Ramos-Andrade Daniel, Ruivo Catarina, Portilha M Antónia, Brito Jorge B, Caseiro-Alves Filipe, Curvo-Semedo Luís
Medical Imaging Department and Faculty of Medicine, University Hospital of Coimbra, Portugal.
Eur J Radiol Open. 2014 Oct 16;1:60-3. doi: 10.1016/j.ejro.2014.09.004. eCollection 2014.
We report a case of a 77-year-old female who was admitted to the emergency department complaining of diffuse abdominal pain for five days, associated with nausea, vomiting and constipation. Physical examination disclosed a large incarcerated umbilical hernia, which was readily apparent on supine abdominal plain films. These also showed a calcified heterogeneous mass in the mid-abdominal region, which was further characterized by CT as a lithopedion (calcified ectopic pregnancy). This is one of the few cases studied on a MDCT equipment, and it clearly enhances the post-processing abilities of this imaging method which allows diagnostic high-quality MIP images. Lithopedion is a rare entity, with less than 300 cases previously described in the medical literature. However, many reported cases corresponded to cases of skeletonization or collections of fetal bone fragments discovered encysted in the pelvic region at surgery or autopsy. It is thus estimated that true lithopedion is a much rarer entity. The diagnosis may be reached by a suggestive clinical history and a palpable mass on physical examination, while the value of modern cross-sectional techniques is still virtually unknown. Ultrasonography may depict an empty uterine cavity and a calcified abdominal mass of non-specific characteristics, and computed tomography or magnetic resonance imaging are able to reach a conclusive diagnosis and may additionally define the involvement of adjacent structures. The differential diagnosis includes other calcified pathologic situations, including ovarian tumors, uterine fibroids, urinary tract neoplasms, inflammatory masses or epiploic calcifications.
我们报告一例77岁女性，因弥漫性腹痛5天入院，伴有恶心、呕吐和便秘。体格检查发现一个巨大的嵌顿性脐疝，仰卧位腹部平片上很明显。平片还显示中腹部区域有一个钙化的不均匀肿块，CT进一步将其诊断为石胎（钙化异位妊娠）。这是少数在MDCT设备上研究的病例之一，它明显增强了这种成像方法的后处理能力，可生成诊断性高质量的MIP图像。石胎是一种罕见的实体，医学文献中此前描述的病例不到300例。然而，许多报告的病例是在手术或尸检时发现盆腔区域有骨骼化或胎儿骨碎片聚集的情况。因此据估计，真正的石胎是一种更为罕见的实体。通过提示性的临床病史和体格检查时可触及的肿块可作出诊断，而现代横断面技术的价值实际上仍不为人知。超声检查可能显示子宫腔空虚和一个具有非特异性特征的钙化腹部肿块，计算机断层扫描或磁共振成像能够作出明确诊断，还可进一步确定相邻结构是否受累。鉴别诊断包括其他钙化性病理情况，包括卵巢肿瘤、子宫肌瘤、泌尿系统肿瘤、炎性肿块或网膜钙化。
