超声在纵隔脓肿诊断中的应用研究

Study of ultrasound in the diagnosis of mediastinal abscess

目的:探讨超声在纵隔脓肿中的诊断价值。方法:回顾性分析1995-01-2013-09期间21例纵隔脓肿患者的超声图像,并与CT扫描及临床随访结果进行比较。结果:2位超声图像的解读者之间的一致性非常好(κ=0.91),超声诊断纵隔脓肿的显示率与CT结果无差异。90.5%(19/21)患者的纵隔脓肿主要表现为:①纵隔病变处胸壁肌层增厚,回声不均匀,肌纹理结构模糊;②由壁层胸膜、生理性胸膜腔液体和脏层胸膜线状结构模糊,代之以增厚不均的软组织回声;③增厚的软组织层内可见散在无回声区或呈"蜂窝状";④纵隔内大血管旁可见脓肿呈类圆形无回声,内透声性欠佳,可见密集点状和絮状回声;⑤纵隔软组织血流信号增多;⑥常伴有不同程度胸腔积液和/或心包积液。结论:纵隔脓肿是临床急症,超声是其首选的影像学诊断技术之一,可在患者床旁及时诊断前中纵隔脓肿,为临床治疗提供有价值的信息。

Objective：To investigate the value of ultrasound in diagnosis of mediastinal abscess.Method：A study on 21 patients with mediastinal abscess between January 1995 and September 2013 were retrospectively analyzed.The ultrasonographic findings were compared with those of CT and follow-up clinical data.Result：Two experienced doctors who reviewed the ultrasonic images had consistently results.The diagnosis rate of mediastinal abscess by ultrasound and CT was similar.The main ultrasonic features of mediastinal abscess are showed as below：①the muscular layer of chest wall adjacent to mediastinal abscess was thicken with uneven internal echo and fuzzy structure.②instead of clearly liner echo,echo between partial pleura,physiological hydrothorax and visceral pleura was changed to uneven thickening of soft tissue.③Thickening soft tissue layer was characterized by scattered anechoic area or ＂honeycomb＂.④Mediastinal abscess beside the large vessels was like round anechoic area, characterized by dense dots and flocculent echoes with poor sound permeability.⑤Blood flow echo signals in mediastinal soft tissue were increased.⑥Often accompanied by varying degrees of pleural effusion and/or pericardial effusion.Conclusion：Mediastinal abscess is a clinical emergency,ultrasound is used as one of the promising diagnostic instrument at bedside,and provide valuable information for further treatment of mediastinal abscess.