來源：jxradiology

上次我們醫(yī)影發(fā)了一篇椎管內積氣的文章，超過1萬人學習，點擊查看——漏診誤診27期—椎管內積氣，一個易被忽視的影像！

如果在頸腰椎CT片，看到椎骨里的氣體密度影，你會考慮什么？相信很多同行朋友會有此類困惑。今天醫(yī)影帶大家一起學習下該病。

影像資料

Vertebral pneumatocysts refer to the presence of air filled cavity within the vertebrae, more prevalent on the cervical spine. Intraosseous pneumatocysts are more common adjacent to the sacroiliac joint while it is rare in the vertebral column. Other causes of vertebral air e.g. Kummel disease, osteomyelitis, post surgery and necrotic tumor should be excluded.

椎體含氣囊腫是指椎體內存在含氣的空腔，常見于頸椎。骨內含氣囊腫在骶髂關節(jié)附近更常見，而在脊柱中罕見。應排除其它導致椎體積氣的病因：Kummel病，骨髓炎，手術后和壞死性腫瘤。

Pathogenesis

Although not completely understood, some authors believe it is an extension from the intradiscal air (vacuum phenomenon) . On follow up of these lesions they changed to fluid filled cavities and became granulation tissue later on . Some of these lesions enlarged in size .

盡管病因尚不明，一些作者認為它是椎間盤內空氣的擴展（真空現象）。隨訪發(fā)現這些病灶開始變?yōu)槌錆M液體的囊腔，隨后變成肉芽組織。有些病灶會增大。

Radiographic features

Plain radiograph

Difficult to detect but sometimes air lucencies are seen within the vertebral bodies.

CT

Considered the best method of diagnosis. Air measures about -800 to -1000 HU in density. Detection of associated intradiscal air and communication between the vertebral and intradiscal gas can be demonstrated. Also epidural extension can be easily detected.

MRI

Air appears as low signal on both T1 and T2 which confuses with sclerotic lesions so CT is pathognomonic.

Treatment and prognosis

Follow up to detect any increase in the size but no specific treatment.

隨訪發(fā)現一些病灶會增大，但不需要特別治療。

Differential diagnosis

Sclerotic lesions e.g. metastasis, Kummel disease, vertebral osteomyelitis, post surgery and tumour with necrosis.

總結：椎體內含氣非常罕見，國內外報道均鮮有報道。

兩種類型：1、患者年齡較輕，表現為小圓形病灶，無椎體退變；

2、年齡較大，病灶也較大，有椎體退變。

Hall等隨訪4年的髂骨含氣囊腫逐漸增大；有學者隨訪6個月-2年未發(fā)生變化；也有報道發(fā)現1-16個月后，自發(fā)轉變?yōu)橐盒阅夷[，后變?yōu)檐浗M織密度（可能為含氣囊腫與周圍骨髓存在壓力差時，導致氣體擴散及液體積聚，之后囊樣結構可被肉芽組織取代）。

總之，頸椎骨內含氣囊腫為良性病灶，不需要特別治療。