Baidu
map

弥漫性淋巴管瘤病合并后胡桃夹综合征1例

2019-05-15 刘国红 卞光利 彭爱琴 医学影像学杂志

患者女,26岁。已婚,因“发现附件包块4天”于2016年12月19日入院。患者5~6天前出现下腹隐痛不适,4天前查B超发现左侧附件囊肿。平素月经规则,14岁4~5天/30天,量中,无痛经。末次月经2016年11月26日。3年前行破宫产术,自述术中因左侧附件血管扩张致大出血。1年前及10天前分别因黄体破裂住院保守治疗,均好转出院。既往自幼左下肢有“血丝虫橡皮肿”病史,逐年增粗、变硬,不痛不痒,未行治

患者女,26岁。已婚,因“发现附件包块4天”于2016年12月19日入院。患者5~6天前出现下腹隐痛不适,4天前查B超发现左侧附件囊肿。平素月经规则,14岁4~5天/30天,量中,无痛经。末次月经2016年11月26日。3年前行破宫产术,自述术中因左侧附件血管扩张致大出血。1年前及10天前分别因黄体破裂住院保守治疗,均好转出院。既往自幼左下肢有“血丝虫橡皮肿”病史,逐年增粗、变硬,不痛不痒,未行治疗。
 
查体:一般情况可,腹平坦,下腹见一长约10 cm的陈旧性疤痕。左附件区轻压痛。下腹壁、会阴处及左下肢明显肿胀,表面凹凸不平呈紫色,边界不清,中等硬度,无压痛,皮温正常,肢体运动、感觉正常,末梢血循环好。
 
实验室检查:血红蛋白92g/L,尿常规及肾功能正常。全腹部CT平扫+增强:后纵隔、腹膜后、盆腔腹膜外间隙及下腹壁、会阴部、左臀部、左下肢深浅间隙见弥漫性囊状、海绵状低密度影,部分见有囊壁及分隔,CT值约7~21HU,增强后囊壁及分隔轻度强化,病灶累及左半身为著(图1,2)。病变区的腰骶椎椎体及左侧椎板、左侧髂骨及坐骨、左侧股骨近端骨质见多发大小不等的低密度区,边界清楚,部分病灶边缘骨质轻度硬化,增强扫描病灶均未见强化(图3)。左侧附件见大小约6.7 cm×3.1 cm的不规则肿块,密度不均,呈囊实性,实性部分大小约3.4 cm×1.8 cm,CT值约74HU,增强后无强化,囊性部分大小约4.1 cm×2.0 cm,增强后无强化(图4,5)。增强静脉期见左肾静脉分前后2支,前支在左肾上极平面经肠系膜上动脉与腹主动脉间汇入下腔静脉,其夹角处前后径约0.8 cm(图6),后支在左肾门平面经腹主动脉与脊柱间隙汇入下腔静脉,其腹主动脉后段受压变窄,狭窄处前后径约0.2 cm,左肾静脉近肾端扩张,其最宽处前后径约1.2 cm(图7),左侧卵巢静脉扩张,附件周围见广泛侧支血管(图8)。肝脏、脾脏、胰腺、双肾大小、形态、密度未见明显异常。腹盆腔未见积液征。
 


图1,2 分别为全腹部增强静脉期冠状位及矢状位重建,后纵隔、腹膜后、盆腔腹膜外间隙及下腹壁、会阴部、左臀部、左下肢深浅间隙弥漫性囊状、海绵状低密度灶,增强后部分病灶囊壁及分隔轻度强化,病灶累及左半身为著;图3 全腹部骨窗冠状位骨窗重建腰骶椎椎体及左侧椎板、左侧髂骨及坐骨骨质多发大小不等的低密度区,病灶边缘骨质硬化;图4,5 分别为附件平面平扫及增强静脉期左侧附件高密度肿块,增强后无强化(短箭),附件周围见广泛侧支血管显影(长箭);图6 肾平面增强静脉期左肾静脉前支经肠系膜上动脉与腹主动脉间汇入下腔静脉;图7 左肾静脉后支经腹主动脉与脊柱间隙汇入下腔静脉,其腹主动脉后段受压变窄,近肾端扩张;图8 全腹部增强静脉期冠状位MIP重建全貌显示左肾静脉前支(短箭)、后支(长箭)与腹主动脉的空间关系,后支狭窄部位及扩张的近肾端和左侧卵巢静脉(箭头)
 
