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标题: CT01252:腹壁少见病变,有病理 [打印本页]

作者: 阿圣 时间: 2005-4-18 06:52
标题: CT01252:腹壁少见病变,有病理
女,37岁.右下腹肿物3年。体检：右下腹可触及一约4×4×4cm大小肿物，质韧、表面光滑，活动可、无压痛。活动后肿物周围有少许疼痛感，并稍有增大。

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作者: 向医生 时间: 2005-4-18 07:01
右下腹壁内可见一软组织肿块，边界较清楚，其内未见钙化，周围脂肪层未见侵犯。增强扫描肿块强化十分明显。
考虑：腹壁血管瘤。

作者: 听蝉观竹 时间: 2005-4-18 07:06
腹壁血管瘤。
依据：平扫描肿块境界清楚，密度均匀，与周围肌肉组织接近，增强扫描后肿块显著强化。

作者: cmg 时间: 2005-4-18 07:16
符合腹壁血管瘤表现。平扫肿块境界清楚，密度均匀，呈软组织密度影，与周围组织分界清晰，增强扫描后肿块显著强化，与同层血管影强化程度相当。

作者: 专党zey 时间: 2005-4-18 15:56
位于浅筋膜下，腹肌前方。富血管病灶，于周边界限善清晰，并推移周围组织，考虑良性病灶，同意楼上意见。

作者: liuwensi 时间: 2005-4-18 16:08
同意腹壁血管瘤的诊断

作者: 放大镜 时间: 2005-4-18 16:46
[emb6]

作者: whli 时间: 2005-4-18 16:58
同意大家的意见,考虑腹壁血管瘤.

作者: liaoqiang 时间: 2005-4-18 17:41
[emb6]

作者: longxiang 时间: 2005-4-18 18:19
1血管瘤2硬纤维瘤

作者: yongzz66 时间: 2005-4-18 19:43
平扫肿块境界清楚，密度均匀，增强扫描后肿块显著强化,同意大家的意见,考虑腹壁血管瘤.

作者: sbb 时间: 2005-4-18 20:42
血管瘤

作者: hejie 时间: 2005-4-18 20:54
标题: 1

右下腹腹直肌鞘内可见一软组织肿块，边界较清楚，其内未见钙化，周围脂肪层未见侵犯。增强扫描肿块强化十分明显。
考虑：腹直肌鞘内血管瘤。
鉴别１硬纤维瘤及纤维瘤常见，强化不明显２慢性血肿（自发或外伤）强化不明显，可见液化区．

[本贴已被 jiajie 于 2005-4-18 13:25:26 修改过]

作者: weixuan 时间: 2005-4-18 22:19
标题: 回复：ct1252:腹壁少见病变,有病理

以下是引用hejie在2005-4-18 12:54:59的发言：[br][br]右下腹腹直肌鞘内可见一软组织肿块，边界较清楚，其内未见钙化，周围脂肪层未见侵犯。增强扫描肿块强化十分明显。[br] 考虑：腹直肌鞘内血管瘤。[br] 鉴别１硬纤维瘤及纤维瘤常见，强化不明显２慢性血肿（自发或外伤）强化不明显，可见液化区．[br][br]
[本贴已被 jiajie 于 2005-4-18 13:25:26 修改过]

作者: huhong1111111 时间: 2005-4-18 22:47
[emb25][emb6][emb20]

作者: 星皓 时间: 2005-4-18 23:05
我想也可能是腹壁血管瘤吧很符合血管瘤在增强时候的表现但最后是什么看病理就ok咯

作者: kjgj 时间: 2005-4-19 02:26
标题: 回复：ct1252:腹壁少见病变,有病理

以下是引用向医生在2005-4-17 23:01:18的发言：[br]右下腹壁内可见一软组织肿块，边界较清楚，其内未见钙化，周围脂肪层未见侵犯。增强扫描肿块强化十分明显。[br] 考虑：腹壁血管瘤。

[emb6]

作者: 晓杰 时间: 2005-4-19 03:30
同意大家的意见,考虑腹壁血管瘤

作者: caihe 时间: 2005-4-19 03:53
[emb6]支持腹壁血管瘤诊断，增强病灶明显强化。

作者: mhy 时间: 2005-4-19 03:57
右下腹腹直肌鞘内可见一软组织肿块，边界较清楚，其内未见钙化，周围脂肪层未见侵犯。增强扫描肿块强化十分明显。
考虑：腹直肌鞘内血管瘤。

作者: jiangjing 时间: 2005-4-19 08:48
病程长，右下腹腹直肌前方软组织肿块明显均匀强化，周界清，无侵袭，活动后又增大考虑腹壁血管瘤。

作者: gaozhengyi 时间: 2005-4-19 15:27
both primary and secondary neoplasms can invove the abdominal wall.although large masses generally are discovered by inspection and palpation,small tumors may be difficult to detect clinically,particularly in obese patients or in those with surgical scars or indurated tissue.computed tomography is capable of demonstrating small abdominal wall tumors and may be valuable in defining the extent of palpable lesions for the purpose of placing radiotherapy ports and assessing the effectiveness of chemotherapy.computed tomography is also helpful in detecting tumor recurrence after surgical excision.

