头颈部淋巴管畸形的CT诊断价值

Value of CT in the diagnosis of head and neck lymphatic malformation

摘要:

目的 探讨儿童头颈部淋巴管畸形(lymphatic malformation，LM)的CT表现及诊断价值。方法 回顾性分析2016—2021年收治的57例经手术及病理证实的头颈部LM患者的CT资料。结果 2岁以内41例，病灶位于左侧26例，右侧26例，双侧5例；位于颈部、咽旁26例，头面部8例，跨越头面、颈或纵隔23例。临床表现无痛性肿块53例，面容改变25例，喉喘鸣、呼吸困难或吞咽困难7例，上述临床表现可单独或者同时出现。单房型25例，多房型32例；瘤内合并出血者30例；55例CT诊断LM，阳性率96.5%(55/57)。CT可表现单房或多房，呈圆形、不规则形及分叶状低密度或等密度影，沿着组织间隙呈现爬行性生长，边界清楚或不清，部分患者可见分隔影，增强后囊内容物不强化，纤维状分隔及囊壁呈点状、条状、条索状及网格状强化。合并感染或出血时CT值升高，部分患者可见液-液平面。结论 CT检查能清晰显示头颈部LM的位置、大小和累及范围，且具有一定的特征性表现，对LM的诊断和制定治疗方案具有重要价值。

Abstract:

Objective To investigate the findings and diagnostic value of computerized tomography (CT) in head and neck lymphatic malformation (LM) of children.Methods The CT data of 57 cases of head and neck LMs confirmed by surgery and pathology from 2016 to 2021 were analyzed retrospectively.Results Forty-one cases (71.9%) were under 2 years old. The lesions were located on the left in 26 cases, on the right in 26 and on both sides in 5, including neck and parapharyngeal mass in 26 cases, head and face mass in 8, and mass across the head, neck or mediastinum in 23. The clinical manifestations were painless mass (n=53), facial changes (n=25), laryngeal wheezing, dyspnea or dysphagia (n=7). The above symptoms could occur alone or simultaneously. The mass was single chamber type in 25 cases and multi-chamber type in 32. Intratumoral hemorrhage was found in 30 cases. LM was diagnosed by CT in 55 cases with a positive rate of 96.5% (55/57). CT findings included single chamber or multi chamber, round, irregular and lobulated low-density or equal density shadows, creeping along the tissue gap with clear or unclear boundary. In some patients, separation shadow was observed in the capsule with unenhanced capsule content and enhanced fibrous separation and capsule wall in point, strip, cord and grid shape after enhancement. When combined with infection or bleeding, the CT value got increased, and the liquid-liquid level was visible at the same time in some patients.Conclusion With advantages of clear display of the mass location, size and range, as well as certain characteristic manifestations, CT is of great value for diagnosis and treatment of head and neck LM.