SIU M CHN ON HCH BCH HUYT

BS. NGUYN QU KHONG BS. NGUYN QUANG TRNG

KHOA CHN ON HNH NH BNH ViN AN BNH TP.HCM

12/14/2013 1

DN BI

i cng. Cch khm siu m hch. Hnh nh siu m. Nguyn nhn. Cm by.

12/14/2013

DN BI

i cng. Cch khm siu m hch. Hnh nh siu m. Nguyn nhn. Cm by.

12/14/2013

I CNG

Hch bch huyt cha cc t bo lympho v t bo vng ni m, c 3 chc nng: 1. Sn xut t bo lympho. 2. Sn xut cc khng th. 3. Lc dch lympho (2 lt/24 gi).

12/14/2013

DN BI

i cng. Cch khm siu m hch. Hnh nh siu m. Nguyn nhn. Cm by.

12/14/2013

CCH KHM SIU M HCH

Khm ton b bng, ch cc mt ct dc v ngang MC bng v TMCD. u d 3,5MHz (khm su), 5 hay 7MHz (khm nng).

12/14/2013

CCH KHM SIU M HCH

12/14/2013

DN BI

i cng. Cch khm siu m hch. Hnh nh siu m. Nguyn nhn. Cm by.

12/14/2013

HNH NH SIU M

Hch c hi m mng so vi m m sau phc mc xung quanh. C th hoi t trung tm hay nang ha (hch vim, hch lao). Hch c hi m gn nh trng v khng km tng m pha sau (Lymphoma). Hch c hi m: do di cn.

12/14/2013

HNH NH SIU M
HCH LNH
Chiu dc /Chiu ngang > 2 (khuynh hng dt) Vng v mng, hi m mng; vng rn hi m dy. Kch thc nh. S lng t.

HCH C
Chiu dc /Chiu ngang < 2 (khuynh hng trn) Vng v rng, lch tm, hi m mng; vng rn hp hoc bin mt, hi m dy. Kch thc to. S lng nhiu.

12/14/2013

C.M.Rumack et al. Diagnostic Ultrasound. 3rdEdition. 2005.p443-482

10

HNH NH SIU M
V TR VNG BNG
-

KCH THC < 1cm - > 1cm, n c - > 1,5cm, n c - > 1cm, a hch
-

PHN LOI Bnh thng. - Nghi ng. - Bt thng. - Bt thng.

-

VNG CHU

> 1,5cm

Bt thng.

* Kch thc ca hch, theo quy c chung, c o theo trc ngn.

12/14/2013

C.M.Rumack et al. Diagnostic Ultrasound. 3rdEdition. 2005.p443-482

11

12/14/2013

12

HNH NH SIU M

Hch sau phc mc thng gp nht trong bnh Lymphoma. Hch cnh MC thy 25% bnh nhn Hodgkin v 50% bnh nhn non-Hodgkin. Siu m xc nh chnh xc t 80-90% hch sau phc mc trong bnh Lymphoma, v hch lymphoma trong cc tng.

12/14/2013

C.M.Rumack et al. Diagnostic Ultrasound. 3rdEdition. 2005.p443-482

13

HNH NH SIU M

Hnh nh siu m thng thy l khi hi m mng hoc hi m trng (khng tng m pha sau) trc v sau mch mu ln. i khi cc hch kt dnh vi nhau to thnh mt lp m hi m mng bao quanh mch mu ln, y mch mu ra xa ct sng.

12/14/2013

C.M.Rumack et al. Diagnostic Ultrasound. 3rdEdition. 2005.p443-482

14

HNH NH SIU M

HCH BAO QUANH TMCD

12/14/2013

C.M.Rumack et al. Diagnostic Ultrasound. 3rdEdition. 2005.p443-482

15

HNH NH SIU M

Hnh nh ny khng c hiu cho Lymphoma. Mt s u sau phc mc pht trin v lan trn dc theo cc khoang sau phc mc, chen gia cc cu trc v khng chn p cc mch mu. Ta gi hnh nh ny l du hiu MC ni (floating aorta sign). Cc U c th c du hiu ny: Lymphoma, Lymphangioma, Ganglioneuroma.

Mizuki Nishino, MD et al. Primary Retroperitoneal Neoplasms: CT and MR Imaging Findings with 12/14/2013 16 Anatomic and Pathologic Diagnostic Clues. Radiographics. 2003;23:45-57.

