势分布。Objective：To study the multi-detector CT （MDCT） appearances of infection and air collection at cervico- thoracic junction,and correlated with anatomic findings on cross-section of cadavers. Methods： 11 adult cadavers were used to study the structure and morphology characteristics of cervico-thoracic junction, with axial section （n=5）, sagittal section （n=4） and coronal section （n=2）. 84 patients with infection or air collection （pneumatosis） at cervico-thoracic junction un derwent MDCT were also studied and correlation with patho-anatomy was performed. Results：The main findings of 11 cada- vers were as follows=anatomic communication was revealed between retropharyngeal space and prevertebral space with ret- roesophageal space of superior mediastinum; prevertebral space extended laterally and inferiorly, communicating with axilla ry fossa via axillary sheath; carotid sheath was continuous with perivascular space of superior mediastinum; pretracheal space of neck communicated with superior mediastinum. The MDCT findings of 84 cases showed infection of retropharyn- geal space extended downward to posterior mediastinum; infection of prevertebral space extended downward to posterior mediastinum and laterally to axillary fossa;infection of carotid sheath could spread downward to superior mediastinum. Air collection in mediastinum in cases of pneumatosis could simultaneously spread to neck and axillary fossa. Conclusion ： The de- tail information of distribution of infection or air collection in cervico-thoracic junction could be revealed clearly on MDCT. The distribution of disease depends on the specific anatomy characteristics which were showed on cross section study of ca- davers.

关 键 词：纵隔 颈胸交界区 颈部 筋膜间隙 腋窝 

分 类 号：R816.4[医药卫生—放射医学]