双膈顶中内侧段幕状改变的X线特征及其临床意义

X-RAY ANALYSIS AND CLINICAL SIGNIFICANCE OF CURTAIN-LIKE CHANGE IN MEDIAL SEGMENT ON TOP OF THE DOUBLE DIAPHRAGM

目的探讨双膈顶中内侧段幕状改变的X线特征,减少对胸膜粘连的误诊误治。方法回顾性分析我院住院病例的影像学资料,由本专业医生从中筛选出具备双膈顶或单膈顶中内侧段幕状改变的病例。共选择符合条件的病例521例,均进行过X线胸部正侧位检查,从图像中观察幕状改变特征及与斜裂的对应关系。结果具备双膈顶中内侧段幕状改变的521例中,463例斜裂显影清晰或部分清晰,即基本可追踪观察斜裂位置,提示幕状改变与斜裂有明确对应关系(88.9%),而不具备胸膜粘连的X线特征。其中58例斜裂显影不清晰,对应关系不明确(11.1%)。结论双膈顶中内侧段幕状改变,大部分并非胸膜幕状粘连所致,而是由胸膜中斜裂在膈顶反折时所形成的上牵改变,应属于正常组织结构在膈顶的X线投影。故不应诊断为胸膜粘连。

Objective To investigate the characteristics of the the medial segment curtainlike change of X - ray double diaphragm top, to reduce the misdiagnosis of pleural adhesions. Methods A retrospective analysis of the imaging data of hospitalized cases in author＇s hospital was performed from January 2007 to January 2012, from which the medial segment tenting change in the double diaphragm top or single phrenic top of case were screened out by the professional physicians, 521 eligible cases were selected with lateral chest X- ray checks, curtainlike change and oblique fissure correspondence between the observed image. Results Among 521 cases of the medial segment tenting change in the top of the double diaphragm, 463 （88. 9%）cases of oblique fissure appeared clear or partially clear development that the position of the ob- lique fissure was observed basic traceability, this results showed a correspondence of curtain- like change with oblique fissure clear between and without X- ray features with pleural adhesions. The corresponding relationship was not clear in 58（11.1%） cases of oblique fissure. Conclusion Most of double diaphragm top medial segment tenting change are not caused by pleural tenting adhesions, but led by the pleura oblique fissure formed on the the phrenic top reflexed change, it should belong to the normal tissue structure in the phrenic top X- ray projection. So it should not be diagnosed as pleural adhesions.