静脉内平滑肌瘤延伸到下腔静脉和心脏的CT诊断

CT Diagnosis of Intravenous Leiomyomatosis Extending to Inferior Vena Cave and Heart

目的静脉内平滑肌瘤病延伸到下腔静脉和心脏是手术治疗面临的一个难题。我们探讨使用CT血管造影在该类疾病术前评估中的应用。方法复习从2010到2017年4例静脉内平滑肌瘤延伸到下腔静脉和心脏病例,研究其术前CT征象及与外科手术的关系。结果结合临床病史和CT征象,所有病人均得到正确诊断。其中3例肿瘤局限于下腔静脉,1例肿瘤突入右心房、右心室、肺动脉。所有病人均有多发盆腔软组织肿块,经髂静脉延伸到下腔静脉,并均见肺内转移。所有病例均经包括血管外科、妇科、心脏外科合作成功手术,未出现严重并发症与死亡。结论 CT血管造影可准确提示静脉内平滑肌瘤病的位置、大小、全部病变的延伸范围以利术前评估,在制定手术计划和获得良好预后方面有重要意义。

Objective Intravenous leiomyomatosis extending to inferior vena cava and heart is one of the most challenging conditions for surgical treatment. We explored the use of CT in preoperative assessment for this disease. Methods 4 patients with intravenous leiomyomatosis extending to inferior vena cava and heart were reviewed from the year 2010 to 2017, focusing on the CT finding characteristics and surgical procedures in clinical treatment. Results All patients were diagnosed correctly combining the clinical medical history and CT imaging. 3 patients had tumors confined within the inferior vena cava, and 1 patient had tumors intruding into the right atrum, the right ventricle and the pulmonary artery. All patients had multiple pelvis soft masses extending into inferior vena cava throght the iliac veins, and had tumors invading into lung. All operations were successfully performed by cooperation including gynecology, cardiac surgery, and vascular surgery, without severve complications or deaths. Conclusion CT imging can present lacation, size, and full-scale extension of intravenous leiomyomatosis lesions, and can be used as first-line imaging technique in preoperative assessment, having great significance in making surgical plan and obtaining successful outcome.