急性薄层硬膜下出血的CT诊断与鉴别

Ct Diagnosis and Diferential Diagnosis of Acute Thin Subdural Hemorrhage

目的:提高对急性薄层硬膜下出血的认识。方法:回顾性分析62例急性薄层硬膜下出血及首检11例误(漏)诊病例的CT征象。结果:发生于大脑镰下表现为大脑镰稍增粗或局部稍增粗;发生于小脑幕下表现为条片状、扇形、"V"、"M""八"字形高密度影;发生于颅板下表现为颅板下弧线状、细新月形高密度影,可呈"假性颅板增厚征"。首检误(漏)诊11例:5例误为蛛网膜下腔出血,6例误为正常而漏诊(其中2例误为大脑镰,3例误为颅骨,1例误为横窦)。结论:正确认识急性薄层硬膜下出血的CT表现及鉴别,可减少误(漏)诊,为临床诊疗提供确切依据。

Objective: To improve the understanding of acute thin subdural hemorrhage. Methods: The CT features of acute thin subdural hemorrhage(n=62)and 11 cases of misdiagnosis and missed diagnosis were analyzed retrospectively. Results: The thin subdural hemorrhage at bilateral cerebral falx was thickened or partially thickened. The thin subdural hemorrhage at bilateral cerebellar tentorium presented as “V”shape,“M”shape,sectors or flakes.The thin subdural hemorrhage under the skull plate resembled a curved, fine crescent shape high density shadow, sometimes appeared as “false skull plate thickening sign”. 11 cases of misdiagnosis and missed diagnosis in the first examination:5 cases were mistaken for subarachnoid hemorrhage, 6 cases were missed diagnosis. Conclusion: Correctly understanding the CT findings and identification of acute thin subdural hemorrhage can reduce the number of misdiagnosis and missed diagnosis and provide reliable evidence for the clinical diagnosis and treatment.