外伤性肾上腺血肿的多层螺旋CT诊断

MSCT diagnosis of traumatic adrenal hematoma

目的回顾性分析外伤性肾上腺血肿的CT表现,探讨多层螺旋CT(MSCT)在外伤性肾上腺血肿诊断中的价值。方法收集我院2015年1月至2016年6月18例经临床随访证实的肾上腺血肿影像学资料,本组病例均按肾上腺血肿急性、亚急性及慢性期的不同分期进行随访,分析外伤性肾上腺血肿的不同时期MSCT表现。结果 18例中13例位于右侧(72%),4例位于左侧(22%),1例双侧(6%)。肾上腺血肿急性期分为弥漫型和肿块型两种类型,弥漫型表现为肾上腺局限性或弥漫性增粗、肿大。肿块型血肿呈椭圆形或不规则形,高于同侧肾脏实质密度。亚急性期弥漫型和肿块型密度都渐减低。10例急性期弥漫型血肿慢性期随访发现血肿完全吸收,恢复正常肾上腺形态。8例急性肿块型血肿随病程延长,密度减低,增强后血肿边缘包膜区域呈环形或断续的边缘强化,中间血肿未见强化,至慢性期5例血肿吸收完全,1例未完全吸收。结论 MSCT薄层轴位扫描对肾上腺血肿的诊断及鉴别诊断具有重要价值。

Objective To analyze the CT features of traumatic adrenal hematoma retrospectively, and to explore the value of MSCT in the diagnosis of traumatic adrenal hematoma. Methods The imaging data of 18 cases with a- drenal hematomas confirmed by clinical follow - up were collected from January 2015 to June 2016 .All cases were followed up according to the different stages of acute, subacute and chronic phase of adrenal hematoma, to analyze the MSCT Manifestations of different Periods of traumatic adrenal hematoma. Results In 18 patients, 13 cases were lo- cated on the fight （72%）, 4 cases were on the left （22%） ,and 1 on both sides （6%）. The acute phase of adrenal hematoma was divided into two types, diffuse type and mass type , diffuse type showed that adrenal swelled limitedly or diffusely, The hematoma of massive shape was oval or irregular, which was higher than density of the same side kidney. The density of diffuse type and mass type were gradually decreased in subacute stage. Ten cases with acute diffuse hematoma showed that the hematoma was absorbed completely, and the normal adrenal morphology was recov- ered in the chronic phase. Eight cases of acute mass type hematoma with the extension of course, lower density, en- hanced the edge of hematoma envelope region of a circular or intermittent edge enhancement, the middle hematoma was not enhanced, to the chronic phase, 5 cases of hematoma were absorbed completely, 1 case is not absorbed com- pletely. Conclusion MSCT thin - slice axial scan had important value in the diagnosis and differential diagnosis of adrenal hematoma.