CT扫描对十二指肠壁血肿的诊断价值

Value of CT scan in the diagnosis of intramural duodenal hematomas

目的探讨十二指肠壁血肿的CT表现及其诊断价值。方法回顾性分析7例十二指肠壁血肿患者的CT表现,4例经手术证实,3例经内科治疗后CT随访证实。结果7例患者中,血肿同时累及水平段和降段1例,同时累及水平段和升段2例,单纯累及水平段4例。7例CT扫描显示均有肠壁增厚,管腔受压变窄。CT平扫示壁内有高密度或等密度肿块,增强后无强化,十二指肠壁血肿的并发症包括:1例合并胰头钩突肿块,2例合并胰腺弥漫肿大且边缘模糊,1例合并胆总管轻度扩张,2例合并腹腔少量积液。3例内科保守治疗患者CT复查血肿有缩小。结论CT能对十二指肠壁血肿作出准确诊断,并为临床治疗方案的选择和随访提供可靠依据。

Objective To study the CT findings of intramural duodenal hematoma（IDH） and to evaluate their value for the diagnosis. Methods CT findings of 7 patients with IDH which was confirmed by surgery（n=4） and CT follow-up after conservative therapy（n=3） were analyzed retrospectively. Results Among 7 patients, simultaneous involvement of horizontal part and descending part were found in 1, simultaneous involvement of horizontal part and ascending part in 2, and single involvement of horizontal part in 4. CT scans showed duodenal wall thickening, luminal compressing and narrowing in all 7 cases. Preeontrast CT images showed intramural hyperdense or isodense soft tissue masses. These masses had not enhancement after contrast-enhanced scans. The complications of IDH in the group patients included mass of pancreatic head uncinate process （n=1）, diffuse pancreas swelling with ill-definite margin （n=2）, slight dilatation of common bile duct （n=2）, and small amount of peritoneal fluid （n=2）. IDHs of 3 patients who underwent conservative therapy were more or less reduced. Conclusion CT scans may accurately diagnose IDH and may provide the reliable evidence for selecting therapeutic protocol and for performing clinical follow-up.