tailieunhanh - Nang khe mang

Bệnh nhi: Phạm Huỳnh Thanh Toàn 8 tuổi, trai Địa chỉ: Gò Vấp Bệnh sử: - giỏi. 2006: Nổi cục cổ trước mổ BV NĐ 2. - Mổ BV NĐ 1 2 lần (7/2009) & 11/2009. - Bé chậm phát triển, lùn, nặng 16 kg, trí tuện bình thường, học lớp 2, hạng | NANG KHE MANG BS Lê Văn Tài Trung Tâm Y Khoa MEDIC Trường hợp 1: NANG KHE MANG Bệnh nhân: Dương Thanh Sơn 28 tuổi, nam Địa chỉ: Bình hánh, Phone: 7602716 Lâm sàng: Khối u cổ (T), không sốt, đau nhẹ. Trường hợp 2: DÒ KHE MANG Bệnh nhi: Phạm Huỳnh Thanh Toàn 8 tuổi, trai Địa chỉ: Gò Vấp Bệnh sử: - giỏi. 2006: Nổi cục cổ trước mổ BV NĐ 2. - Mổ BV NĐ 1 2 lần (7/2009) & 11/2009. - Bé chậm phát triển, lùn, nặng 16 kg, trí tuện bình thường, học lớp 2, hạng Bàn luận Type I first branchial cleft cysts appear posterior and inferior to the external auditory canal. Type II first branchial cleft cysts appear near the angle of the mandible or in the anterior triangle of the neck. First branchial cleft cyst, type II. Contrast-enhanced axial computed tomography scan at the level of the hyoid bone reveals an ill-defined, nonenhancing, water attenuation mass (m) posterior to the right submandibular gland (g). Second branchial cleft cysts, by far the most common, appear immediately anterior to the upper third of the sternocleidomastoid muscle. Second branchial cleft cyst. Contrast-enhanced axial computed tomography scan at the level of the hyoid bone reveals a large, well-defined, nonenhancing, water attenuation mass (m) on the anterior border of the left sternocleidomastoid muscle(s). Third branchial cleft cysts lie beneath or posterior to the sternocleidomastoid muscle, within the posterior triangle of the neck. Third branchial cleft cyst. Contrast-enhanced axial computed tomography scan at the level of the thyroid cartilage reveals a large, well-defined, nonenhancing, water attenuation mass (m) deep to the right sternocleidomastoid muscle (s), medially displacing the common carotid artery and internal jugular vein. Fourth branchial cleft cysts, which are exceedingly rare, may be located in the larynx, in the thyroid gland, in the mediastinum, or along the course of the recurrent laryngeal nerve. The diagnosis of branchial cleft cysts is based primarily on the location of the lesion. CT scan findings are usually diagnostic for branchial cleft cysts, but differential considerations include lymphangioma (cystic hygroma, lymphatic malformations), glandular cysts, lymph nodes, ranulas, dermoid cysts, laryngoceles, thyroglossal duct cysts, lipomas, hemangiomas (venous malformations), and paragangliomas Ultrasonography may be used to confirm the cystic nature of a neck mass, but it is not commonly used in North America. Branchial cleft cysts have high signal intensity on T2-weighted images. On T1-weighted images, the signal intensity is usually low, but previous infection can provoke proteinaceous debris that increases the T1 signal intensity. Uninfected branchial cleft cysts should not enhance on MRI. Fluoroscopic fistulography or CT fistulography may be used to delineate the course of a branchial cleft sinus or fistula. This can aid in surgical planning and in predicting potential complications from surgery. Kết luận Cấu trúc dạng nang vùng góc hàm, tam giác cổ trước, cổ bên cần nghĩ tới nang khe mang Khi thấy dò vùng cổ trước nên nghĩ tới dò khe mang thứ tư để điều trị thích hợp. Siêu âm có thể tiếp cận bệnh lý khe mang, trong những trường hợp khó nên kết hợp với CT, MRI.