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2006年第29卷第1期 目录
颅板下薄层出血的CT诊断与鉴别诊断
匡楚龙，兰征科1，王甫玉
（都江堰市人民医院：影像科CT室；1外二科，四川都江堰 611830）
摘 要 目的：分析急性外伤性颅板下薄层出血的CT表现，以便正确诊断和鉴别不同性质的出血。方法：回顾性分析36例头部外伤后颅板下薄层弧带（线）状出血病例的CT表现的异同。结果：硬膜下出血，表现为颅骨“假性增厚”，内缘模糊，多有一定的占位效应；蛛网膜下腔出血，出血内缘呈“锯齿”或“羽毛”状，外缘相对清晰，相邻脑沟密度增高或湮没，无占位效应，出血在短时间内淡化、消散；硬膜外出血呈内缘清晰的弧线状影，伴发同侧颅骨骨折、头皮血肿，无占位效应；硬膜下合并蛛网膜下腔出血，发生于对冲部位，占位效应较明显，内缘“锯齿”或“羽毛”状，短时间内复查，蛛网膜下腔出血多已消散；硬膜外合并同侧硬膜下出血，发生于伤侧，伴发骨折，呈相对较厚的“新月”形或“波浪”状，跨越颅缝。结论：颅板下薄层出血的内、外缘形态，有否占位效应，与外伤部位的相互关系是不同性质出血的鉴别诊断要点；CT复查，更容易将蛛网膜下腔出血与其它出血相鉴别；多窗技术和局部薄层扫描更能显示颅板下薄层出血及其形态学特点。
关键词 薄层出血；硬膜下；硬膜外；蛛网膜下腔；
CT DIFFERENTIAL
DIAGNOSIS OF THIN BLEEDING ADJACENT TO INNER PLATE OF SKULL
Kuang Chulong, et al
Department of Radiology, People’s Hospital of Dujiangyan City
Abstract Objective: To assess the different
CT manifestations of the thin bleeding which accumulated in
the spaces next to the inner plate of the skull caused by acute
head trauma, so that a correct diagnosis and differential diagnosis
can be made. Methods: 36 patients with arc profile of thin bleeding
caused by acute head trauma were reviewed retrospectively and
the differences of their corresponding CT manifestations were
discussed. Results: Cases of subdural hemorrhage(SDH) manifested
false thickened skull, the inner margin of the skull were hazed,
and most of them showed some mass effect. In the cases of subarachnoid
hemorrhage(SAH), the profiles of the inner borders were in “saw-toothed”
or “feather” shape and the outer margins were relatively clear,
density of adjacent cortical sulci was increased or annihilated
and none of them showed mass effect. CT countercheck within
a short period showed that the blood was resolved spontaneously.
Cases of extradural hemorrhage(EDH) showed that the profiles
of the inner rim of the thin bleeding were clearly in arc shape
and accompanied with local skull fracture or scalp hematoma,
but no mass effect indication was shown. Cases of SDH coexisted
with SAH, which were contrecoup injury, accompanied with great
mass effect. The inner margins demonstrated the saw-toothed
or feather shape. Countercheck in a short period showed that
the blood in the subarachnoid cavity vanished. The case of EDH
seen in conjunct with SDH, thickened crescentic or wave shape
appeared, accompanied with local skull fracture but no mass
effect and the hematoma was crossing the suturae cranii. Conclusion:
The key points to the differential diagnosis between the different
types of bleedings are as follows: the shape of the border of
the thin blood, the indications of mass effect and the relationship
between the injury site and blood. Countercheck within a short
period is especially useful to the differential diagnosis of
SAH. Multi-windows setting technique and local thin section
scan are helpful to show the blood and their imaging features.
Key words
Thin bleeding; Subdural; Epidural; Subarachnoid; CT
