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Neurology:貌似肺恶性肿瘤的脊柱结核

2018-10-26 zyx整理 神经科病例撷英拾粹

32岁女性,表现为背痛4月。患者还诉有咳嗽,厌食和一些体重下降。其T6-T7椎体有局部压痛。中枢神经系统查体正常。胸部X片可见左下肺叶病变

32岁女性,表现为背痛4月。患者还诉有咳嗽,厌食和一些体重下降。其T6-T7椎体有局部压痛。中枢神经系统查体正常。胸部X片可见左下肺叶病变(图A)。胸部CT和脊柱MRI可见左肺实变,胸腔积液,T6椎体楔形塌陷以及椎旁积液(图B-E)。鉴别诊断包括脊柱结核(Pott病)以及转移性病变。胸膜活检提示结核性肉芽肿病变(图F)。患者接受抗结核药物治疗。1月后,注意到疼痛明显缓解。


(图:A:胸部X片提示左下肺阴影;B-C:胸部CT可见小叶中心结节[树芽征];D-E:MRI可见T6-T7椎体塌陷伴椎旁积液;F:胸膜活检可见结核性肉芽肿伴多核巨细胞,上皮样细胞和干酪样坏死;抗酸杆菌染色阴性;×400)

原始出处:Garg RK, Mehta MM, Jaiswal R, et al. Mystery Case: Spinal tuberculosis masquerading lung malignancy. Neurology. 2018 Sep 25;91(13):632-633. 

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