不典型少量急性硬膜下血肿CT诊断(附30例报告)

CT diagnosis of atypical small acute subdural hematoma(30 cases report)

目的:提高对不典型少量硬膜下血肿的CT征象认识及正确诊断。方法:30例头部外伤患者于伤后24小时内行头部CT检查,多于治疗后3天～2周复查头部CT,并分析其不典型CT征象。结果:单纯表现为硬膜下小血肿20例合并硬膜外血肿3例,并脑挫裂伤及蛛网膜下腔出血7例。所有硬膜下血肿均表现为邻近颅骨内缘模糊不清,呈“掩盖征”局部颅骨“假性增厚”改变;血肿内缘与脑表面分界欠清,形态呈线弧状、细新月状改变,大部分病例颅内占位效应不明显结论:颅骨内缘变模糊,呈“掩盖征”、局部颅骨“假性增厚征”是诊断不典型少量硬膜下血肿的重要CT征象。

Objective: To improve the knowledge of the CT findings of atypical small acute subdural hematoma. Methods: Thirty cases of head trauma were performed with head CT within 24 hours after trauma and follow-up CT scans were performed 3 days to 2 weeks later, and their atypical CT signs were analysed. Results: Twenty cases of which were pure subdural hematoma, 3 cases accompanied by extradural hematoma, 7 cases accompanied by brain contusion and subarachnoid hemorrhage. All of the subdural hematomas obscured the inner margin of the skull(i.e. covering sign), and the adjacent skull bone seemed as thickened(i.e. false skull bone thickening sign); the medial margin of the hematoma was indistinguished from the brain surface, and its shape appeared as linear-arc or thin-crescent shadow; however, most of cases had no obvious intra-cranial occupying effect. Conclusion: Signs of covering of skull bone inner edge and false skull bone thickening, are important CT findings of non-typical small acute subdural hematoma.