结肠气囊肿症MSCT征象

MSCT features of pneumatosis cystoides intestinalis

目的分析结肠气囊肿症的MSCT征象,以提高对本病的认识。方法回顾性分析7例经临床诊断为结肠气囊肿症患者的临床和MSCT资料,观察病变累及肠段的范围、部位、数量、形态、大小、密度、腹腔有无游离气体等;根据病变在肠壁的分布不同,将结肠气囊肿症分为浆膜下型、黏膜下型和混合型。结果 7例结肠气囊肿症患者中,伴有肺结核、慢性支气管炎1例,胃及十二指肠溃疡4例,食管炎、慢性胃炎1例,克罗恩病1例。浆膜下型2例,1例累及结肠肝曲及脾曲,1例累及回盲部、升结肠、结肠肝曲、横结肠;混合型5例,1例累及结肠脾曲、乙状结肠,3例累及结肠肝曲、横结肠、结肠脾曲,1例累及回盲部、升结肠、结肠肝曲及脾曲、乙状结肠。CT表现为肠壁黏膜和/或浆膜下多发、大小不等小囊状、簇状或串珠状囊样低密度气体影,3例合并浆膜下气囊肿破裂,相邻肠系膜面见多发点状游离气体影。结论结肠气囊肿症MSCT表现具有一定特征,气腹而无腹膜刺激征是其特征性表现之一,MPR技术可为临床提供客观的影像学诊断依据。

Objective To analyze MSCT features of pneumatosis cystoides intestinalis(PCI),in order to improve the understanding of this disease.Methods Clinical and MSCT data of 7 patients with clinically diagnosed PCI were retrospectively analyzed.The range,location,quantity,shape,size and density of the lesions and intraperitoneal free gas were observed.According to the different distribution of lesions in the intestinal wall,PCI were divided into 3 types,i.e.submucosal,subserosal and mixed types.Results Among all 7 patients,4 combined with gastric and duodenal ulcer,1 with pulmonary tuberculosis and chronic bronchitis,1 with esophagitis and chronic gastritis,1 with Crohn's disease.Subserosal type PCI was found in 2 patients,involving the right flexure and left flexure of colon in 1,the ileocecal colon,ascending colon,transverse colon and right flexure of colon in the other one.Mixed type PCI was found in 5 patients,involving the left flexure of colon and sigmoid colon in 1,the right flexure of colon,transverse colon and left flexure of colon in 3,and the ileocecal colon,ascending colon,right flexure of colon,left flexure of colon and sigmoid colon in the rest one.MSCT showed multiple,small,clustered or beaded cystic low density gas shadows in the submucosa and/or subserosa of the intestinal wall.The subserosal gas cyst ruptured in 3 patients with multiple spots of free gas in the adjacent mesenteric surface.Conclusion There are certain MSCT characteristics of PCI,one of which is pneumoperitoneum without peritoneal irritation.MSCT and MPR can provide objective basis for imaging diagnosis of PCI.