讨论:
 
1)弥漫性淋巴管瘤病(disseminated lymphangiomatosis,DL)是一种起源于淋巴系统的罕见病变,以淋巴管瘤弥漫或者多灶分布为特征,可广泛累及软组织、内脏、腹膜后、骨骼等部位。DL病因尚不明确,认为与原发性淋巴管发育不良伴淋巴管增生有关,好发于儿童和20岁以下的青少年,预后不良。
 
DL的CT表现:复习相关文献及结合本例的影像资料,对DL的CT表现归纳如下:
 
①累及腹部脏器病变,如脾脏、肝脏等,表现为实质内单发或多发液性低密度灶,边界清楚,一般无钙化,多发病灶呈“葡萄”外观,较大病灶可见分叶及分隔,囊壁薄、规则,增强扫描囊内无强化,囊壁及分隔可见强化;
 
②累及腹部脏器外及纵隔病变,如肠系膜、腹膜后、躯干、四肢及皮下等,表现为相应部分圆形、类圆形、不规则形大小不等的囊状均匀水样低密度影,囊内可见分隔或呈“蜂窝”状,当含有乳糜液时,CT值可低于水,如合并出血和感染,囊内密度可增高,囊壁增厚,由于腹膜后、四肢及皮下间隙疏松,以及淋巴系统走行关系,病灶弥漫及较大时常沿组织间隙生长分布,累及四肢及皮下病变常造成肢体增粗,皮肤增厚,具有特征性CT改变;
 
③累及骨骼病变,可发生全身任何骨骼,病灶呈多发或弥漫性分布,通常表现为单囊或多囊溶骨性破坏,边界一般较清楚,部分病灶边缘硬化,较大病灶囊内呈液性低密度,增强扫描无强化,椎体及骨干病变可合并病理性骨折。本例病变累及后纵隔、腹膜后、盆腔腹膜外间隙及下腹壁、会阴部、左臀部、左下肢深浅间隙,弥漫性分布,左侧躯干及左下肢增粗,同时累及腰骶椎椎体及左侧附件、左侧髂骨及坐骨、左侧股骨近端,邻近软组织同时受累,具有特征性。直接淋巴管造影是淋巴管异常诊断的金标准,造影后的CT可显示腹腔脏器、腹膜后、皮下及骨骼病变区淋巴管极度扩张、迂曲,结构紊乱,部分淋巴管对比剂异常淤积,对DL与其他肿瘤的鉴别有极高价值。
 
2)胡桃夹综合征(nutc racker syndrome,NCS)是腹部血管解剖变异导致左肾静脉在穿过肠系膜上动脉与腹主动脉的夹角时受压,出现腰痛、血尿、蛋白尿、侧支静脉曲张等临床症状。临床依据受压左肾静脉走行于腹主动脉前后方的不同解剖特点,将NCS分为前胡桃夹综合征与后胡桃夹综合征。
 
后胡桃夹综合征罕见,发生率0.5%~3.7%,国内两种分型:左肾静脉走行于腹主动脉后方,并汇入下腔静脉;环形左肾静脉,即左肾静脉分两支,分别位于腹主动脉前后方。本例属于后型。后胡桃夹综合征的CT表现:复习相关文献及结合本例的影像资料,对后胡桃夹综合征的CT表现归纳如下:通过MSCT及后处理技术显示肠系膜上动脉与腹主动脉间隙和腹主动脉与脊柱间隙的空间关系,可见该处间隙的左肾静脉受压变形、狭窄,肾门段增粗、扩张,汇入左肾静脉的静脉,如左侧精索静脉、左侧卵巢静脉扩张。
 
