猫抓病诊断中浅表淋巴结病变的超声图像分析

Sonography of superficial lymph nodes in patients with cat-scratch disease

目的 了解猫抓病患者浅表淋巴结的超声图像表现。方法 分析经病理证实的26 例猫抓病患者的浅表淋巴结的超声图像。结果 26例中共有92枚淋巴结为超声波所检出。受累淋巴结主要位于颈部、耳后、腋下及腹股沟等部位,大小0.4 cm×0.3 cm^4.7 cm×2.1 cm。约81%患者的受累淋巴结短/长径之比≥0.5。有助于诊断CSD的超声图像表现包括受累淋巴结的回声较低(100%),淋巴结周围的组织正常(100%),高回声的淋巴结门结构存在(76.09%),较大的受累淋巴结或化脓淋巴结的后方回声增强。59.78%受累淋巴结内可显示彩色血流信号,其中43.48%可检出小动脉血流信号,平均RI为0.58。结论 CSD的超声改变缺乏特异性,但结合临床资料,浅表淋巴结超声检查仍有助于CSD的诊断。

Objective To characterize the sonographic appearance of the lymph nodes in patients with cat-scratch disease (CSD). Methods The sonograms of superficial lymph nodes in 26 patients with proven CSD were analyzed between May 2001 and October 2004. Results A total of 92 involved lymph nodes were detected,most commonly in the cervical, parotid, axillary, submandibular, and inguinal regions. The size of involved lymph nodes ranged from 0.4 cm×0.3 cm to 4.7 cm×2.1 cm. The largest involved node had a short axis/long axis ratio of 0.5 or greater in 81% of patients. Useful features for the differential diagnosis included markedly decreased echogenicity (100%), normal surrounding tissues (100%), and the presence of an echogenic hilum (76.09%). Posterior sound enhancement was significantly associated with larger and abscessed lymph nodes. Signal of blood flow was showed by CDFI in 55 nodes (59.78%), among which 40 nodes (43.48%) possessed arterious flow. The mean RI was 0.58. Conclusion Despite the absence of a specific sonographic finding for CSD, gray-scale sonography and CDFI can provide clues to the diagnosis of CSD in the proper clinical setting.