左心膈角区病变的CT诊断价值(附46例分析)

Diagnosis value of CT in the heart diseases of the left side posterior border:clinical analysis of 46 cases

目的:探讨左心膈角区病变的CT表现,以提高对该区域病变的认识水平。方法:收集本院2005年1月～2010年3月间经手术、病理或CT增强扫描、CT三维重建、心脏超声证实的临床和CT资料完整的左心膈角区病变46例,分析其X线和CT影像学表现。所有病例均行X线平片和CT平扫,其中42例行CT增强扫描。结果:周围型肺癌5例,左中央型肺癌3例,左肺下叶肺不张3例,肺部感染6例,肺隔离症4例;食管下段癌5例,贲门癌3例,贲门失弛缓症2例,左膈疝5例;巨大左心房2例,降主动脉瘤3例;后纵隔蔓状血管瘤1例,后纵隔神经源性肿瘤3例;下胸段胸椎结核伴椎旁脓肿1例。结论:X线平片上心脏左后缘病变因来源不同,表现各异,但各具有一定影像特征,CT平扫+增强扫描在左心膈角区病变的发现和鉴别诊断方面明显优于X线平片,CT检查在左心膈角区病变的诊断与鉴别诊断中具有重要价值,并且是诊断该区域病变的可靠方法。

Objective： To observe the CT images of diseases in the left side posterior border of heart. Methods： Image data of X-ray plain film and CT scan of 46 cases that were confirmed as heart diseases of the left side posterior border by operation, pathological examination, CT enhancement or three-allmensional reconstruction of heart or ultrasound detection lyzed. Results： All these patients underwent examination during January 2005 and March 2010 were ana of X-ray plain film and CT enhancement scan.Peripheral lung cancer was shown in 5 cases, left side central type lung cancer in 3 cases, pulmonary atelectasis of inferior lobe of left lung in 3 cases, pulmonary infection in 6 cases, pulmonary sequestration in 4 cases, esophageal inferior segment cancer in 5 cases, carcinoma of gastric cardia in 3 cases, achalasia of cardia in 2 cases, left side diaphragmatic hernia in 5 cases, giant left atrium（GLA） in 2 eases, aneurysm of descendens aorta in 3 cases, angioma arteriale racemosu of mediastinum posterius in 1 cases, mediastinum posterius neurogenic tumor in 3 cases,lower breast thoracic segments tuberculosis of thoracic vertebra accompanied with abscess in 1 cases. Conclusions： Though diseases in the left side posterior border of heart can be shown as different images with characters in X-ray film, contrast-enhenment CT plus X-ray is prior to X-ray alone. CT is an effective method for the diagnosis and differentiation of diseases in left side posterior border of heart.