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腹腔内局灶性脂肪梗死疾病分为2种特殊类型:肠脂垂炎和大网膜梗死。而腹腔局灶性脂肪坏死虽然发病机制与前二者不同,但临床表现及影像学表现类似,临床上都可表现为轻重不等的急腹症似的症状,如腹痛、发热、恶心、呕吐等,WBC可升高,一般多为自限性疾病。若腹痛进一步加重同时伴有发热或WBC升高时,提示出现相应并发症的可能,如大网膜扭转,多需行外科手术治疗。笔者结合文献复习,分析并总结了2例儿童大网膜扭转引起的大网膜梗死和相应继发改变的多层螺旋CT(multislice spiral CT,MSCT)征象和鉴别诊断要点。
儿童少见大网膜梗死的MSCT诊断与鉴别诊断二例
MSCT diagnosis and differential diagnosis of rare greater omentum infarction in children: two cases report
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摘要: 笔者报道了2例儿童少见大网膜梗死的多层螺旋CT(MSCT)表现,归纳和总结MSCT对该病的诊断价值。儿童大网膜梗死相对比较少见,且该病的临床表现缺乏特异性,起病类似急性阑尾炎或胆囊炎。超声检查对儿童大网膜病变诊断价值有限,MSCT检查为该病的主要影像学检查方法并具有诊断特异性。在儿童继发性大网膜扭转、梗死时疾病进展较快,不及时准确诊断和治疗容易并发弥漫性腹膜炎等疾病,危及患儿生命。术前进行MSCT检查能准确地显示病变程度、累及范围以及是否存在并发症,可作为该病的首选检查方法,能有效避免漏诊或误诊。Abstract: The authors reported 2 cases of multislice spiral CT (MSCT) imaging findings with the greater omentum infarction in children, and summarized the diagnostic value of MSCT for the disease. Greater omentum infarction in children is relatively rare, and the clinical manifestation of the disease is not specific, the onset is similar to acute appendicitis or cholecystitis. For diagnosing the disease of the omentum infarction, ultrasound shows limitations, whereas the MSCT is the major method and has the specificity in the diagnosis. In children with secondary omental torsion and infarction, the disease progresses rapidly, and it is easy to be complicated with diffuse peritonitis without timely and accurate diagnosis and treatment, which endangers the lives of children. MSCT is helpful for showing the degree, extent, and complications of this disease and can be the first method used to avoid missed or erroneous diagnosis.
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