Choi S J, Lee J S, Song K S, Lim T H
Department of Diagnostic Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
AJR Am J Roentgenol. 1998 Sep;171(3):591-4. doi: 10.2214/ajr.171.3.9725279.
The purpose of this study was to differentiate ruptured from unruptured mediastinal teratomas using CT. MATERIALS AND METHODS; CT findings in 17 cases of surgically resected mediastinal teratomas were reviewed retrospectively. Preoperative rupture was found in seven patients during surgery. We compared the clinical symptoms and CT findings of ruptured tumors with those of unruptured tumors. On CT, we evaluated size, wall thickness, location of the mass, presence or absence of internal septation, homogeneity of the internal components of each compartment, calcification or fat within the mass, and ancillary findings in adjacent structures.
Severe symptoms (chest pain or hemoptysis) were more commonly found in ruptured (71%) than in unruptured tumors. All ruptured mediastinal teratomas had a tendency to display inhomogeneity of the internal components, whereas 90% of unruptured masses showed homogeneous densities of internal components in each compartment of the mass. Ancillary CT findings in ruptured tumors included fat-containing masses in adjacent lung parenchyma in two patients, consolidation or atelectasis in the adjacent lung in three patients, pericardial effusion in one patient, and pleural effusion in four patients.
In cases of mediastinal teratoma, CT findings of inhomogeneity of the internal components and changes in the adjacent lung parenchyma, pleura, or pericardium can be used as signs of tumor rupture.
本研究旨在利用CT鉴别破裂与未破裂的纵隔畸胎瘤。材料与方法：回顾性分析17例经手术切除的纵隔畸胎瘤的CT表现。术中发现7例患者术前肿瘤已破裂。我们比较了破裂肿瘤与未破裂肿瘤的临床症状和CT表现。在CT上，我们评估了肿瘤的大小、壁厚、位置、内部是否有分隔、各部分内部成分的均匀性、肿瘤内的钙化或脂肪以及相邻结构的伴随表现。
破裂肿瘤（71%）比未破裂肿瘤更常出现严重症状（胸痛或咯血）。所有破裂的纵隔畸胎瘤内部成分均有不均匀的倾向，而90%的未破裂肿瘤各部分内部密度均匀。破裂肿瘤的CT伴随表现包括2例患者相邻肺实质内有含脂肪肿块，3例患者相邻肺出现实变或肺不张，1例患者有心包积液，4例患者有胸腔积液。
对于纵隔畸胎瘤病例，内部成分不均匀以及相邻肺实质、胸膜或心包的改变等CT表现可作为肿瘤破裂的征象。
