双侧输卵管结扎后陈旧性输卵管妊娠的MRI表现及诊断1例报道

MRI manifestations and diagnosis of old tubal ectopic pregnancy after bilateral tubal ligation:1 case report

本文旨在报道1例双侧输卵管结扎后陈旧性输卵管妊娠的磁共振成像(MRI)表现及诊断。通过综合分析陈旧性输卵管妊娠的临床特点、妇科与实验室检查、宫颈筛查、超声检查、盆腔MRI和腹腔镜手术,给予准确诊断。盆腔平扫可见子宫与直肠间增粗管状异常信号影,T_(1)、T_(2)呈高低混杂信号,DWI上以高信号影为主;病灶边界欠清晰,形态不规则;病灶后方与直肠分界不清,直肠右前壁局部增厚,盆腔肠管部分走行显示欠清;右下腹及右侧附件区可见不规则片状长T_(2)信号影;右侧卵巢和宫颈壁均可见一类圆形长T_(1)长T_(2)信号影。盆腔内可见广泛片絮状影呈网格及絮状强化;盆腔增强扫描可见管状异常信号影的病灶壁强化,病灶内可见多发片状高信号影。特别地是,MRI表现为管状走行出血样信号,有助于诊断。此外,陈旧性输卵管妊娠容易误诊,尤其针对输卵管结扎术后的生育期女性,应引起重视。

This paper aims to report the magnetic resonance imaging(MRI)manifestations and diagnosis of a case old tubal ectopic pregnancy after bilateral tubal ligation.The accurate diagnosis was made through comprehensive analysis of clinical features,gynecological and laboratory examinations,cervical screening,ultrasonography,pelvic MRI and laparoscopic surgery of old tubal ectopic pregnancy.Pelvic plain scan showed thickened tubular abnormal signal shadow between uterus and rectum,T_(1) and T_(2) showed high and low mixed signals,and high signal shadow was mainly on DWI;the boundary of the lesion was not clear and the shape was irregular;the demarcation between the back of the lesion and the rectum is unclear,the right anterior wall of the rectum is locally thickened,and the course of the pelvic bowel is not clear;irregular flake long T_(2) signal shadow can be seen in the right lower abdomen and right accessory area;a kind of circular long T_(1) and long T_(2) signal shadow can be seen in the right ovary and cervical wall.Extensive flocculent shadow with grid and flocculent enhancement was seen in the pelvis;enhanced pelvic scan showed enhancement of the lesion wall with tubular abnormal signal shadow,and multiple patchy high signal shadow was seen in the lesion.In particular,MRI showed tubular walking of blood signals,which was helpful for diagnosis.In addition,old tubal pregnancy was easy to be misdiagnosed,especially women in childbearing period after tubal ligation,which should be paid attention to.