電腦斷層檢查對急性縱膈腔炎的評估

在過去4年之中，一共有15例各種不同原因的急性縱膈腔炎，都作了常規胸部X光和胸部電腦斷層攝影評估。在常規胸部X光檢查中，大部分只能發現有非特異性上縱膈腔變寬。而電腦斷層(CT)可對急性縱膈腔炎提供更正確的診斷和評估。我們依CT影像把病人分為兩大類：1.瀰漫性縱膈腔炎－CT可見瀰漫性軟組織浸潤和正常脂肪組織界面的消失（8個病例）。2.縱膈腔膿瘍－CT特點為局限性的液體積聚（7個病例）。CT可以很清楚的分辨不能開刀的瀰漫性縱膈腔炎和可以引流的縱膈腔膿瘍，且同時可以發現一些常規胸部X光像不易發現的游離空氣和各種併發症，如胸椎脊髓骨髓炎合併硬腦膜外膿癟，心包膜積水和肋膜積膿。因此，我們可以以CT的特點，使我們早一步診斷和作治療方向的決定。所以我們認為CT對急性縱膈腔炎的評估是非常有價值的。在統計的15個病例中，死亡率為27.6%(4/15)。而單就瀰漫性縱膈腔炎而言，死亡率為37.5%(3/8)，15例中就有8例為瀰漫性縱膈腔炎，其中有3例死亡，死亡率比縱膈腔膿瘍的病人高。

關鍵字

電腦斷層攝影；急性縱膈腔炎

並列摘要

In the past 4 years, 15 cases of acute mediastinitis of various etiologies in Mackay Memorial Hospital were studied. The most common cause is perforation of the esophagus. On chest radio- graphs, studies reveal non-specific superior mediastinal widening with either irregular or smooth border. CT is helpful in diagnosing mediastinal infection. Based on CT appearances, patients were classified into 2 groups: (1) Diffuse mediastinitis-showing diffuse soft tissue infiltration with or without mediastinal free air. (8 patients); (2) Mediastinal abscess-showing well-defined fluid collection. (7 patients) CT was proved reliable in distinguishing diffuse mediastinitis from drainable abscess. CT was also helpful in the detection of mediastinal free air and associated complications, such as; empyema, and osteomyelitis of the thoracic spine associated with epidural abscess. Thus allow diagnosis and management decision to be confidently made base on the CT findings. We believe CT is the procedure for evaluation of suspected mediastinal infection. The overall mortality rate in our series was 26.7% (4/15).

並列關鍵字

Computed tomography ； CT ； acute mediastinitis

國際替代計量

電腦斷層檢查對急性縱膈腔炎的評估

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