本例前支肾静脉在左肾上极平面经肠系膜上动脉与腹主动脉间汇入下腔静脉,此处间隙较大,通过的前支肾静脉无受压变窄。后支肾静脉在左肾门平面经腹主动脉与脊柱间隙汇入下腔静脉,此处间隙狭小,通过的后支肾静脉受压变窄,肾门段静脉扩张,汇入后支肾静脉的左侧卵巢静脉扩张。本次患者经前1周左右出现下腹痛,CT表现左侧卵巢增大合并不强化的血肿形成,符合黄体破裂出血,既往有多次黄体破裂出血住院病史,笔者认为是NCS左侧卵巢静脉压力增高导致反复黄体破裂出血加重。提醒临床,当反复出现左侧黄体破裂出血时,应想到NCS左侧卵巢静脉曲张所致可能。本例左肾静脉分前后2支,前支肾静脉通畅,后支肾静脉受压、变窄,但整体左肾静脉血回流未受影响,因此,临床尿常规未出现血尿、蛋白尿。
 
3)DL是原发性淋巴管先天性发育不良伴淋巴管增生所致。后胡桃夹综合征是腹部血管解剖变异导致左肾静脉在穿过腹主动脉与脊柱间隙处受压,出现腰痛、血尿、蛋白尿、侧支静脉曲张等临床症状。两者均为脉管类发育异常,合并存在,实属罕见。是否有关联性,有待今后更多病例进一步证实。
 
原始出处:

刘国红,卞光利,彭爱琴,袁昌贵.弥漫性淋巴管瘤病合并后胡桃夹综合征1例[J].医学影像学杂志,2018,28(03):515-516.

版权声明:
本网站所有内容来源注明为“梅斯医学”或“MedSci原创”的文字、图片和音视频资料,版权均属于梅斯医学所有。非经授权,任何媒体、网站或个人不得转载,授权转载时须注明来源为“梅斯医学”。其它来源的文章系转载文章,或“梅斯号”自媒体发布的文章,仅系出于传递更多信息之目的,本站仅负责审核内容合规,其内容不代表本站立场,本站不负责内容的准确性和版权。如果存在侵权、或不希望被转载的媒体或个人可与我们联系,我们将立即进行删除处理。
在此留言
评论区 (5)
#插入话题
  1. [GetPortalCommentsPageByObjectIdResponse(id=366653, encodeId=c86f366653d4, content=谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=193b2402424, createdName=123592b0m72暂无昵称, createdTime=Thu May 23 13:01:21 CST 2019, time=2019-05-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2005128, encodeId=4adb200512805, content=<a href='/topic/show?id=413a6598082' target=_blank style='color:#2F92EE;'>#淋巴管瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65980, encryptionId=413a6598082, topicName=淋巴管瘤)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5494471, createdName=HNYYM, createdTime=Wed Aug 07 00:47:00 CST 2019, time=2019-08-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1431524, encodeId=d34f1431524ae, content=<a href='/topic/show?id=f9b9e9124a8' target=_blank style='color:#2F92EE;'>#综合征#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79124, encryptionId=f9b9e9124a8, topicName=综合征)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Thu May 16 23:47:00 CST 2019, time=2019-05-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1438611, encodeId=19351438611e9, content=<a href='/topic/show?id=9851500416c' target=_blank style='color:#2F92EE;'>#弥漫性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=50041, encryptionId=9851500416c, topicName=弥漫性)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Thu May 16 23:47:00 CST 2019, time=2019-05-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1529372, encodeId=223215293e21d, content=<a href='/topic/show?id=4735659e3cf' target=_blank style='color:#2F92EE;'>#淋巴管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65973, encryptionId=4735659e3cf, topicName=淋巴管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ee7311933759, createdName=amyloid, createdTime=Thu May 16 23:47:00 CST 2019, time=2019-05-16, status=1, ipAttribution=)]
    2019-05-23 123592b0m72暂无昵称

