腹膜弥漫性少见病之MDCT征象探讨  

MDCT Findings of Diffuse Rare Peritoneal Disease

作　　者：陈淑香 陈晓芳[1] 杜瑞宾[1] 张惠娟[1] CHEN Shu-xiang;CHEN Xiao-fang;DU Rui-bin;ZHANG Hui-juan(Department of Radiology,Provincial Clinical College of Fujian Medical University,Fujian Province Hospital,Fujian Province Hospital Jinshan Branch,Fuzhou 350028,Fujian Province,China)

机构地区：[1]福建医科大学省立临床医学院/福建省立医院/福建省立金山医院放射科,福建福州350028

出　　处：《罕少疾病杂志》2021年第3期1-4,共4页Journal of Rare and Uncommon Diseases

基　　金：福建医科大学启航基金项目资助(2018QH1138)。

摘　　要：目的总结累及大网膜的腹膜弥漫性少见病的MDCT特征,提高对此类病变的认识及鉴别诊断水平。方法回顾性分析经病理确诊的腹膜弥漫性少见病的临床及影像表现并复习相关文献。结果10例中,腹膜间皮瘤2例,Burkkit淋巴瘤2例,结核性腹膜炎6例;男8例,女2例,年龄5~76岁,平均年龄42.7岁。影像表现为:(1)弥漫型腹膜间皮瘤:大网膜、肠系膜间隙浑浊且广泛不均匀增厚、呈“丝瓜瓢状”“污秽征”,增强呈轻中度渐进性强化,沿着腹膜不均匀浸润呈“塑形征”,并可累及腹腔组织器官的腹膜面,但肠系膜血管间隙及与之相连的腹膜后大血管间隙区、腹膜后器官无受累呈“回避征”,腹腔积液少-中量,沿肝、脾、胃周及结肠旁沟、结肠下间隙分布,较少有淋巴结肿大。(2)累及腹膜的弥漫性淋巴瘤具有“蒸馒头征”“血管漂浮征”及胃肠道病变的动脉瘤样扩张等特征性,常并腹腔脏器浸润及腹膜后淋巴结肿大,但密度均匀、很少坏死。(3)结核性腹膜炎腹膜增厚较均匀,临近肠管可轻度增厚,易粘连甚至出现肠梗阻,腹腔积液较多且包裹呈“铠甲样”聚积于腹腔前外侧,肠管受压向内后聚集;多继发于肺部结核。结论弥漫型腹膜间皮瘤、淋巴瘤、结核性腹膜炎影像表现有一定的特征,认识上述特征能提高诊断准确性,但部分重叠应密切结合临床及影像特征进行诊断和鉴别诊断。Objective To evaluate the MDCT features of rare diffuse peritoneal disease involving the greater omentum and to improve the diagnosis and differential diagnosis accuracy of these diseases.Methods Clinical and imaging manifestations of ten patients with pathology-proven diffuse rare peritoneal diseases were analyzed retrospectively and review the relevant literature.Results Among the 10 cases,2 were peritoneal mesothelioma,2 were Burkkit lymphoma and 6 were tuberculous peritonitis.There were 8 males and 2 females,aged from 5 to 76 years,with an average age of 42.7 years.MDCT findings:(1)diffuse peritoneal mesothelioma:omentum majus,mesenteric space cloudy and widely uneven thickening,similar to towel gourd ladle and filthy sign,with mild to moderate progressive enhancement,the inhomogeneous infiltration of the lesion along the peritoneum was similar to"Casting shape"and can involve the peritoneal surface of abdominal cavity tissue organ,Mesenteric vascular space and the connected retroperitoneal large vascular space and retroperitoneal organs was not affected and showed"avoidance signs".Litter to medium amount of ascites,which distributed along the periphery of the liver,spleen,stomach,paracolon and subcolon.Lymphadenopathy was rare.(2)Diffuse lymphoma involving the peritoneum,similar to"the swelling sensation of steamed buns"and"vessels levitation sign"the"aneurysmal dilatation"of gastrointestinal lesions,which are characteristic,often accompanied by lymphadenopathy which the density was uniform and little necrosis.(3)Tuberculous peritonitis has relatively uniform peritoneum thickening,slightly thickened of the adjacent intestinal canal,easy adhesion,and even lead to intestinal obstruction,resulting in more ascites wrapped accumulation in the anterolateral abdominal cavity,intestinal compression to inward and backward aggregation.Tuberculous peritonitis was almost secondary to pulmonary tuberculosis.Conclusion Diffuse peritoneal mesothelioma,lymphoma,and tuberculous peritonitis are rare diseases:grasp their certa

关 键 词：腹膜 间皮瘤 淋巴瘤 结核性腹膜炎 CT 

分 类 号：R656.4[医药卫生—外科学] R445.3[医药卫生—临床医学]