作者: gaozhengyi 时间: 2005-4-19 15:29
lipomas are common ,benign tumors that can be found throughout the body,including the subcutaneous fat or muscle layers of the abdominal wall.they are well-defined,homogeneous,fat attenuation(-40 to –100hu)masses that may contain thin soft tissue seota and vessels.

作者: gaozhengyi 时间: 2005-4-19 15:55
dismoid tumors are locally aggressive .benign fibrous tissue neoplasms
that occur most commonly in the musculoaponeurotic fascia of the anterior
abdominal and internal oblique muscles and their fascial covering.
approximately three fpurths of abdominal wall dismoids occur in women,
predominantly during the childbearing years.on precontrast ct images,
dismoids have an attenuation value similar to that of muscle,but they may
enhance on postcontrast ct scans to become hyperdence relative to
muscle.on mr images,dismoids commonly appear isointense to muscle
on t1-weighted images,variable in signal intensity on t2-weighted images,
and demonstrate diffuse enhancement after intravonous administration of
gadolinium.extensive fibrosis is suggested by areas of low signal intensity
on both t1-and t2-weighted images.these mr signal characteristics are
nonspcific,but suggestive in the proper clinical setting.the mutiplanar capability
of mri is helpful in defining the connection of the mass to the abdominal wall
muscle or fascia.

作者: gaozhengyi 时间: 2005-4-19 16:22
the most common primary malignant neoplasms of the abdominal wall are sarcomas,followed
in frequency by lymphomas.hematogenously spread metastases may involve either the
abdominal wall muscles or the subcutaneous fat.metastasic involvement of muscle produces
enlargment of the muscle,often with an associated alteration in normal attenuation value.
subcutaneous metastases usually are nodular,and are readily detected by ct as soft tissue
attenuation masses in the lower attenuation subcutaneous fat.direct spread to the abdominal
wall by an intraabdominal neoplasm appears as a thickening of the muscles with loss of the intermuscular and perimuscular fat planes.malignant neoplasms that spread intraperitoneally
,such as ovarian and gastrointestinal carcinoma,have a tendency to involve the umbilical
region,producing periumbilical masses.abdominal wall metastases of colon,ovarian,gastric
,and gallbladder carcinomar have been reported in incisions and port sites after laparoscopy.
differentiation of abdominal wall neoplasm from abscess or hematoma may not be possible
using ct criteria alone and clinical correlation is offen necessary.percutaneous needle biopsy
under ct guidance may be required to differentiate among these entities.

作者: gaozhengyi 时间: 2005-4-19 16:54
标题: 1

肿块边缘清楚,范围局限,且结合其病史较长及查体特点,考虑为良性病变.
病变强化非常明显,与同层面的髂动脉强化幅度一致,应该考虑其为血管性来源.但是有不符之处:病变质韧,表面光滑,活动可,这一般是良性实体性肿瘤的特点.血管瘤一般都是触诊柔软,边缘不清,除非有机化的纤维组织较多时.动静脉畸形及动脉瘤等因为其无搏动感基本排除。
该病例从性别、发病年龄以及病变部位符合硬纤维瘤，但是强化程度过于明显。
综上所述，考虑为良性肿瘤性病变，伴有机化的海绵状血管瘤可以首先考虑，不排除硬纤维瘤。

[本贴已被 jiajie 于 2005-4-19 13:12:51 修改过]

作者: 郑家新 时间: 2005-4-19 21:12
我也支持血管瘤诊断，首先这是一个良性的

作者: heihuzi 时间: 2005-4-20 00:03
[emb6]血管瘤

作者: gbj8004 时间: 2005-4-20 00:05
病灶边界清楚内部密度均匀还是多考虑为良性病变可以考虑为1、血管瘤2、纤维瘤3、肌源性的肿瘤；

作者: 阿圣 时间: 2005-4-24 06:48
标题: 结果
手术记录：术中见肿瘤位于腹直肌内，边界清楚，有完整薄膜，大小约6×6×6cm，血运丰富。切除包括周围肌肉组织在内的肿瘤。

病理诊断：纤维组织细胞瘤。

[本贴已被 jiajie 于 2005-4-24 7:12:50 修改过]

作者: pbp789 时间: 2005-4-26 07:03
收到

作者: ct_r 时间: 2005-5-8 04:06
[emb26]

作者: jinguoji 时间: 2006-11-23 07:59
收到,学习了!

作者: 吴医师 时间: 2010-2-9 19:39
谢谢学习了

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