Creteur V, De Poerck A F, De Raedemaeker K, Salhadin A, Peetrons P
Service de Radiologie, Centre Hospitalier Molière-Longchamp, Bruxelles.
J Belge Radiol. 1994 Dec;77(6):270-1.
We present a case of dramatic radiation enterocolitis inducing portal venous air diagnosed by Doppler sonography only. The sonographic pattern consisted of multiple irregular hyperechoic areas into the liver, with internal repetitive noisy bidirectional peaks superimposed on the usual continuous Doppler display of the portal flow. Although portal hyperechoic moving foci alone may reflect only slow portal velocity, they do not create any Doppler distortion as do moving bubbles. Portal air may have multiple causes such as abdominopelvic abscesses, sepsis, intestinal distension, fulminant hepatitis, cholangitis, cholecystitis, diabetic acidosis..., but mesenteric infarct, necrotic enterocolitis, and radiation enteritis are life-threatening conditions that have to be diagnosed as soon as possible. Although large quantities of portal air may be demonstrated on plain film of the abdomen or by computed tomography, Doppler sonography may detect smaller quantities, allowing earlier diagnosis of intestinal pathology requiring immediate surgical treatment. Therefore, Doppler sonography of the liver should be performed in any patient with acute abdominal pain or distension, especially if being treated by abdominal radiotherapy.
我们报告一例仅通过多普勒超声诊断出的由放射性小肠结肠炎诱发门静脉积气的病例。超声表现为肝脏内多个不规则高回声区，在门静脉血流通常的连续多普勒显示上叠加有内部重复性嘈杂的双向峰值。虽然单独的门静脉高回声移动灶可能仅反映门静脉流速缓慢，但它们不会像移动气泡那样产生任何多普勒失真。门静脉积气可能有多种原因，如腹盆腔脓肿、败血症、肠扩张、暴发性肝炎、胆管炎、胆囊炎、糖尿病酸中毒……但肠系膜梗死、坏死性小肠结肠炎和放射性肠炎是必须尽快诊断的危及生命的疾病。虽然腹部平片或计算机断层扫描可能显示大量门静脉积气，但多普勒超声可能检测到较少量的积气，从而能够更早地诊断需要立即手术治疗的肠道病变。因此，对于任何有急性腹痛或腹胀的患者，尤其是正在接受腹部放疗的患者，都应进行肝脏多普勒超声检查。
