双语病例后纵隔囊性占位性病变需考虑哪
2016-12-7 来源：不详 浏览次数：次History:A50-year-oldmanwithahistoryofmilddysphagia.
病史：50岁男性，轻度吞咽困难。
Asingle-contrastesophagramwasperformed.
行单对比剂食管造影
CTimages
ACTscanoftheupperabdomenwithoralandintravenouscontrastwasobtainedinportalvenousphase.
上腹部CT扫描门脉期（口服及静脉注射对比剂）
Findings
Esophagram:Thesingle-contrastesophagramdemonstratessmooth,broad-based,extrinsicmasseffectonthelowerthirdoftheesophagus,displacingtheesophagusslightlylaterally.Thereisnormalsingle-contrastappearanceoftheesophagealwallswithoutevidenceofesophagealdiverticulum.CT:Thereisahypodensemasswiththinwallsandnocalcifcationslocatednearthegastroesophagealjunction,abuttingtheaorta,intheinferiorandposteriormediastinum,displacingtheesophaguslaterally.
表现：
食管钡餐：单对比剂食管造影示食管下1/3可见光滑的宽基底的外压性占位效应，食管轻度向对侧移位。食管壁正常，未见食管憩室征象。
CT：后下纵隔邻近胃食管连接处及主动脉，可见一低密度肿物，壁薄，无钙化，食管向对侧移位。
Differentialdiagnosis
Esophagealduplicationcyst
Lymphaticmalformation
Neurentericcyst
Bronchogeniccyst
鉴别诊断：
食管重复囊肿
淋巴管畸形
神经管原肠囊肿
支气管源性囊肿
Diagnosis:Esophagealduplicationcyst
诊断：食管重复囊肿
Keypoints
Esophagealduplicationcyst
Pathophysiology
Esophagealduplicationcystispartofaclassoflesionstermedasforegutduplicationcysts.
Foregutduplicationcystsmaybelocatedadjacentlytotheesophagus,duodenum,jejunum,orileum.
Theyarethoughttobeduetothepersistenceofanabnormalembryonicforegutvacuole.
Upto50%ofcasesmaycontainectopicgastricmucosa.
病理生理学
食管重复囊肿是前肠重复畸形囊肿一类疾病中的一种；前肠重复畸形囊肿可邻近食管、十二指肠、空肠或回肠。被认为是胚胎前肠液泡的异常残留。多达50%的病例可包含异位胃粘膜。
Epidemiology
Theselesionsarecongenitalandnonfatal;therefore,theyarepresentinallagegroups.Symptomaticcysts,however,generallypresentinchildhood.
流行病学
病变是先天性的非致命性的，所有年龄段的人群均可发生。然而有症状的囊肿常见于儿童。
Clinicalpresentation
Esophagealduplicationcystsareusuallydiscoveredincidentally.
Symptomaticesophagealduplicationcystspresentwithsymptomsofmasseffectontheesophagus.
临床表现
食管重复囊肿多为偶然发现；
有症状的表现为食管压迫症状。
Imagingfeatures
Esophagram:Maydemonstrateextrinsicmasseffectontheesophagus.
Ultrasound:Appearsasahypoechoicstructureadjacenttotheesophaguswithposterioracousticenhancement,consistentwithasimplecyst.
CT:Appearsasahypodenselesionadjacenttotheesophaguswiththinwallsandlackofaggressivefeatures,suchasthicksepatations,muralnodularity,orgrossinvasionofadjacentstructures.
MRI:AppearsT2hyperintense,T1hypointense,withnoenhancement,norestricteddiffusion,andfindingsconsistentwithasimplecyst.
Nuclearmedicine:Technetium-99mpertechnetatescanmaydemonstrateradiotraceruptakeinaportionofthecystwall,consistentwiththepresenceofectopicgastricmucosa.
影像表现
食管造影：可见食管受外力所致压迹表现；
超声：表现为邻近食管的低回声结构，后方可见回声增强，与单纯囊肿相一致。
CT：食管旁低密度病灶，壁薄，无侵袭性表现，如厚的分隔、壁结节、周围结构受侵犯。
MRI：表现为T2高信号，T1低信号，增强无强化，无明显弥散受限，与单纯囊肿表现一致。
核医学：锝-99m扫描一部分囊肿壁可见放射性示踪剂摄取，提示有异位的胃粘膜。
Treatment
Treatmentisusuallyunnecessaryunlessthepatientissymptomatic.
