肘部猫抓病性淋巴结炎的超声影像分析  

Ultrasonographic analysis of cat-scratch disease associated lymphadenitis of the elbow

作　　者：周永 杨珊燕 刘金华 肖萤[3] Zhou Yong;Yang Shanyan;Liu Jinhua;Xiao Ying(Department of Ultrasound Diagnosis,The Third Hospital of Changsha,Changsha 410015,China;Department of Respiratory,The Third Hospital of Changsha,Changsha 410015,China;Department of Ultrasound Imaging,Xiangya Hospital,Central South University,Changsha 410008,China)

机构地区：[1]长沙市第三医院超声诊断科,长沙410015 [2]长沙市第三医院呼吸内科,长沙410015 [3]中南大学湘雅医院超声影像科,长沙410008

出　　处：《中国医师杂志》2022年第12期1811-1815,共5页Journal of Chinese Physician

基　　金：国家自然科学基金(62071178)。

摘　　要：目的分析肘部猫抓病(CSD)性淋巴结炎的超声影像特征,提高超声医师对CSD的诊断及鉴别诊断能力。方法按照纳入标准和排除标准回顾性收集2015年3月至2021年10月在长沙市第三医院因肘部肿块就诊的患者,按照病理来源分为CSD组和非CSD组,对比分析两组肿块内部的超声表现及肿块周围的超声改变,归纳CSD的超声影像特征。结果在90例肘部肿块中,CSD组14例,非CSD组76例,CSD组有猫抓伤病史8例、咬伤史2例,潜伏期4 d至3个月不等,4例否认猫抓咬病史或密切接触病史。8例使用抗生素治疗,6例未采用任何治疗,1~3个月后进行随访,14例CSD患者均诉康复。CSD组和非CSD组在肿块位置上差异有统计学意义(χ2=14.507,P<0.05),CSD组的肿块全部位于肘内侧;CSD性淋巴结炎的内部超声表现特异性不高,但肿块外超声改变有一定特征,表现为淋巴结周围炎及局限性浅静脉炎,CSD组和非CSD组在肿块外超声改变上差异亦有统计学意义(χ2=34.070,P<0.05)。结论肘部CSD性淋巴结炎一般好发于肘内侧,当有相关流行病学史支持及典型的淋巴结结内和结外声像改变时,超声可做出高度提示,进而减少肘部肿块非必需的侵入性操作。Objective To analyze the ultrasonographic features of lymphadenitis caused by cat-scratch disease(CSD)of the elbow,and to improve the diagnosis and differentiation of CSD by sonologist.Methods According to the inclusion and exclusion criteria,we retrospectively collected the patients who visited Changsha Third Hospital from March 2015 to October 2021 due to elbow mass,and divided them into CSD group and non CSD group according to the pathological source.We compared and analyzed the ultrasonic manifestations inside and around the mass in the two groups,and summarized the ultrasonic image characteristics of CSD.Results In 90 cases of elbow mass,there were 14 cases in CSD group and 76 cases in non CSD group.There were 8 cases of cat scratch history and 2 cases of bite history in CSD group.The incubation period ranged from 4 days to 3 months.There were 4 cases of denied cat scratch and bite history or close contact history.Eight patients were treated with antibiotics,and 6 patients did not receive any treatment.14 patients with CSD were followed up after 1-3 months.There was statistically significant difference between CSD group and non CSD group in tumor location(χ2=14.507,P<0.05),the masses in CSD group were all located in the medial elbow;The specificity of internal ultrasound in CSD lymphadenitis was not high,but the ultrasonic changes outside the mass had certain characteristics,such as lymphadenitis and localized superficial phlebitis.There was also a statistical difference between CSD group and non CSD group in the ultrasonic changes outside the mass(χ2=34.070,P<0.05).Conclusions CSD lymphadenitis usually occurs in the medial epitrochlear region of the elbow.Ultrasound can be highly suggestive when there is a relevant epidemiological history and typical intra and extra-nodal sonographic changes,thus reducing the unnecessary invasive manipulation of the elbow mass.

关 键 词：猫抓病 肘 淋巴结炎 超声检查 

分 类 号：R516[医药卫生—内科学]