盆腔脓肿的CT诊断与鉴别诊断

CT Diagnosis and Diferential Diagnosis of Pelvic Abscess

目的探讨盆腔脓肿的CT征象,提高盆腔脓肿诊断及鉴别诊断的水平。方法回顾性分析35例经手术或穿刺病理证实的盆腔脓肿的临床和CT表现,其中8例CT误诊。结果(1)盆腔肿块:肿块呈囊实性或囊性,增强扫描后,肿块间隔及实性成分明显强化。2例囊内见积气。(2)盆腔脏器改变:17例附件增粗并明显强化,12例子宫增大、宫腔积脓。(3)盆腔水肿及盆腔积液:盆腔水肿共29例,表现为骶子宫韧带增厚、盆腔脂肪和盆底筋膜模糊。盆腔积液共28例。结论CT扫描能清楚地显示肿块的内部结构和范围及其与周围脏器的情况,为临床选择治疗方案提供准确的参考依据。CT增强扫描对于盆腔脓肿的诊断与鉴别诊断很有帮助。

Objective To study the CT manifestations of pelvic abscess. Methods The CT features and clinic manifestations in 35 patients with pathologically proved pelvic abscess were reviewed restrospectively. Misdiagnosis was made in 8 of the 35 cases. Results （ 1 ）Pelvic masses ：The lesions were cystic or cysfic-parenchymatous mass,in which the parenchyma and septum were remarkably enhanced after the contrast agent was given intravenously. In 2 patients,air was shown within the cavity of the cysts. （2）Alternation of pelvic organs：Appendage thick connective tissue which was enhanced obviously after contrast was found in CT in 17 patients. Enlargement of uterus and pyometra were detected in 12 patients. （3）Pelvic edema and fluid collection in pelvis：Pelvic edema was found in 29 patients. CT images showed thickening of uterosacral ligaments,haziness of pelvic fat and obscuration of the pelvic floor fascial planes. Fluid collection in pelvis was shown in 28 patients. Conclusion CT scan can clearly demonstrate the structure and the extent, of the mass and the adjacent organs, and provide valuable information for clinical treatment. Contrast enhanced CT scan plays a valuable role in diagnosis or differential diagnosis of pelvic abscess.