【摘要】 目的 回顾性分析以单侧颈部结节为首发症状的13例淋巴瘤的CT表现,并总结其误诊原因。方法 收集经病理证实的淋巴瘤患者108例,总结以单侧颈部结节首发的淋巴瘤13例,所有病例均行16排或320排螺旋CT平扫加增强检查。结果 13例淋巴瘤中,非霍奇金淋巴瘤11例,均为B细胞型,其中以弥漫大B细胞型(n=8)最为常见:霍奇金淋巴瘤2例。除累及颈部淋巴结外,6例并发纵隔(n=3),腹膜后、肠系膜(n=3)淋巴结肿大,7例无并发其他部位淋巴瘤。按照颈部病变形态,分为单一肿块型(Ⅰ型),多发结节不融合型(Ⅱ型),多发结节融合型(Ⅲ型)。Ⅰ型4例,CT表现为颈部单一肿块,类圆形或椭圆形,密度均匀(n=2)/不均(n=2),增强扫描轻中度强化(n=2)环形强化(n=2)。此型术前4例均误诊。Ⅱ型3例,CT征象均表现为单侧颈部多发结节,不融合,密度较均匀,边界较清,增强扫描轻中度强化。此型影像学征象无明显特征性,术前2例误诊。Ⅲ型6例,均表现为单侧颈部多发结节,部分融合,增强扫描轻中度强化(n=6);此型影像相对典型,术前无误诊。结论 以单发颈部结节首发的恶性淋巴瘤临床少见,容易误诊,CT能够准确观察结节形态、范围、密度、强化等特点,仔细分析影像学特征后有望做出倾向性诊断。更多还原

【Abstract】 Objective To investigate CT findings of lymphoma with original appearance of nodule in the unilateral neck,and to analyze the reasons of misdiagnosis.Methods The clinicopathological manifestations were analyzed retrospectively in 108 patients with surgically confirmed lymphoma.13 cases of lymphomas were summarized with original appearance of nodule in the unilateral neck and all these patients received plain and enhanced CT examination.Results Among 13 cases of lymphoma,11 cases were nonHodgkin lymphoma originated from B-cell,and the most common histologic subtype was diffuse large B cell lymphoma(n=8),2cases were Hodgkin lymphoma.In addition to involving the cervical lymph nodes,6 cases merged with mediastinal(n=3),peritoneum and mesentery(n=3) masses,7 cases without other parts of masses.There were three types of lesion appearances:4 cases were single mass type(type Ⅰ),presented with well-defined round or elliptic margins and with mild-moderate enhancement(n=2) or ring-enhancement(n=2).Type Ⅰ was the most easily misdiagnosed and 4 cases were all misdiagnosed before operation.3 cases were multiple nodules without fusion type(type Ⅱ),presented with well-defined margins,uniform density,and with mild or moderate enhancement.Type Ⅱ was not characteristic,and 2 cases were misdiagnosed before operation.6 cases were multiple nodules with fusion type(type Ⅲ),whose CT findings were relative typical.Conclusion Lymphomas with original appearance of nodule in the unilateral neck are rare.CT can provide the information on the position,shape and range of nodules,and careful analysis of radiographic features is expected to make the tendency of diagnosis.更多还原