急性消化道出血的CT表现2例

2018-03-20 佚名 中国医学影像学杂志

男,68岁,因上腹不适0.5d、呕血3h入院;

患者1

【一般资料】

男,68岁

【主诉】

因上腹不适0.5d、呕血3h入院;

【体格检查】

入院时血红蛋白144g/L,入院后3h再次出现呕血1次,量约1000ml,伴大汗、心悸、头晕,血压87/58mmHg,中度贫血貌,

【辅助检查】

血红蛋白92g/L。CT检查见图1。急诊数字减影血管造影(DSA)检查证实:胃左动脉破裂出血,见大量对比剂外溢至胃腔内



【治疗】

遂行出血动脉栓塞,止血满意。

患者2

【一般资料】

女,77岁

【主诉】

右下肢肌间静脉血栓形成

【治疗】

给予低分子肝素5000U皮下注射抗凝治疗,2次/d,于入院第3天清晨排干硬大便后出现便血,复查血常规:血红蛋白117g/L,较入院时下降;CT检查见图2。MSCT考虑直肠前壁活动出血;外科肛门镜直视下证实,距肛缘约5cm、直肠前壁黏膜纵行裂口,长约1cm,活动出血,行直肠黏膜破裂出血缝合止血,止血满意,术后未再出血。最后诊断直肠前壁撕裂伴活动性出血。



【讨论】

MSCT一站式急性消化道出血检查是集全腹常规平扫和多期相动态增强扫描及腹部血管重建为一体的检查方法。本研究通过实践发现,急性消化道出血的MSCT一站式检查,检查前无需进行特殊的胃肠道准备,不额外增加患者的痛苦,可即时检查,对于血流动力学不稳定的急性消化道出血患者,在积极抗休克、扩充血容量治疗的同时即可完成检查,检查方法简单,扫描时相对规范,检查时间短,检查野无盲区,可同时显示肠腔、肠壁、肠壁外及腹腔情况,图像便于观察,能满足临床急会诊需求,不仅能提供消化道腔内出血及定位的相关信息,而且能提供一系列管壁及管腔外的信息(血管畸形、消化道肿瘤等),为进一步明确出血原因提供有效证据。活动性出血在增强CT上表现为肠壁下肠腔内高密度“碘征”,即高密度的对比剂外溢至肠腔内,在动脉期即出现,随时间推移外溢对比剂剂量增加,与肠道液体混合后密度较前降低,在肠道内具有流动性和聚集性,具有特征性;藉此可与肠道内高密度食物、各种高密度外源性引入物、肠道内富血供病变、肠黏膜异常强化、患者呼吸运动及肠道蠕动产生的高密度伪影相鉴别。Sun等对113例活动性消化道出血患者进行前瞻性研究发现,MSCT血管造影诊断活动性消化道出血的敏感度和特异度分别为86.0%和100.0%;Kuhle等[5]使用单螺旋CT通过动物实验表明,当消化道活动性出血达到0.3ml/min时,CT即可检测出来,小于DSA可明确诊断0.4~0.5ml/min消化道活动性出血的量。动脉期CT扫描及血管重建可提供消化道血管解剖信息,血管解剖变异及畸形对于进一步介入治疗也具有重要意义。尽管多项研究指出MSCT诊断活动性消化道出血,其阴性预测值不如阳性预测值,但本研究结果提示,MSCT急性消化道出血检查阴性时,无需再行DSA检查[1,4,8];因此,尽管MSCT一站式急性消化道出血检查不像消化道内镜及血管造影具有治疗价值,但是检查价值是肯定的,可作为传统内镜检查的有力补充,特别是对于血流动力学不稳定的患者,能大大减少检查前的准备时间,为临床选择针对性的治疗赢得更多的时间,可推荐作为此类急性消化道出血患者的首要检查手段。

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    2018-03-22 易水河

    这种探索方式很好

    0

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    2018-03-20 王秀

    学习了.涨知识了!

    0

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    2018-03-20 惠映实验室

    学习了.谢谢分享.

    0

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急诊心电图明确提示是急性ST段抬高型心梗,当我们快速说出其中可能发生急性闭塞的罪犯血管时,急诊医生总会问起:你是如何根据心电图判断出急性ST段抬高型心梗罪犯血管的呢?

中国卒中杂志:急性爆发性鼻脑型毛霉菌感染致海绵窦血栓形成发病一例

患者,男,42岁,因“左眼疼痛、视力下降5天,加重伴肢体无力4小时”入院。患者于入院前5 d无诱因自觉左眼胀痛,左眼睑下垂伴视物成双,当地医院CT示左眼视神经较右侧增粗。

心肌梗死为何发生心源性休克?

心源性休克是由于心脏功能异常所引起的泵功能下降的一种疾病状态(又称之为“泵衰竭“和”动力衰竭“),表现为血压下降、心率增快、脉搏细弱、全身软弱无力、面色苍白、皮肤湿冷、紫绀、尿少或尿闭、神志模糊不清、烦躁或昏迷。其最常见的原因的是急性心肌梗死所引起的严重左心室功能障碍。