CL0556:胎儿石化

Software · 发表于 2007-8-7 02:39

案例2439

lithopedion (litho =石头； pedion =孩子): 石头婴儿.
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出版日期：: 2003.11.02
doi: 10.1594/eurorad/case.2439
alymlahi ek, chat l, chellaoui m, dafiri r
r
1100 - ksar elkbir / morocco
病人：
年龄：62岁
性别：女

临床摘要：
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palpable abdominal mass with a 17 years history. the patient had recently
suffered from lower abdominal discomfort.

临床历史性回顾：
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the patient was referred to our hospital for palpable abdominal masse with
a 17 years history. the patient had recently suffered from lower abdominal
discomfort.
ultrasound revealed a huge densely calcified mass with a normal
postmenopausal uterus.
the abdomino-pelvic computed tomographic scan (figs. 1. 2. 3) showed
the presence of an ectopic foetus, with peripheral calcifications.
the femoral length of the lithopedion measured 77 mm, equivalent to
a foetus at 40 weeks’ gestation. ct scan studies were unable to identify
any organs due to complete calcification of the foetus.
on further questioning, the patient reported that she had become pregnant
17 year before and that the pregnancy had continued for about 8 to 9 months
with foetal movement and abdominal distension until she experienced a
vaginal bleeding. because of poor accessibility to doctors and hospitals
she stayed at home and sought the alternative medicine. after sometime,
the foetal movement and the abdominal distension disappeared and the
palpable mass developed.

讨论：
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lithopedion (litho = stone； pedion = child) is the name given to an
extra-uterine pregnancy that evolves to foetal death and calcification.
it is a rarely encountered result of an undiagnosed and untreated advanced
abdominal pregnancy where the dead foetus is retained in the maternal
abdominal cavity and calcification ensues.
the incidence of abdominal pregnancy is 1 of 11,000 live births and
lithopedion occurs in 1.5% to 1.8% of these cases. there are less than
300 cases reported in the medical literature. the age of the patients on
the date of diagnosis varied from 23 to 100 years, 2/3 of them being over
40 years old. abdominal pregnancy results from the rupture of tubal
or ovarian pregnancy with abdominal cavity implantation.
an abdominal pregnancy that calcifies can be classified into three sub
types according to the involvement of calcification to the membranes
and the foetus: lithokelyphos (litho = rock, kelyphos = shell), in which
the membranes alone are calcified； lithokelyphopedion in which both
membranes and the foetus are calcified, and true lithopedion or lithotecnon,
in which the foetus is calcified and the membranes are negligible.
most cases of lithopedions are found incidentally when taking abdominal
films for various reasons, or when a palpable abdominal mass is felt during
pelvic examination.
some associated complications have been reported after a long asymptomatic
evolution: urinary bladder and rectum perforation； extrusion of foetal parts
through the abdomen wall, rectum and vagina； intestinal obstruction (due to
collision of foetal parts with the intestine or adherence) volvulus, fistula formation,
cephalopelvic disproportion of a concomitant pregnancy and pelvic abscess.
the diagnosis is revealed by a suggestive clinical history, a pelvic mass found
during the physical examinations, and frequently, an x-ray of the abdomen is
enough to confirm it. the ultrasound examination shows an empty uterine
cavity and a non-s