背景:恶性腹膜间皮瘤是一种罕见的疾病过程,其放射学特征是腹水和多个小肿瘤结节浸润腹膜。顶腹膜和内脏腹膜均被多个恶性肿瘤结节所累及。计算机断层扫描(CT)已用于识别由这种恶性过程的进展引起的解剖病理学。
目的:识别并描述恶性腹膜间皮瘤患者的异常CT图像。识别这些不寻常的放射学发现会导致放射科医生怀疑这种罕见的恶性过程。
方法:在100例接受恶性腹膜间皮瘤明确治疗的患者中,我们对术前CT扫描的结果进行了分类.这些变化中的许多在CT扫描中被反复注意到。其他病理CT图像较少见。在本手稿中专门研究了这些不寻常的放射学表现。
结果:选择了8例恶性腹膜间皮瘤的影像学表现进行研究。这些不寻常的发现包括发生在Spigelian疝中的肿块,球形间皮瘤肿块浸润脾实质,肿瘤浸润下纵隔,左侧腹股沟管内的间皮瘤肿块,心膈角淋巴结肿大,与恶性腹膜间皮瘤进展相关的胸膜斑块,由脾脏周围的疾病引起的脾切口,与近端空肠相关且直接邻近Treitz韧带的解剖位置的大于5cm的肿块。
结论:恶性腹膜间皮瘤的影像学表现非常重要,这对于通过CT准确诊断该病非常重要。
BACKGROUND: Malignant peritoneal mesothelioma is an unusual disease process characterized radiologically by ascites and infiltration of the peritoneum by multiple small tumor nodules. Both parietal and visceral peritoneum are involved by the multiple malignant tumor nodules. Computed tomography (CT) has been used to identify the anatomic pathology induced by the progression of this malignant process.
OBJECTIVE: To identify and then describe unusual CT images in patients with malignant peritoneal mesothelioma. Recognition of these unusual radiologic findings can cause the radiologist to be suspicious of this rare malignant process.
METHODS: In 100 patients who were to undergo definitive treatment of malignant peritoneal mesothelioma, the findings on preoperative CT scans were catalogued. Many of these changes were repeatedly noted on the CT scans. Other pathologic CT images were less common. These unusual radiologic presentations were specially studied in this manuscript.
RESULTS: Eight unusual radiologic presentations of malignant peritoneal mesothelioma were selected for study. These unusual findings included a mass occurring within a Spigelian hernia, infiltration of the splenic parenchyma by spherical mesothelioma masses, infiltration of the lower mediastinum by tumor, a mesothelioma mass within a left inguinal canal, enlarged cardiophrenic angle lymph nodes, pleural plaques associated with the progression of malignant peritoneal mesothelioma, splenic notches caused by disease surrounding the spleen, and a mass greater than 5 cm associated with the proximal jejunum and directly adjacent to the anatomic location of the Treitz ligament.
CONCLUSIONS: There are unusual radiologic presentations of malignant peritoneal mesothelioma that are important to recognize in order to accurately diagnose this disease by CT.