传染性单核细胞增生症颈部淋巴结病的超声表现  

Ultrasonographic Findings of Cervical Lymphadenopathy with Infectious Mononucleosis

作　　者：傅先水[1] 任柳琼 杨丽娟[1] 吕珂[3] 陈媛媛[1] 李振彩[1] 

机构地区：[1]中国人民解放军总医院第一附属医院超声科,北京100083 [2]中国人民解放军总医院海南分院超声科,海南三亚572013 [3]中国医学科学院北京协和医学院北京协和医院超声科,北京100730

出　　处：《中国医学科学院学报》2015年第6期715-719,共5页Acta Academiae Medicinae Sinicae

摘　　要：目的分析传染性单核细胞增多症的颈部肿大淋巴结的灰阶和彩色多普勒超声特征。方法对30例传染性单核细胞增多症患者的59个增大淋巴结的声像图特征进行回顾性分析。超声评估包括形态、内部回声、淋巴门、边界、融合性生长、囊性变、钙化、血流分布模式。3例患者接受颈部淋巴结活检病理学分析。结果传染性单核细胞增多症颈部淋巴结多为类圆形(69.5%),双侧分布(96.7%),融合性生长(83.3%),甚至双侧融合性生长(66.6%),边界不清(79.7%),淋巴门消失(66.1%),皮质回声不均质(61.0%)。彩色或能量多普勒超声显示89.8%传染性单核细胞增多症颈部淋巴结可见中央门样血流。2例超声显示淋巴门结构消失的淋巴结活检病例,其病理显示正常的髓质结构消失,淋巴细胞和组织细胞增殖。淋巴门结构仍可显示的传染性单核细胞增多症淋巴结中,其淋巴门(85.0%)多表现为不均匀的低/等回声,且与皮质分界不清,1例组织学检查显示明显扩张的窦腔和组织细胞增殖。结论虽然传染性单核细胞增多症淋巴结和其他病因的肿大淋巴结的超声特征之间有相当大的重叠性,但综合超声分析仍然有助于鉴别诊断。Objective To evaluate the high-resolution and color Doppler ultrasonographic（ US） characteristics of cervical lymphadenopathy in patients with infectious mononucleosis. Methods High-resolution and color Doppler US were performed in 30 patients aged 2 to 30 years with a total of 59 palpable enlarged cervical lymph nodes due to infectious mononucleosis. The US characteristics of the nodes including shape,echotexture,hilum,border,matting,cystic necrosis,calcification and vascular pattern were assessed. Three patients received cervical lymph nodes biopsies. Results The common US findings of cervical lymphadenopathy due to infectious mononucleosis were round shape（ 69. 5%）,bilateral distribution（ 96. 7%）,matting（ 83. 3%） [even bilateral matting（ 66. 6%） ],indistinct margin（ 79. 7%）,absence of hilum（ 66. 1%）,heterogeneous echotecture（ 61. 0%）,and central hilar vascular pattern（ 89. 8%）. In 2 patients with absence of the echoic hilum,lymph nodes biopsies showed histological features including marked effacement of the normal architecture inthe medullary region accompanied by a mixed proliferation of lymphocytes and histiocytes. In all infectious mononucleosis nodes with a hilum,85. 0% had heterogeneously hypo / iso-echoic hila and indistinct demarcation to the cortex. One of them underwent lymph node biopsy and histological findings showed obvious dilation of the sinus oidal lumen and proliferation of histiocytes. Conclusion Although several ultrasonographic characteristics frequently present in the nodes of infectious mononucleosis are not specific,the combination of ultrasound findings may be valuable in differential diagnosis.

关 键 词：传染性单核细胞增生症 超声 淋巴结病 

分 类 号：R445.1[医药卫生—影像医学与核医学]