病例来源:AmericanCollegeofRadiology CaseAuthors: MarcoMarangoni,MD;GabrielaAbrego,MD;BruceCurtGilbert,MD A72-year-oldwomanpresentswithrapidlyprogressivehorizontalandverticaldiplopiaaswellaspainintherightforeheadandrightnasalregion 72岁女性,进行性水平及垂直方向复视,进展迅速,伴有右侧前额、鼻部疼痛。 Question 1.Whichofthefollowingarepresentontheseimages?(Checkallthatapply.) 此组图像的可见下列那种表现?(选择全部正确选项) Orbitalapexinvolvement 眶尖部侵犯 Osseoussclerosis 骨质硬化 Mastoidaircelldestruction 乳突气房破坏 Sphenoidsinuscorticaldisruption蝶窦皮质破坏 正确选项:1、3、4 注释: Thelesioninvolvesthelateralwallofthesphenoidsinusextendingintotherightorbitalapex,asdemonstratedbylossofnormalfatattenuationinthislocation. 此病变累及蝶窦外侧壁,侵入右侧眶尖,表现为此处正常脂肪消失。 Thewallsofthebilateralsphenoidsinusesarethickenedandsclerotic,asistheintersphenoidalseptum.Thesphenoidsinusisopacified. 双侧蝶窦壁及间隔增厚、硬化,蝶窦浑浊。 Thereisnoevidenceofadestructiveprocessinvolvingthemastoidaircellsontheprovidedimages. 所示图像并无证据表明乳突气房破坏。 Focalcorticaldisruptionofthelateralwalloftherightsphenoidsinusispresent. 可见右侧蝶窦外侧壁局部骨皮质破坏。 Question 2.BrainMRimagesdemonstratewhichofthefollowing?(Checkallthatapply) 颅脑MR图像的表现包括下列那种?(选择全部正确选项) Sphenoidsinusopacification 蝶窦浑浊 Internalcarotidarteryocclusion 颈内动脉闭塞 Normalpatternofsphenoidsinusmucosalenhancement 蝶窦粘膜正常强化 Unilateralcavernoussinusexpansion 单侧海绵的膨胀 正确选项:1、4 注释: Thecontrast-enhancedT1-weightedimagesshowdiffuselossofnormalaerationofthesphenoidsinuswithintrinsicT1hyperintensesignalandperipheralmucosalenhancement.Thereissomeassociatedleftsphenoidsinusexpansion,consistentwithearlymucocele-likechanges. 对比增强T1WI示蝶窦内气体弥漫缺失,周围粘膜强化,T1像呈高信号,相应左侧蝶窦膨胀,与黏液囊肿早期改变相符。 Thereisnoevidenceofinternalcarotidarteryocclusionintheseimages. 此组图像未见颈内动脉闭塞。 Atthesuperolateralmarginsofthebilateralsphenoidsinuses,thereislossofmucosalenhancementpattern,andnodularsoft-tissuethickeningispresent. 双侧蝶窦侧上方未见粘膜强化,并见结节样软组织增厚。 Asymmetricexpansionoftherightcavernoussinuswithsoft-tissueattenuationandoutwardconvexityofthelateralwalloftherightcavernoussinusareseen. 右侧海绵窦膨胀并见软组织信号,向右侧海绵窦侧壁外侵犯,与左侧不同。 Question 3.Whichofthefollowingsymptomscanbeexplainedbyacavernoussinussyndrome?(Checkallthatapply) 海绵窦综合征可引起下列哪些症状?(选择全部正确选项) Diplopia 复视 Mandibulardeviationwithmouthopening 张口时下颌偏斜 Ptosis 上睑下垂 Foreheadparesthesia 前额感觉异常 Unilateralblindness 单侧盲 正确选项:1、3、4 注释: Inthecavernoussinus,theabducensnerverunslateraltotheinternalcarotidarteryandmedialtotheoculomotorandtrochlearnerves,whicharecontainedwithinthelateralduralborderofthecavernoussinus.Lesionsaffectingthesecranialnervescanpotentiallyresultindiplopia. 海绵窦内外展神经在动眼神经及滑车神经之间,走形于颈内动脉外侧,为海绵窦硬脑膜包裹,当有病变累及这些颅神经时可导致复视。 