    谢谢分享

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=366653, encodeId=c86f366653d4, content=谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=193b2402424, createdName=123592b0m72暂无昵称, createdTime=Thu May 23 13:01:21 CST 2019, time=2019-05-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2005128, encodeId=4adb200512805, content=<a href='/topic/show?id=413a6598082' target=_blank style='color:#2F92EE;'>#淋巴管瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65980, encryptionId=413a6598082, topicName=淋巴管瘤)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5494471, createdName=HNYYM, createdTime=Wed Aug 07 00:47:00 CST 2019, time=2019-08-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1431524, encodeId=d34f1431524ae, content=<a href='/topic/show?id=f9b9e9124a8' target=_blank style='color:#2F92EE;'>#综合征#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79124, encryptionId=f9b9e9124a8, topicName=综合征)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Thu May 16 23:47:00 CST 2019, time=2019-05-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1438611, encodeId=19351438611e9, content=<a href='/topic/show?id=9851500416c' target=_blank style='color:#2F92EE;'>#弥漫性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=50041, encryptionId=9851500416c, topicName=弥漫性)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Thu May 16 23:47:00 CST 2019, time=2019-05-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1529372, encodeId=223215293e21d, content=<a href='/topic/show?id=4735659e3cf' target=_blank style='color:#2F92EE;'>#淋巴管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65973, encryptionId=4735659e3cf, topicName=淋巴管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ee7311933759, createdName=amyloid, createdTime=Thu May 16 23:47:00 CST 2019, time=2019-05-16, status=1, ipAttribution=)]
  3. [GetPortalCommentsPageByObjectIdResponse(id=366653, encodeId=c86f366653d4, content=谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=193b2402424, createdName=123592b0m72暂无昵称, createdTime=Thu May 23 13:01:21 CST 2019, time=2019-05-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2005128, encodeId=4adb200512805, content=<a href='/topic/show?id=413a6598082' target=_blank style='color:#2F92EE;'>#淋巴管瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65980, encryptionId=413a6598082, topicName=淋巴管瘤)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5494471, createdName=HNYYM, createdTime=Wed Aug 07 00:47:00 CST 2019, time=2019-08-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1431524, encodeId=d34f1431524ae, content=<a href='/topic/show?id=f9b9e9124a8' target=_blank style='color:#2F92EE;'>#综合征#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79124, encryptionId=f9b9e9124a8, topicName=综合征)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Thu May 16 23:47:00 CST 2019, time=2019-05-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1438611, encodeId=19351438611e9, content=<a href='/topic/show?id=9851500416c' target=_blank style='color:#2F92EE;'>#弥漫性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=50041, encryptionId=9851500416c, topicName=弥漫性)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Thu May 16 23:47:00 CST 2019, time=2019-05-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1529372, encodeId=223215293e21d, content=<a href='/topic/show?id=4735659e3cf' target=_blank style='color:#2F92EE;'>#淋巴管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65973, encryptionId=4735659e3cf, topicName=淋巴管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ee7311933759, createdName=amyloid, createdTime=Thu May 16 23:47:00 CST 2019, time=2019-05-16, status=1, ipAttribution=)]
  4. [GetPortalCommentsPageByObjectIdResponse(id=366653, encodeId=c86f366653d4, content=谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=193b2402424, createdName=123592b0m72暂无昵称, createdTime=Thu May 23 13:01:21 CST 2019, time=2019-05-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2005128, encodeId=4adb200512805, content=<a href='/topic/show?id=413a6598082' target=_blank style='color:#2F92EE;'>#淋巴管瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65980, encryptionId=413a6598082, topicName=淋巴管瘤)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5494471, createdName=HNYYM, createdTime=Wed Aug 07 00:47:00 CST 2019, time=2019-08-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1431524, encodeId=d34f1431524ae, content=<a href='/topic/show?id=f9b9e9124a8' target=_blank style='color:#2F92EE;'>#综合征#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79124, encryptionId=f9b9e9124a8, topicName=综合征)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Thu May 16 23:47:00 CST 2019, time=2019-05-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1438611, encodeId=19351438611e9, content=<a href='/topic/show?id=9851500416c' target=_blank style='color:#2F92EE;'>#弥漫性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=50041, encryptionId=9851500416c, topicName=弥漫性)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Thu May 16 23:47:00 CST 2019, time=2019-05-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1529372, encodeId=223215293e21d, content=<a href='/topic/show?id=4735659e3cf' target=_blank style='color:#2F92EE;'>#淋巴管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65973, encryptionId=4735659e3cf, topicName=淋巴管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ee7311933759, createdName=amyloid, createdTime=Thu May 16 23:47:00 CST 2019, time=2019-05-16, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=366653, encodeId=c86f366653d4, content=谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=193b2402424, createdName=123592b0m72暂无昵称, createdTime=Thu May 23 13:01:21 CST 2019, time=2019-05-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2005128, encodeId=4adb200512805, content=<a href='/topic/show?id=413a6598082' target=_blank style='color:#2F92EE;'>#淋巴管瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65980, encryptionId=413a6598082, topicName=淋巴管瘤)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5494471, createdName=HNYYM, createdTime=Wed Aug 07 00:47:00 CST 2019, time=2019-08-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1431524, encodeId=d34f1431524ae, content=<a href='/topic/show?id=f9b9e9124a8' target=_blank style='color:#2F92EE;'>#综合征#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79124, encryptionId=f9b9e9124a8, topicName=综合征)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Thu May 16 23:47:00 CST 2019, time=2019-05-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1438611, encodeId=19351438611e9, content=<a href='/topic/show?id=9851500416c' target=_blank style='color:#2F92EE;'>#弥漫性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=50041, encryptionId=9851500416c, topicName=弥漫性)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Thu May 16 23:47:00 CST 2019, time=2019-05-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1529372, encodeId=223215293e21d, content=<a href='/topic/show?id=4735659e3cf' target=_blank style='color:#2F92EE;'>#淋巴管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65973, encryptionId=4735659e3cf, topicName=淋巴管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ee7311933759, createdName=amyloid, createdTime=Thu May 16 23:47:00 CST 2019, time=2019-05-16, status=1, ipAttribution=)]
    2019-05-16 amyloid

