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摘要


自從抗生素廣泛應用在感染性疾病後,感染性硬膜竇栓塞嶺生機會已大為降低,但在少數易感染性疾病如糖尿病,及免疫力不全的病人,如合併顏面、眼部、鼻竇或耳部感染常引起感染性硬膜竇栓塞。在過去17年間我們收集13例感染性硬膜竇栓塞,並分析其電腦斷層表徵。於13例感染性硬膜竇栓塞中,7例為感染性海綿狀竇栓塞,3例為側硬膜竇栓塞,3例為上矢狀竇栓塞。於7例感染性海綿狀竇栓塞,6例合併顏面部位感染,l例於感染前3日拔牙,其中6例於病灶側海綿狀竇呈現鼓起,另2例除可見鼓起之海綿狀竇,亦可見低密度於竇內,另1例海綿狀竇並無異常。於3例側硬膜竇栓塞之電腦斷層皆可見中耳感染合併小腦膿瘍,側硬膜竇為膿瘍所掩蓋。於3例上矢狀竇栓塞,1例合併顏面及頭皮感染,有empty delta sign及氣體栓塞存於上矢狀竇,1例於注射對比劑後於上矢狀竇有不正常之加強現象併發臨近腦膜炎。另1例無明顯感染源,但於上矢狀竇有empty delta sign及近側腦膜炎。臨床上鑑別感染性及非感染性硬膜竇栓塞非常重要,因其治療方式有別。如病人有硬膜竇栓塞合併顏面、眼部、鼻竇或耳部感染,則應高度懷疑為感染性硬膜竇栓塞,治療則以抗生素為主。電腦斷層因其方便性及可直接觀察硬膜竇,因此在診斷及追蹤硬膜竇栓塞是一種重要的工具。

並列摘要


We retrospectively analysed the CT findings of 13 patients with septic dural sinus thrombosis (SDST). Among which, seven were septic cavernous sinus thrombosis (SCST); three were septic lateral sinus thrombosis (SLST); three were septic superior sagittal sinus thrombosis (SSSST). Six of 7 patients with SCST had facial, orbit or air sinus infection; one experienced dental extraction recently. Bulging of involved cavernous sinus (CS) were observed in the 6 of 7 patients and low density lesions within the CS are depicted in the two cases; one showed no remarkable change in the CS. The 3 patients with SLST all had similar CT pictures of infectious process involving middle ear and/or mastoid with adjacent cerebellar abscess formation and sigmoid sinus thrombosis. In the patients with SSSST, one presented with empty delta sign and air thrombus in the superior sagittal sinus (SSS); one showed abnormal enhancement in the SSS with subjacent meningitis; the third one was also depicted of empty delta sign and subjacent meningitis. Due to different treatment strategies, it is important to differentiate septic from aseptic dural sinus thrombosis. CT can reveal directly the dural sinus and the associated orbital, facial and air sinus changes and will permit earlier diagnosis and treatment with better results. CT is also useful in detecting intracranial complications that may impede recovery, such as abscesses, empyema, or infarctions. CT plays an important role in the evaluation of the SDST, and has become one of the imaging modality of choice in the diagnosis and follow up for SDST.

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