Thethirddivision(V3)ofthetrigeminalnervesuppliesthemusclesofmastication.ThisbranchofthetrigeminalnerveexitsinferiorlythroughtheforamenovalefromMeckelcaveanddoesnotcoursethroughthecavernoussinus. 三叉神经第三支(V3)支配咀嚼肌,从Meckel腔经卵圆孔出颅,并不经海绵窦走形。 Theoculomotornerveinnervatesthelevatorpalpebraesuperiorismuscleand,whenaffectedbyalesionofthecavernoussinus,canresultinptosis. 动眼神经支配提上睑肌,当海绵窦病变累及时可致上睑下垂。 Theophthalmicnerve(V1),thefirstdivisionofthetrigeminalnerve,runsthroughthelateralduralborderofthecavernoussinusandcarriessensoryinformationfromthescalp,forehead,uppereyelid,conjunctivaandcorneaoftheeye,andnose.Whenaffected,thismayresultinparesthesiasoftheseareas. 三叉神经第一支即眼支(V1),穿行于海绵窦硬脑膜,传递头皮、前额、上眼睑、结膜及角膜、鼻部的感觉信息,当受累及时可导致这些区域感觉异常。 Theopticnerveisnotlocatedinthecavernoussinusandisnotaffectedinacavernoussinussyndrome. 视神经不从海绵窦走形,不受海绵窦综合征的影响。 图片说明: Thisaxialcontrast-enhancedCTofthebraininbonewindowshowscorticaldisruptionofthelateralwalloftherightsphenoidsinus(arrow)withapermeativepatternofbonedestruction. 此骨窗轴位增强颅脑CT示右侧蝶窦外侧壁骨皮质中断(箭),呈穿凿样骨质破坏。 ThisaxialcontrastenhancedCTimagedepictsasymmetricsoft-tissueattenuationwithintherightcavernoussinusandorbitalapex(arrows). 此轴位增强颅脑CT示右侧海绵窦及眶尖软组织密度影(箭),与左侧不对称。 ThisT1coronalpostcontrastMRimageshowshyperintensemucosalenhancementofthesphenoidsinuswithdisruptionoftheenhancementpatternsuperolaterallybyanodularmass(arrow)thatislessintensethanadjacentmucosal. 此冠状位增强T1MR像示蝶窦粘膜强化呈高信号,侧上方可见结节样肿块(箭),强化信号低于临近粘膜。 ThisT1coronalpostcontrastimageshowshyperintensemucosalenhancementofthesphenoidsinus.Thereisdiffusemass-likeinfiltrationintotherightcavernoussinuswithsinusexpansionandconvexityofthelateralwall(arrow). 此冠状位增强T1WI示蝶窦粘膜强化呈高信号,右侧海绵窦膨胀,并见弥漫肿块样病变侵入海绵窦及其外侧壁(箭)。 ThisnonenhancedT1MRimageinthecoronalplaneshowsasymmetricT1isointensesignalandexpansionoftherightcavernoussinussecondarytoanintracavernousmass(arrow). 此T1WI冠状位平扫MR像示右侧海绵窦肿块(箭)呈等信号,致海绵窦膨胀,与左侧海绵窦不对称。 ThisT2coronalimagedemonstratesthattheT2signaloftherightcavernoussinuslesionisisointensetograymatter.Themassencasesthecavernoussegmentoftherightinternalcarotidarterywithoutapparentluminalnarrowing(arrow). 此T2WI示右侧海绵窦病变与脑灰质呈等信号,此肿块包绕右侧颈内动脉海绵窦段,而管腔无明显狭窄(箭)。 ThisT2axialimageshowshyperintensematerialoccupyingthesphenoidsinusandhypointenseirregularlesionsalongthelateralwallofthesphenoidsinus,extendingtotheposteriorethmoidcells(arrowhead).Thelesionextendstotheorbitalapex(arrow).Thereisexpansionoftheipsilateralcavernoussinusrelatedtothelesion. 此T2轴位像示蝶窦高信号病变,沿海绵窦外侧壁见不规则低信号病变,并侵入筛窦后部蜂房(箭头)及眶尖(箭),病变导致同侧海绵窦膨胀改变。 Diagnosis Bilateralnon-Hodgkinlymphomaofthesphenoidsinuswithextensionintotherightcavernoussinusandorbitalapex双侧蝶窦非何杰金氏病淋巴瘤累及右侧海绵窦及眶尖 CasePoints Lymphomaisanun北京白癜风医院新疆治疗白癜风的医院
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