相关资讯

腰椎管狭窄症合并左骶髂关节弥漫性大B细胞淋巴瘤1例

腰椎退变性疾病合并骶部或盆腔肿瘤时,因两者临床表现有很大的相似、重叠性,易误诊、漏诊。脊柱淋巴瘤多数为转移瘤,也可表现为原发性病变。原发于骨的淋巴瘤较少,约占非霍奇金淋巴瘤21.8%。我院收治1例腰椎管狭窄症合并左侧骶髂关节弥漫性大B细胞淋巴瘤患者,现报道如下。

9种弥漫性肺泡实变影像的鉴别诊断

引起X线上肺密度增高的疾病不同程度地累及肺脏的实质和间质。。。。

Lancet Haematol:R-GemOx一线治疗弥漫性大B细胞淋巴瘤老年患者怎么样?

2018年6月,中国学者在《Lancet Haematol》发表一项单组、开放性2期试验,考察了吉西他滨-奥沙利铂+利妥昔单抗(R-GemOx)作为弥漫性大B细胞淋巴瘤老年患者一线治疗的有效性、安全性和可行性。

儿童弥漫性肺淋巴管瘤病1例

患儿男, 5岁,因“反复咳嗽气促1年余,间断 咯血1个月,发热3d”于2015-11-02入院。患儿于入院前1年无明显诱因下出现阵发性单声咳嗽,活动后有气喘,无发热,当地医院查胸部CT示心包积液,肺部大片状毛玻璃影改变;予抗感染治疗 (具体不详)后,患儿咳嗽好转,心包积液减少。入院前1个月患儿出现咯血,痰中带血丝, 2~3次/d; 胸部增强CT示两肺门成蝴蝶样实变影,纵隔、肺 门淋巴结肿大;行颈部

原发性子宫及双侧附件弥漫性大B细胞淋巴瘤1例

患者,71岁,因间断性心悸21天,黑嚎10余天于2017年 7月20日在河北医科大学第二医院心内科就诊,行全腹CT检 查发现盆腔肿物。入院查体:生命体征平稳,一股隋况尚可,浅 表淋巴结未触及肿大,腹软,心肝脾肺肾检查未见明显异常。 妇科查体:老年外阴,阴道通畅,官颈萎缩,子宫体前位,稍大, 质中,活动欠佳,表面光滑,无压痛,双侧附件区均可触及一大小约5 am×5 cm x5 cm包块,边界不清,无

椎间孔镜术后弥漫性腹膜后血肿1例

近年来,临床上广泛应用经皮椎间孔镜技术(PELD)治疗腰椎间盘突出症,并取得良好的效果。其创伤小,出血少,恢复快,病人满意度高。血肿形成是PELD术后罕见的并发症,目前国内外关于血肿形成的报道大多行保守治疗,本文报道1例高龄腰椎神经根管狭窄患者行PELD手术,术后发生弥漫性腹膜后血肿并行二次血肿清除术。

Baidu
map
Baidu
map
Baidu
map