伴有脊柱后突的不可复性食管裂孔疝——胸部平片与CT、MRI对照观察

Irreversible Esophageal Hiatal Hernia with Kyphosis: Chest Radiograph vs CT/MRI

目的 加深对伴有脊柱后突的不可复性食管裂孔疝影像表现的认识 ,并探讨此类食管裂孔疝形成的机制。材料与方法对照分析 8例经钡餐造影确诊的伴有脊柱后突的不可复性食管裂孔疝的胸片与CT、MR影像表现。结果 8例均为老年人 ,以女性居多。胸片与CT、MR影像表现均见疝囊在心脏之后呈肿块状 ,内含气体或气 液面。并有食管裂孔增宽、膈肌后份变平、后肋膈角变浅、贲门位于膈上而食管不短 ;均见脊柱胸腰段后突 ,该水平胸廓前后径增大。胸片初诊半数误诊。结论 脊柱后突的老年人发现心后肿块要警惕食管裂孔疝的可能。

Objective To make a further understanding of irreversible esophageal hiatal hernia with kyphosis and to probe its possible formative mechanism.Materials and Methods Chest film and CT/MRI findings in 8 patients with barium meal proved esophageal hiatal hernia and kyphosis were analyzed.Results All 8 patients, mainly female, were senile. On chest film, CT and MRI, the lesion appeared as a mass, containing air or air fluid level, behind the heart. Widened esophageal hiatus, flattened posterior diaphragm, shallow posterior costophrenic angle and cardia above diaphragm could be seen. Besides, all patients had thoracolumbar kyphosis with increased antero posterior chest diameter at this level. The diagnosis was missed in 4 cases on initial chest films.Conclusion In a senile patient with kyphosis, a mass shadow behind the heart should alert one to the possibility of esophageal hiatal hernia. This kind of irreversible esophageal hiatal hernia may be due to the traction caused by kyphosis.