HNH NH SIU M

LYMPHOMA
Mizuki Nishino, MD et al. Primary Retroperitoneal Neoplasms: CT and MR Imaging Findings with Anatomic and Pathologic Diagnostic Clues. Radiographics. 2003;23:45-57. 12/14/2013 17

HNH NH SIU M

Khi mc treo b dy ln do hch to thnh lp m mm dy. Mch mu bt thuc chy gia 2 lp mc treo dy cho ra du hiu bnh sandwich (sandwich sign). y l du hiu c hiu cho Lymphoma mc treo (Mesenteric Lymphomas), bnh ny c th gy ra tng mng hch ph i nh th m c th cha c triu chng lm sng.

12/14/2013

Seth M. Hardy, MD. The Sandwich Sign. Radiology 2003;226:651-652.

18

HNH NH SIU M

Cc u c tnh khc thng nhanh chng xm ln thnh rut gy thng rut, xut huyt, ch khng to thnh tng mng hch ph i. Cc bnh Vim nhim cng khng to nn tng mng hch ph i nh th.

12/14/2013

Seth M. Hardy, MD. The Sandwich Sign. Radiology 2003;226:651-652.

19

HNH NH SIU M

SANDWICH SIGN

12/14/2013

Seth M. Hardy, MD. The Sandwich Sign. Radiology 2003;226:651-652.

20

12/14/2013

21

12/14/2013

22

HNH NH SIU M

Biu hin Lymphoma ngoi hch in hnh cng c hi m mng, v c th lan truyn trc tip t hch qua cc tng c. iu ny thng thy bnh nhn AIDS-related lymphoma hoc lymphoma bnh nhn suy gim min dch. Biu hin ca hch c tnh khng phi l Lymphoma thng c hi m dy hn v khng ng nht so vi Lymphoma. C th hoi t trung tm hay nang ha (hch vim, hch lao).
C.M.Rumack et al. Diagnostic Ultrasound. 3rdEdition. 2005.p443-482
23

12/14/2013

HNH NH SIU M

HCH DI CN SAU PHC MC

12/14/2013

C.M.Rumack et al. Diagnostic Ultrasound. 3rdEdition. 2005.p443-482

24

HNH NH SIU M

HCH DI CN T TESTICULAR EMBRYONAL CELL CARCINOMA

Marylin J. Siegel et al. Pediatric Sonography. 3rd edition. 2002. p475-523

12/14/2013

25

K NG TIU HA DI CN GAN, LCH, HCH

12/14/2013 26

DN BI

i cng. Cch khm siu m hch. Hnh nh siu m. Nguyn nhn. Cm by.

12/14/2013

27

NGUYN NHN

Hch vim: do vi trng sinh m hay do lao. Hch do phn ng vim: Sarcoidose, Vim gan, Vim ng rut, AIDS. Lymphoma: Non-Hodgkin hay Hodgkin. Hch di cn: Quanh gM thn tng, ty: K d dy, K ty. Quanh rn thn: K thn, K tinh hon. Vng bn: Sarcoma chi di, Squamous cell carcinoma ca m h, K dng vt, K 1/3 di m o, K hu mn.
28

12/14/2013

DN BI

i cng. Cch khm siu m hch. Hnh nh siu m. Nguyn nhn. Cm by.

12/14/2013

29

CM BY

Hch c th lm vi: Nang (nht l Lymphoma). TM, dn TM, phnh gM. Mu t khu tr. Tng sinh hng cu ngoi ty (extramedullary hematopoiesis). Rut (t trng D3). Lch ph.

12/14/2013

30

CM BY

Khc phc: Ct theo nhiu mt phng vi k thut p. Dng Doppler mu. Cnh gic cc cm by khi lm siu m.

12/14/2013

31

TI LIU THAM KHO

C.M.Rumack et al. Diagnostic Ultrasound. 3rdEdition. 2005.p443-482 Marylin J. Siegel et al. Pediatric Sonography. 3rd edition. 2002. p305-323 Mizuki Nishino, MD et al. Primary Retroperitoneal Neoplasms: CT and MR Imaging Findings with Anatomic and Pathologic Diagnostic Clues. Radiographics. 2003;23:45-57. Seth M. Hardy, MD. The Sandwich Sign. Radiology 2003;226:651-652.

12/14/2013

32