腹壁可触及肿物的超声鉴别(二)

2006-10-08 00:00 来源:丁香园 作者:xihuansushi
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Miscellaneous Lesions 其他病变

.. Urachal Cyst 脐尿管囊肿
A urachal cyst may be seen in between the umbilicus and the bladder. It is usually situated in the lower third of the urachus but can be seen just inferior to the umbilicus. These cysts may appear totally anechoic or may reveal low-level internal echoes (Figure 11 )
脐尿管囊肿见于脐和膀胱之间,通常位于脐尿管的下1/3 ,但也可见于仅位于脐下。这些囊肿可表现为完全无回声或低回声。

Figure 11. A, Urachal cyst. The cyst is infected and contains faintly echogenic fluid. B, Urachal cyst. The anterior wall of the tense cyst produces reverberation artifacts.
图11A,脐尿管囊肿,此囊肿已受感染,内部含有微弱回声的液体。B,脐尿管囊肿,紧绷的囊肿前壁产生反射伪影。

..Endometriosis子宫内膜异位

Endometriosis of the abdominal wall may occur as a long-term complication of uterine surgery. It has no specific appearance but is seen as a focal mass at the scar of previous surgery with attacks of cyclic pain and swelling (Figure 12 ).
腹壁子宫内膜异位是子宫手术后的长期合并症,无特殊表现,但可于以前手术的瘢痕处见一局部肿物,并有周期性的疼痛和肿胀。

Figure 12. Endometriosis in a cesarean delivery scar.
图12 ,剖宫产伤疤处子宫内膜异位

...Abdominal Wall Hematoma 腹壁血肿

A rectus sheath hematoma may develop after paroxysms of coughing or sneezing or after seizures. The underlying cause is usually either anticoagulant therapy or some bleeding disorder. Because these hematomas are limited within the rectus sheath, they are not very big. Their shape depends on their location. Above the arcuate line, they are usually ovoid in shape with the long axis superoinferior and are seen on one side (Figure 13A ). Below the arcuate line, because of the absence of the linea alba, they can extend across the midline. Then the hematoma may be seen as a padlike lesion with its maximum length along the transverse axis.21–23 In one neonate, an abdominal wall hematoma was seen to spread transversely in the supraumbilical region (Figure 13, B and C ). In patients with post surgical disseminated intravascular coagulation, large hematomas are seen in the abdominal wall in the vicinity of the surgical scar (Figure 13D ).

腹直肌鞘血肿可发生于发作性咳嗽后、喷嚏或癫痫发作后,其根本原因通常是抗凝治疗或出血性疾病。由于血肿限制于腹直肌鞘内,通常不很大,其形状根据所处位置而定,在弓状线以上,血肿常为卵圆形,长轴呈上下方向,可于一侧见到(图13A);在弓状线以下,由于腹白线缺如,可扩展横过中线,因此血肿表现为分叶状,其最大长度位于横轴上。在新生儿腹壁血肿可见于脐上横向扩展(图13B、C)。术后弥散性血管内凝血的病人可于腹壁手术瘢痕附近见到大的血肿(图13D)。

Figure 13. A, Rectus sheath hematoma in an elderly woman after severe cough. Arrows point to the fascia transversalis. B, Abdominal wall hematoma in a neonate. C, Abdominal wall hematoma overlying umbilical vein insertion in a neonate. UV indicates umbilical vein. D, Abdominal wall hematoma in a cesarean delivery scar in a patient with disseminated intravascular coagulation.
图13A,一中年妇女剧烈咳嗽后腹直肌鞘血肿,箭头指示腹横筋膜。B,新生儿腹壁血肿。C,一新生儿脐静脉附着处上面的腹壁血肿。UV,脐静脉。D,一弥散性血管内凝血的剖宫产术后病人疤痕处腹壁血肿。

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