急性肠系膜血管梗塞的CT表现

CT diagnosis in acute mesenteric infarction

目的评价CT对急性肠系膜血管梗塞(AMI)的诊断价值。方法搜集AMI病例10例,男6例,女4例,平均年龄67.2岁。除1例在诊断次日死亡外,其余均经手术病理证实。其中肠系膜上动脉(SMA)梗塞4例,肠系膜上静脉梗塞(SMV)5例,肠系膜下静脉(IMV)梗塞1例。除1例行CT平扫外,其余9例均行CT平扫及增强扫描,详细分析其影像学表现。结果直接征象为血管内充盈缺损(8例)。间接征象包括肠腔扩张积液(4例)、肠壁增厚(6例)、薄纸样肠壁(4例)、缆绳征(5例)、肠系膜积液(3例)、肠壁积气(2例)、门静脉积气(1例)及腹腔积液(3例)。结论CT是诊断急性肠系膜血管梗塞的一种快速、敏感、可靠及无创伤的影像学方法。

Objective To determine the diagnostic value of CT in acute mesenteric infarction（AMI）. Methods Ten patients with mesenteric infarction （6 male, 4 female, average age 67.2 years old）were analysed from April 2003 to September 2004, whose symptoms include abdominal pain, melena,nausea and vomiting, etc. Nine cases were confirmed by surgery and pathology except one died immediately after CT scan. They included superior mesenteric arterial （SMA） thrombosis （n = 4 ）, superior mesenteric venous（SMV） thrombosis （n =5） and inferior mesenteric venous（IMV） thrombosis （ n = 1 ）. Except one routine CT scan, all the other cases were performed by contrast-enhanced CT examination. Results The direct sign of acute mesenteric infarction in CT images was filling defect in mesentery vessels（ n = 8 ）. The indirect signs included dilatation of bowl loops （ n = 4 ）, bowel wall thickening （ n = 6）, the paper-thin wall sign （ n = 4 ）, mesenteric stranding（ n = 5 ） , mesenteric haziness （ n = 3 ）, pneumatosis of bowel wall （ n =2）, portal veno gas （ n = 1 ） and ascites （ n = 3 ）. Conclusion Computed tomography is sensitive to acute mesenteric infarction and is valuable in diagnosis.