目的:探讨髂骨血友病性假肿瘤(hemophilic pseudotumor,HP)的影像特征.方法:收集8例经临床、实验室确诊的髂骨A型HP的病例资料.均为男性;年龄19～43岁,中位数27岁;均有明确外伤史,临床主要表现为局部软组织肿胀和血肿,其中皮肤表面张力增高5例、关节功能障碍4例、不能行走3例;血浆凝血因子Ⅷ活性均低于正常值,活化部分凝血活酶时间延长.1例患者仅行X线检查、2例仅行CT检查、1例仅行MRI检查、2例同时行X线和CT检查、2例同时行CT和MRI检查,其中2例行CT增强扫描、1例行MRI增强扫描.分析病变的影像特征.结果:①病变部位与大小.左侧髂骨病变4例,右侧髂骨病变2例,双侧髂骨病变2例;病变位于髂骨体4例,髂骨翼4例,其中髂前上棘2例、髂后上棘1例、髂前下棘1例;病变最大径5～60 cm,中位数18 cm.骨内型5例,骨膜下型2例,肌间型1例.②X线表现.3例行X线检查,病变位于左侧髂骨2例、双侧髂骨1例.2例骨质呈多囊状破坏伴轻度膨胀改变,破坏边缘骨质轻度硬化,周围软组织肿胀不明显.1例骨质呈明显膨胀性破坏,破坏边缘硬化,部分囊壁缺失,伴周围软组织肿胀与肿块.③CT表现.6例行CT检查,病变位于左侧髂骨3例、右侧髂骨2例、双侧髂骨1例.骨质呈囊状破坏1例,侵蚀性破坏2例,膨胀性破坏3例.骨皮质部分吸收消失2例,大部分吸收消失2例,骨皮质完整2例.破坏边缘的骨质硬化3例.6例均有界限清楚的软组织肿块,密度高于肌肉组织,CT值45～68 HU;其中1例软组织肿块最大径>10 cm,密度低于周围正常肌肉组织,密度不均匀,CT值21～25 HU.2例CT增强扫描,肿块均未见强化.④MRI表现.3例行MRI检查,病变位于左侧髂骨1例、右侧髂骨1例、双侧髂骨1例.骨质呈溶骨性破坏1例,侵蚀性破坏1例,膨胀性破坏1例.骨皮质部分吸收消失2例,大部吸收消失1例.3例MRI信号于T2WI、T1WI、短时间反转恢复序列和扩散加权成像均呈高低混杂信号,其中2例病变区可见分隔.3例均有软组织肿块,边界清楚,其中1例软组织肿块最大径>10 cm;软组织肿块信号在T1 WI、T2 WI、短时间反转恢复序列和扩散加权成像上均呈高低混杂信号.1例增强扫描未见强化.⑤病理表现.8例患者病变组织肉眼见囊内为退化性血凝块或陈旧性出血,显微镜下可见囊壁为正常组织或纤维组织,无炎症性变化和新生物;肿胀软组织为反复出血而形成的血肿,血肿内密度较高,其中1例可见细小的钙化.结论:髂骨HP分为肌间型、骨膜下型和骨内型,病变部位骨质呈囊状、膨胀性、溶骨性或侵蚀性破坏,骨皮质菲薄,部分伴有骨皮质缺损及软组织血肿,CT密度不均、MRI信号混杂,结合临床表现和实验室检查可明确诊断.

Objective To investigate the imaging features of adult bones Langerhans cell histiocytosis (LCH).Methods The DR,CT,and MRI findings of 25 adults patients with LCH from January 2008 to June 2019 in Yueqing Sixth People's Hospital of Zhejiang Province (3 cases),Yueqing Third People's Hospital of Zhejiang Province (7 cases) and Wenzhou People's Hospital of Zhejiang Province (15 cases) were retrospectively analyzed.Results Among the 25 patients,the lesions located in the skull in 5 cases,in the spine in 5 cases,in the long bones in 10 cases,in the other flat bones in 3 cases,and in multiple bones in 2 cases.DR features (17 cases) showed:cystic destruction in 11 cases (6 cases with dilated changes),osteolytic damage in 6 cases;peripheral bone cortex thickening in 5 cases,bone lesions with less smooth inner edge in 4 cases,soft tissue mass around the lesion in 12 cases;‘hole set cave sign’ in 2 cases,‘flat vertebra’ in 2 cases,and ‘button-like dead bone’ in 1 case.CT features (15 cases) showed:cystic destruction in 9 cases (5 cases with dilated changes),osteolytic damage in 6 cases;‘hole set cave sign’ in 2 cases,‘flat vertebra’ in 2 cases,and ‘button-like dead bone’ in 1 case.MRI features (14 cases) showed:cystic destruction in 9 cases (5 cases with dilated changes),osteolytic damage in 5 cases;in the bone destruction area,8 cases had low T1WI signal and high T2WI signal,4 cases had equal T1WI signal and higher mixed T2WI signal,2 cases had slightly higher T1WI signal and higher mixed T2WI signal;STIR lipoprotein sequence showed high signal in 11 cases,and isointense signal in 3 cases;DWI showed high signal.Conclusions The imaging performance of adults LCH has certain characteristics,and the diagnostic accuracy can be improved according to the imaging performance and the clinic.

目的 探讨CT对诊断隆胸术后并发症的临床价值.方法 对13例具有隆胸术后并发症的患者行CT扫描并图像后处理,并分析其临床及CT表现.结果 并发症包括假体破裂逸漏3例,纤维囊挛缩变硬5例,变形移位2例,乳腺组织感染1例,纤维腺瘤1例,乳癌1例.结论 CT检查可明确隆胸术后有无并发症.

<正>纵隔气肿是胸部结构内病理性气体的异常积聚,临床上较少见,加之部分患者无典型的临床症状及积气较少时,临床上难以发现,因此放射诊断有重要意义。CT有很高的密

患儿男性,2个月.自出生起发现后脑部有一儿头般大小的球状物,遂来院就诊.患儿一般情况尚可,足月产.母亲孕期无特殊不适.临床检查:婴儿头围较小,顶枕部见一椭圆形软组织包块与头颅相连,其边缘光整,约110×105mm大小,质地软.