患者男,37岁,右手掌肿物伴压痛3年;既往无特殊病史.专科查体:右手大鱼际处触及7 cm×8 cm质硬包块,向腕横纹处延伸,边界不清,活动度差,压痛(+),手指活动无明显受限;局部皮肤无明显异常.实验室检查未见异常.右手超声:大鱼际肌间隙内见7.8 cm×4.2 cm×2.7 cm分叶状实性不均匀低回声肿物(图1A),其浅缘位于皮下、深缘达骨间肌及第二掌骨,肿瘤包绕屈肌腱及正中神经(图1B),与之分界不清,其内未见明显强回声及液性区;CDFI示肿物内部血流信号丰富(图1C);超声提示右手占位待查.行右手病灶全切术.术后病理:送检物为灰白色半透明质软肿物;镜下见皮肤深层结节状结构,细胞呈短梭或卵圆形,核仁明显,胞质粉染、透明(图1D),周围可见纤维性分隔;免疫组织化学:HMB45(+),S-100(++),Vim(+);病理诊断为透明细胞肉瘤.临床诊断:右手透明细胞肉瘤.

患者女,30岁,右侧面部、前臂、大腿及左小腿硬肿6年,未接受系统治疗;既往体健.查体:右面部、前臂、大腿及左小腿非凹陷性肿胀伴压痛,肢体较健侧增粗.实验室检查:嗜酸性粒细胞0.51×109/L.超声:右下颌区咬肌、右前臂尺侧腕伸肌、小指固有伸肌、指伸肌、拇长伸肌及示指固有伸肌、右大腿半腱肌及半膜肌、左小腿三头肌广泛增厚、肿胀,肌纹理显示不清,回声减低,周围深筋膜增厚且回声增强(图1A),肌筋膜内血流信号增多(图1B);右侧半膜肌横断面呈旋涡样(图1C);左侧胭动静脉、腓动静脉及胫后动、静脉管径增宽,走行纡曲;超声提示:右下颌区咬肌、右前臂伸肌群、右侧半腱肌半膜肌、左小腿三头肌及周围深筋膜弥漫性病变,左小腿动静脉扩张,结合临床考虑嗜酸性筋膜炎.MRI:右前臂伸肌群、右侧半腱肌半膜肌、左小腿三头肌水肿,筋膜增厚,T1WI呈低信号、脂肪抑制T2WI呈高信号,左侧胭血管、胫后血管粗大、走行纡曲.行右前臂、右大腿及左小腿部分病灶活检术.病理:光镜下见横纹肌、深筋膜炎细胞弥漫性浸润,胶原纤维增生(图1D).病理诊断:多发性嗜酸性筋膜炎(eosinophilic fasciitis,EF).

目的 探讨产前超声检查对胎儿胆囊增大或缩小的诊断价值.方法 回顾性分析北京积水潭医院2003年2月至2020年2月进行产前超声检查的17859例孕妇的临床资料,均采用彩色多普勒超声对胎儿的胆囊进行检查,总结分析其超声图像特征.结果 共有17788例(99.6％)胎儿显示了胆囊,其中25例(0.14％)胎儿胆囊异常增大,4例(0.02％)胎儿胆囊缩小.胆囊异常增大胎儿中整倍体2例,18三体1例,13三体1例,全部引产终止妊娠,其余21例染色体正常,均活产;胆囊异常增大胎儿染色体异常率为16％.4例胆囊缩小胎儿染色体检查均正常,且胎儿均活产.结论 使用彩色多普勒超声在产前对胎儿胆囊进行检查,可较好地检出胆囊异常增大及缩小胎儿,能尽早提示染色体异常的可能性,对临床具有重要的意义.

患儿男,6岁.10余d前因右膝关节外伤行X线检查诊断为“骨囊肿”来我院诊治.专科查体:右股骨远端可及质硬肿瘤,边界清,活动度差,无压痛.生化检查:血磷、血钙、碱性磷酸酶、维生素D3、甲状旁腺激素正常.超声检查:右大腿远端扫查,股骨远端形态结构失常,局部膨胀,皮质变薄,骨质破坏,其内可见范围约3.7 cm×2.5 cm的实性椭圆形低回声肿物,边界尚清,病变内可见不规则间隔强回声(图1～2),周围软组织未见明显异常,CDFI:病变内可见丰富血流信号.手术病理结果:磷酸盐尿性间叶瘤,不除外恶性变.

