Rettenbacher T, Tzankov A, Hollerweger A
Klinische Abteilung für Radiologie II, Universitätsklinik für Radiodiagnostik, Medizinische Universität Innsbruck.
Ultraschall Med. 2006 Jun;27(3):240-4. doi: 10.1055/s-2006-926776.
To correlate the sonographic findings of tissue oedema with histopathological changes in order to find an explanation for the different sonographic appearances of oedema.
Subcutaneous and cutaneous tissue of the chest wall, the abdominal wall, and the thigh of 4 human cadavers with clinically evident oedema were examined sonographically. A specimen was then taken from each region for histological examination.
Twelve cutis-subcutis-regions underwent sonographic-histological correlation. 9 out of 12 subcutaneous regions exhibited a diffusely increased echogenicity. 5 of the 9 regions with increased echogenicity also showed hypoechoic bands (up to 3 mm) within the subcutaneous tissue. Histologically, all of the 9 sonographically altered subcutaneous regions displayed lentiform or band-like optically empty spaces within the connective tissue between lobules of fatty tissue as well as between groups of fat cells within lobules of fatty tissue corresponding to fluid. Hypoechoic stripes at sonography represented very broad bands of fluid. The cutis appeared hyperechoic in all cases. At histology, 9 of 12 cases exhibited uniformly distributed optically empty spaces between connective tissue fibres of the dermis. Dermal thickness corresponded to the degree of oedema.
Subcutaneous oedema results in diffusely increased echogenicity, which is caused by the difference in acoustic impedance occurring at the edges of numerous bands of fluid. In addition, hypoechoic bands are observed if broad spaces of fluid are present in severe cases. Encased fluid in the dermis is uniformly distributed between connective tissue fibres. Sonographically, the homogenous hyperechoic appearance of normal dermis remains unaltered in cases of oedema, but dermal thickness increases.
将组织水肿的超声表现与组织病理学变化相关联，以解释水肿不同超声表现的原因。
对4例临床有明显水肿的人体尸体的胸壁、腹壁和大腿的皮下及皮肤组织进行超声检查。然后从每个区域取标本进行组织学检查。
对12个皮肤-皮下区域进行了超声-组织学相关性研究。12个皮下区域中有9个表现为回声弥漫性增强。9个回声增强区域中有5个在皮下组织内还显示低回声带（可达3毫米）。组织学上，9个超声改变的皮下区域在脂肪组织小叶间的结缔组织内以及脂肪组织小叶内脂肪细胞群之间均显示透镜状或带状光学空泡，对应于液体。超声检查时的低回声条纹代表非常宽的液带。所有病例的皮肤均表现为高回声。组织学上，12例中有9例在真皮结缔组织纤维之间表现为均匀分布的光学空泡。真皮厚度与水肿程度相对应。
皮下水肿导致回声弥漫性增强，这是由众多液带边缘处声阻抗的差异引起的。此外，在严重病例中，如果存在宽的液腔，则会观察到低回声带。真皮内包裹的液体在结缔组织纤维之间均匀分布。超声检查时，水肿病例中正常真皮的均匀高回声外观保持不变，但真皮厚度增加。
