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患者男,16岁。因腹胀、腹痛并腹部包块一个多月就诊。患者慢性病容,被动体位(端坐呼吸),平卧时腹部有压迫感致呼吸困难。查体:全身皮肤、巩膜无黄染,浅表淋巴结无肿大,心肺正常,肝脾触诊不满意。腹部隆起,呈蛙状腹,腹壁静脉无怒张,未见胃型及肠蠕动,腹式呼吸消失;腹肌软,全腹轻压痛,无反跳痛,腹部叩诊无移动性浊音、肠呜音存在。自剑突下至耻骨联合上可触及巨大腹部肿物约20.0cm×15.0cm,表面光滑,质中,无活动,边缘尚清。化验检查:白细胞:7.1×10~9/L,中性粒:60％,淋巴细胞:40％。患者否认以往有类似腹痛发作史,无外伤、手术史。 B超检查:用SAL—38A型复合超声诊断仪,探头频率3.5MHz,所见:肝胆脾肾未见异常,自剑突下至耻骨联合上2.0cm可探及一22.3cm×20.8cm的多房性囊性包块,包膜完整,内可见网络状的强光带将囊腔分隔成无数个大小不等、形态不一的无回声暗区,内透声尚好,远侧增强效应明显,探头加压囊腔内未见液体流动。B超诊断:腹腔巨大囊性多房性包块(考虑来自肠系膜,良性肿瘤可能性大)。CT诊断:腹腔巨大良性囊性占位性病变考虑来自肠系膜。
Male patient, 16 years old. Due to abdominal distension, abdominal pain and abdominal mass for more than a month. The patient’s chronic disease, passive posture (end-breathing breathing), abdominal oppression caused by breathing difficulties. Physical examination: The body skin and sclera were not yellow-stained, superficial lymph nodes were not swollen, heart and lung were normal, and palpation of liver and spleen was not satisfactory. The abdomen bulges in abdomen, showing a froglike abdomen. There is no engorgement in the abdominal wall veins. There is no gastric and peristaltic movements. Abdominal breathing disappears. The abdominal muscles are soft, the whole abdomen is light and tender, and there is no rebound tenderness. Abdominal palpation is without moving dullness and intestinal palsy. The sound exists. From the xiphoid to the pubic symphysis can reach a large abdominal mass about 20.0cm × 15.0cm, smooth surface, quality, no activity, the edge is still clear. Laboratory tests: White blood cells: 7.1 x 10-9/L, neutrophils: 60%, lymphocytes: 40%. The patient denied that there had been a history of similar episodes of abdominal pain and no history of trauma or surgery. B-ultrasonic examination: SAL-38A-type ultrasonic diagnostic apparatus, probe frequency of 3.5MHz, seen: no abnormal liver, spleen and kidney, from the xiphoid down to the pubic symphysis 2.0cm can be detected and a 22.3cm × 20.8cm Atrial cystic mass, complete envelope, network-like strong light band is seen within the cyst space is divided into numerous non-echo dark areas of varying sizes and shapes, the internal sound is still good, the distal enhancement effect is obvious, There is no liquid flow in the pressure chamber of the probe. B-diagnosis: large cystic multi-atrial masses in the abdominal cavity (considered from the mesentery, benign tumors are more likely). CT diagnosis: Abdominal cavity with a large benign cystic lesion is considered from the mesentery.