少见成人腹部淋巴管瘤的CT表现及临床特点

CT and clinical characteristics of rare abdominal lymphangioma in adults

目的:对成人腹部淋巴管瘤的临床资料、CT表现进行分析,结合文献对其进行总结、讨论,以提高其术前诊断正确率。方法:回顾性分析5例经手术病理证实的罕见腹部淋巴管瘤的CT表现及临床资料,总结其诊治要点。结果:5例病变中,女性4例,男性1例,发病年龄37~59岁(平均51.6岁)。2例患者无明显临床症状而在体检时发现,其余3例均以腹部包块伴或不伴腹痛、腹胀为首发症状。3例患者存在腹部手术史,2例分别伴有外伤及输血史。病变体积均较大,最大径从4.3~33cm不等。呈爬行性或塑形生长,边界尚清,表现为不同程度的占位效应致使临近组织结构受压移位。病变呈囊性者2例;囊实性者1例,其内可见线样钙化影;实质性者2例,病变周围可见清晰的包膜结构环绕。增强扫描病变部分示病灶囊壁及包膜轻度强化,部分病灶未见明显强化成分。病理证实4例为囊性淋巴管瘤,1例为海绵状淋巴管瘤,其中1例来源于脾脏,3例位于腹腔,1例位于腹膜后。确诊后均经手术完整切除,术后3年未见复发。结论:淋巴管瘤是成人腹部极少见的占位性病变,CT平扫及增强检查能够提供较多的诊断信息,根据其CT图像及临床资料特点,尤其是当患者有明确手术及外伤史,且病变为囊性并呈'爬行性生长'、临床出现巨大占位与轻微占位效应不相称时,首先考虑囊性淋巴管瘤的诊断,并在与腹部其他病变甄别后常可做出正确诊断。

Objective: To analyze the CT and clinical characteristics of rare abdominal lymphangioma in adults,in order to improve the accuracy of preoperative diagnosis. Methods: To summarize the main points of CT diagnosis and treatment of abdominal lymphangioma,a retrospective analysis of the clinical data and imaging findings of 5 cases of abdominal lymphangiom confirmed by operation and pathology has been made. Results: In 5 adults( 4 females and 1male),aged from 37 ~ 59( mean age 51. 6 years old),2 patients whose disease was detected though routine physical examination presented no special clinical manifestation. Other 3 cases were detected by obvious starting symptoms of abdominal mass with or without abdominal pain,abdominal distention. Among 5 cases,3 patients exist a history of abdominal surgery and 2 case with history of trauma and multiple transfusions. All these lesions were characterized by different levels of placeholder effect of obvious compression for adjacent structure,as well as giant and the largest diameter ranged from 4. 3 to 33 cm,crawled or shaped growth with clear boundary,2 lesions offer giant long- sack shape,1 lesion was cystic- solid with visible line of calcification and solid lesions of 2 case arounded by clear coated structure. CT enhanced scan showed that some wall of cystic lesions and coat showed mild enhancement,while some lesions showed no obvious enchancement. Final pathology confirmed 4 cases of cystic lymphangioma,1 case cavernous lymphangioma,1 case originated from spleen,3 cases located in the abdominal cavity,1 case located in the retroperitoneal. All of lesions showed no recurrence in 3 years after completly resection operation. Conclusion: Lymphan- gioma is a rare abdominal tumor of adult,CT can provide detail information for lesins size,boundary and vessel. Briefly,according to characteristics of the clinical and CT images of cystic lesion with crawled growth,especially when patients have a history of surgery or trauma with a giant lesion but slight placeholder effect,it is necessary to take cystic lymphangioma into consideration and make differentiation with other abdominal lesions carefully.