外伤后迟发性膈疝合并胃坏死的CT诊断

CT Diagnosis of Gastric Necrosis Caused by Tardive Diaphragmatic Hernia after Trauma

目的探讨胸腹部外伤后迟发性膈疝所致胃坏死的CT表现特征。资料与方法回顾性分析6例经外科手术证实的闭合性胸腹部外伤后膈疝合并胃坏死患者的临床和CT检查资料。6例均行常规胸腹部CT平扫,除1例病情危重外,另5例均行双期增强扫描,图像分析结合多平面重组(MPR)和最大密度投影(MIP)等CT后处理技术。结果6例膈疝发生于外伤后3个月～6年不等,单侧发生,均为左侧。胃底坏死3例,小弯侧1例,大弯侧2例,其中1例伴穿孔。胃经膈肌破口进入胸腔,胃不同程度扩张,坏死区胃壁稍厚与未坏死部分分界较清楚;3例增强扫描早期坏死区不强化,其中1例周围胃动脉分支无对比剂充盈,延迟期坏死区轻度强化,2例增强早期轻度强化;胃坏死区周围脂肪层模糊、密度增高;1例胃腔内可见少量溢出对比剂,表现为动脉期斑点状高密度影;1例大弯侧穿孔处胃壁连续性中断,可见小缺口,胃内容物经缺口溢出;胸腔积液3例,其中1例穿孔者呈混杂密度。1例伴左肾疝入胸腔,1例伴局部陈旧性脾梗死。结论外伤后迟发性膈疝合并胃坏死具有一定的直接和间接特征性CT表现,运用合适的检查技术并正确认识胃坏死的CT征象有助于提高诊断准确率,为尽早手术治疗提供客观依据。

Objective To study CT findings of gastric necrosis caused by tardive diaphragmatic hernia after trauma. Materials and Methods The clinical and CT date of 6 patients with gastric necrosis caused by blunt trauma were analyzed retrospectively. All of 6 cases were performed thoracoabdominal CT plain scan, and additional double phased enhancement in 5 cass. Muhplanar reformation and maximum intensity projection were applied in all cases. Results Diaphragmatic hernia occurred after blunt abdominal trauma 3 months to 6 years. All the diaphragmatic hernia occurred at left side. Necrosis area located at gastric fundus in 3cases, lesser curvature side in 1 case, body of stomach in 2 cases and 1 case of necrosis was complicated by perforation. Gaster intruded into thoracic cavity through ruptured diaphragma with some extent dilated. Necrosis gastric wall thickened and had relative clear border with normal area. Necrosis areas were hypointensity in plain scan and enhanced slightly in 2 cases at early phase, not enhanced in 3 cases at early phase, slightly enhanced at delayed scan. Vascular arch and its tributaries could not be visualizedin one area. Fat plane around necrosis area showed hyperlntensity. Necrosis area discontinuation displayed in 1 case and contrast media leaked from rupture area at aratery phase. Hydrothorax occurred in 3 cases. Left kidney entered into thoracic cavity and spleen necrosised in lcase respectively. Conclusion There are some direct and indirect characteristics on the CT imaging of gastric necrosis caused by tardive diaphragmatic hernia after trauma. The CT features are helpful to improve the accurately diagnosis and to provid information for operation as early as possible and avoid severity complication occurring.