【臨床症状】60代 膵酵素上昇 USで膵管軽度拡張
【問題】画像所見と診断名は?
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➡ 拡散強調 他
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➡ CT単純/造影 横断像
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➡ CT造影 冠状断像
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▶答えはこちら
- 腹腔動脈の腹側にT2WIで高信号を呈する分葉状の腫瘤影を認める
- 拡散強調で高信号、ADCでも高値を示す
- 画像上、膵管との交通は認めない
- CTでも同様に4cm程度の嚢胞性病変を認める
- 壁は薄く、また壁在結節は認めない
- またCTでも膵管との交通は認めない事から、リンパ管腫が第一に疑われる
【リンパ管腫】
・リンパ管腫(lymphatic malformation:LM)はリンパ管奇形との呼ばれ、全身のどこにでも発生しうる
・拡張した異常なリンパ管がびまん性に増殖する
・頭部に多く、腹部に発生するのは約5%と頻度は少ない
・基本的に無症状だが、炎症や出血を生じる事もあり急性腹症の原因となることもある
・全身性に多発する事がある
・macrocystic type、microcystic type、mixed typeに分けられる
・画像所見は、薄壁の多房性嚢胞病変を認めT2WIで高信号である事が多い
・隔壁に造影効果を認める事がある
参考書籍:ジェネラリストを目指す人のための画像診断パワフルガイド 第2版
参考文献:白井秀仁、新開真人、北河徳彦 他、腹部リンパ管奇形(リンパ管腫)28例の検討と感染・炎症例へのドレナージの有効性、日小外学会、第58巻 7号