第三鳃裂瘘管影像诊断并文献复习

THE THIRD BRANCHIAL CLEFT FISTULA:IMAGING DIAGNOSIS AND LITERATURE REVIEW

目的分析第三鳃裂瘘管病人的临床和影像学表现,提高对该病的认识。方法回顾分析经手术病理证实的11例第三鳃裂瘘管病人临床表现、影像学特点和病理结果。结果第三鳃裂瘘管表现为感染性包块7例,非感染性包块3例,颈痛1例。8例位于颈部左侧。10例累及甲状腺,1例紧邻甲状腺。11例直接喉镜检查4例发现窦道或瘘管内口。1例行钡餐检查未发现病灶。7例行超声检查,5例对诊断有提示作用。10例CT平扫、4例对比增强CT、3例CT瘘管造影的诊断结果均与病理结果相符。1例行甲状腺闪烁扫描显示甲状腺左侧叶碘摄取量降低。结论第三鳃裂瘘管主要表现为累及或紧邻甲状腺的颈部左侧感染性包块。超声、CT、直接喉镜等检查有助于第三鳃裂瘘管的诊断。

Objective To analyze the clinical manifestations and imaging findings of the third branchial cleft fistula （TBCF） and improve the understanding of the disease. Methods The clinical manifestations, imaging features and pathological findings of 11 cases of the third branchial cleft fistula confirmed by surgery and pathology were retrospectively analyzed. Results The TBCF manifested as an infected mass was seen in seven cases, a non-septic mass three cases and neck pain in one. Eight lesions located on the left side. Ten cases involved the thyroid, one closely adjacent to thyroid. Direct laryngoscopy was performed in 11 ca- ses, with sinus or endostoma of the fistula was seen in four cases. Barium meal examination was done in one case without any ab- normal findings. Ultrasonography was done in seven cases, of which, five were helpful to the diagnosis. The diagnosis made by plan CT scan in 10 cases, contrast enhancement CT in four cases, and CT fistulography in three cases agreed with the results of patholo- gy. One case underwent thyroid scintiscan showed the left lobe of thyroid iodine uptake reduced. Conclusion The third branchial fistula mainly presents as an infected mass, on left side of the neck, involving the thyroid. Ultrasonography, CT scan, and direct laryngoscopy are all conducive to the diagnosis of this condition.