上腔静脉综合征侧支循环形成的少见CT征象

Infrequent features of collateral pathways in superior vena cava syndrome depicted on computed tomography

目的:观察上腔静脉综合征(SVCS)的胸部增强CT表现,总结并认识SVCS侧支循环形成的少见CT征象。方法:搜集经临床证实SVCS患者31例病例资料,回顾性分析其上腔静脉阻塞侧支循环形成的多层螺旋CT征象,将侧支循环在身体出现的位置分为前胸壁组、纵隔组、胸背组、膈下组,并找出少见的CT征像。结果:前胸壁组:胸外侧静脉19例,占61.3%,胸廓内静脉29例,占93.5%;纵隔组:心包膈静脉12例,占38.7%;后胸背组:椎静脉丛14例,占45.2%;膈下组:肝被膜静脉4例,占12.9%,肝局灶异常强化4例,占12.9%。结论:体-肺静脉瘘与肝脏局灶异常强化是SVCS少见征象,认识体-肺静脉瘘有助于进一步理解SVCS患者呼吸困难,并指导治疗;认识肝脏局灶异常强化能够帮助鉴别肝脏肿瘤类病变,明确诊断。

Objective：To describe and analyze infrequent features of collateral pathways in superior vena cava syndrome（SVCS） depicted on contrast-enhanced multi-detector CT（CE-MDCT）.Methods：A retrospective analysis of CE-MDCT examinations of chest was performed in 31 patients with clinically proven SVCS.The locations,frequencies,infrequent features of each collateral pathway were analyzed.Collateral veins were grouped into one to four collateral pathways（anterior thoracic,mediastinal,dorsal thoracic and subdiaphragmatic） on the basis of their anatomic locations.Results：Of the 31patients,19（61.3%） had lateral thoracic veins and 29（93.5%） had internal mammary veins in anterior thoracic group,12（38.7%） had pericardiacophrenic veins in mediastinal group,14（45.2%） had vertebral venous plexuses in dorsal thoracic group,4（12.9%） had hepatic capsule veins,4（12.9%） had focal contrast enhancement of the liver.Conclusion：Systemic-pulmonary shunt and focal contrast enhancement of the liver on CT are uncommon features of collateral pathways in superior vena cava syndrome.An understanding of the systemic-pulmonary shunts is essential in a patient with caval occlusion who presents with dyspnea or has unusual enhancing lesions in the liver.