奇静脉病变的影像表现及其病理解剖学基础

        陈金华张伟国 （第三军医大学大坪医院野战外科研究所放射科重庆 400042） 摘要：掌握奇静脉的病理解剖学基础，有助于提高奇静脉病变的影像诊断水平，为临床早期诊断有血流动力学变化却无明显临床 症状的隐性病变提供依据，为奇静脉疾病的诊断及治疗提供帮助。本文就奇静脉病变的影像表现及其病理解剖学基础加以综述。 关键词：奇静脉；X 线计算机；体层摄影术 中图分类号：R816.2 文献标识码：A 文章编号:1673-6273（2009）11-2141-03 imagingfeature AzygosVein disease itspathoanatomy foundation Jia Ying, Cheng Rong, Ran Qi-sheng, Cheng Jin-hua, Zhang Wei-guo Radiology,Institute SurgeryResearch, Daping Hospital, Third Military Medical University, Chongqing 400042，China） ABSTRACT: Recognition pathoanatomyfoundation azygosvein contributes diagnosticimaging levels itsclinical diagnosis, treatment insidiousdisease hemodynamicsvariance withoutmarked clinical symptom. articlere- views imagingfeature azygosvein disease itspathoanatomy foundation. Key words: Azygos vein；X-raycomputed；Tomography Chinese Library 816.2Documentcode: ArticleID:1673-6273（2009）11-2141-03 奇静脉是连接上、下腔静脉之间最大的一条引流静脉，是 腰升静脉向胸部的延伸，负责引流肋间和脊柱旁静脉。及时、准 确地判断奇静脉异常,可早期发现一些无临床症状的隐性病变, 提示临床进一步行相关检查,明确诊断及时治疗。 本文对奇静 脉病变的影像学表现及其病理解剖学基础作一综 述，以提高 奇静脉病变的影像诊断水平，为临床医生在奇静脉 相关疾病的早期诊断及治疗提供帮助。 奇静脉分别注入奇静脉。杜颋等 测量奇静脉系管径结果为：奇静脉平均约 7.97+1.44mm，半奇静脉平均约 4.71+1.46mm，副半 奇静脉平均约 3.07+0.98mm。 1.2 奇静脉系统的正常影像学表现 在普通 线检查中，正常奇静脉与纵隔重叠，当奇静脉无病变时是不可见的。奇静脉沿脊柱走行段（即奇静脉弓以下段） CT轴位显示为圆形断面影，以上段沿脊柱的左前缘继续上 椎体平面移行至右缘转向前,绕过肺根上缘注入上腔静脉,称为奇静脉弓。增强后奇静脉表现为均匀性强化,但峰值 强化时间迟于主、肺动脉,即 CT 值低于主动脉 。奇静脉汇入上腔静脉交点处的直径范围为 4.3-16mm，CT 奇静脉的正常解剖及影像学表现1.1 奇静脉的正常解剖 在胚胎时期，胸部主要静脉分为两个系统：来自上腔静脉 的主静脉、来自奇静脉与半奇静脉的下主静脉。右侧下主静脉 来自奇静脉，左侧下主静脉来自半奇静脉。双侧下主静脉常于 椎体水平吻合，左下主静脉于左、右下主静脉吻合处完全或部分萎缩,或持续走行至副半奇静脉。 奇静脉约在腰 椎体水平起自于右腰升静脉并向上走行，于食管后方沿脊柱右前方上行至第 胸椎高度，呈弓形向前跨过右肺根上方，至左无名静脉和右无名静脉汇合处 1cm处进入上腔静脉后壁。右肋间静脉、右肋下静脉、半 奇静脉、副半奇静脉，肋间静脉及上胸段椎静脉丛直接回流至 奇静脉，少部分食管、纵隔及心包静脉也回流至奇静脉。半奇静 脉及副半奇静脉约在胸 椎体高度注入奇静脉，二者汇入奇静脉的方式有三种：一是半奇静脉与副半奇静脉共干后注入奇静 脉；二是半奇静脉及副半奇静脉分别注入奇静脉；三是在奇静 脉及副半奇静脉之间存在交通支，而交通支、半奇静脉及副半 示大多数奇静脉弓注入上腔静脉的交点位于第 MRI上，奇静脉显示为长 T1 T2信号，当奇静脉内血流流速 变慢时，表现为长 T1 T2信号。 静脉瓣膜是静脉内膜在发育过程中折叠而形成的袋状皱 襞，它能防止血流双向流动。Benjamin 通过研究表明奇静脉瓣常见于距离上腔静脉约 4cm 的奇静脉弓内，奇静脉弓内发 生造影剂逆流的可见率约 68.2%，CT 扫描时，从右上臂注入高 浓度造影剂更容易显示奇静 MSCT观察奇静脉瓣膜价值的研究结果是一致的 奇静脉系变异的影像学表现2.1 奇叶及奇静脉迁移 奇叶是指在胚胎发育过程中，奇静脉弓位置降低，将右肺 尖压向下方并进入右上肺，致肺组织沿奇静脉周围发育。奇静 脉位于壁层胸膜及脏层胸膜之间并压迫胸膜形成奇裂，奇裂将 部分肺实质与其它肺分开形成奇叶。奇叶的存在通常无临床意 义。Maldjian 提出“ 这个名称不太正确，因为奇叶并不是 一个独立的肺段，其支气管及血管的供应还是来自于右 肺上叶 作者简介：贾颖（1983-），女，本科，医师，主要从事胸部影像学诊断 E-mail:[e-mail] Tel:[phone] 通讯作者：张伟国，E-mail:[e-mail] （收稿日期：2009-04-02 接受日期：2009-04-28） 奇静脉逆流是急性心包填塞的 CT 影像征象之一 [17] CT动态增强扫描，表现为造影剂集中于上腔静脉并回 奇静脉病变的影像学表现 线平片可提示奇静脉病变的可能，CT检查可进一 步明确奇静脉病变，准确判断血管性疾病的部位，MRI 信号改 变可提示奇静脉的血流动力学变化。 史二栓.奇静脉系的应用解剖[J].中国解剖学杂志, 1996, 19 (3):280 Du ting, Shi er-shuan. applicationanatomy AzygosVein Sys- tem ChineseJournal ClinicalAnatomy, 1996, 19(3):280 张开华,唐建华, 闫伟伟,等.CT 观察奇静脉的临床应用 临床放射学杂志, 2004,23(7):577-580 Zhang Kai-hua, Tang Jian-hua, Yan Wei-wei, et al. 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