目的 探讨经会阴超声诊断宫颈机能不全的临床价值.方法 选取2014年10月至2017年4月北京积水潭医院收治的86例诊断为宫颈机能不全的孕妇,所有孕妇均行经会阴超声检查,回顾性分析其经会阴超声检查结果及临床转归情况.结果 本研究中,同期有3例临床诊断为宫颈机能不全的患者因为宫颈位置和姿势原因,导致超声观察不满意,故宫颈机能不全的超声检出率为96.51％(83/86);观察宫颈内口满意83例(96.51％)、不满意3例(3.49％),观察宫颈外口满意84例(97.67％)、不满意2例(2.33％).有11例(12.79％)行宫颈环扎缝合术,其中足月剖宫产6例(6.98％),早产2例(2.33％),术后难免流产3例(3.49％);62例(72.09％)行保守治疗,其中早产11例(12.79％),足月产51例(59.30％,包括33例顺产);13例(15.12％)羊膜囊突入宫颈管内者均流产.结论 经会阴超声可为宫颈机能不全提供明确诊断,具有重要的临床价值.

目的 分析滑膜肉瘤(SS)声像图表现,探讨超声对其诊断及术后随访的价值.方法 回顾性分析经病理证实的17例患者滑膜肉瘤超声特征以及术后随访声像图所见.结果 17例滑膜肉瘤患者平均年龄32.7岁,声像图主要表现为关节附近的单发实性低回声,未侵犯关节,呈团块状、分叶状,边界清晰,形态不规则12例、规则5例;回声不均11例、均匀6例;3例伴液化,1例伴钙化,血流分级以Ⅲ级为主,为13例.术后随访:10例未见异常;2例手术区积液;1例术区超声发现团块误诊为复发,经手术病理示脂肪瘤;5例发生原位复发.复发病例与无复发病例术前超声相比:病灶最大径线更大、多形态不规则、回声不均匀、可伴钙化、液化,血流丰富者较多.结论 超声可以清楚显示滑膜肉瘤的二维特点及血流情况,并可监测肿物复发情况.

Objective To investigate the clinical significance of ultrasound examination in diffuse-type giant cell tumor of the tendon sheath.Methods Retrospective analysis of 17 cases of diffuse-type giant cell tumor diagnosed from.Results 14 cases were diagnosed as giant cell tumor of the tendon sheath by ultrasound,1 cases were misdiagnosed as haemangioma,and 2 cases were diagnosed as synovitis.8 patients had a recurrence in postoperative follow-up by ultrasound,in which 7 cases were proved to be diffuse-type giant cell tumor of the tendon sheath.Conclusions Ultrasound examination can assist in the clinical diagnosis and postoperative follow-up in diffuse-type giant cell tumor of the tendon sheath.

Objective To investigate the risk factors during pregnancy of fetal growth restriction,their influence on prognosis and their correlations.Methods The fetal and maternal condition during pregnancy of 46 cases including low birth weight less than 2 500 g and abortion cases were studied retrospectively.Results The constitution of risk factors and the prognosis of newborn infants had a significant difference between 2nd trimester FGR and 3rd trimester FGR,(both P＜0.05).There was no significant difference between maternal factors such as hypertensive disorder complicating pregnancy and fetal appendages factor such as blood flow pulsation index of umbilical artery (P＞0.05).Conclusions Fetal growth restriction risk factors have important influence on its stage and prognosis.Sequential monitoring of fetal growth,development and systematic ultrasound screening during pregnancy have great value for diagnosis and treatment of fetal growth restriction.

近年来,宫外孕的发生率逐年升高,宫外孕是妇科常见急腹症之一,宫外孕破裂出血可导致患者盆腹腔内大量出血,如不及时做出诊断、积极抢救,可危及生命[1-2].在宫外孕早期能够及时做出正确的诊断,可以为临床选择治疗方案提供可行性依据,同时也能提供患者的生存质量[3].本文对自2010-01-2014-01期间来我院经阴道彩色超声检查诊断的50例宫外孕进行超声图像的观察分析,现总结如下.

Objective To investigate the application of fetal heart malformation examination by color Doppler echocardiography in diagnosis of fetal atrial septal aneurysm (ASA). Methods Five thousand three hundred and ten cases were screened from October 2007 to November 2011 in our hospital. The cut surfaces of four chamber of heart were observed carefully to screen the potential ASA. Results The acoustic image results of 30 cases of fetal ASA showed that the atrial septal became thinner and swollen from the RA side to the LA side in the shape of "the pouch baggy" or "the balloon type". The bulging depth of ASA was 6.0 to 11.0 mm , occupying about 1 / 2 to 2 / 3 of the LA path, and the fundic diameter was 4.6 to 8.9 mm in length. The above observations in fetal hearts were validated after birth. Conclusion For fetal heart malformation examination,color Doppler echocardiography can be used to detect and diagnose ASA.