儿童患者影像学表现

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1、MichaelGaies,HMSIVGillianLieberman,MDJuly2001RadiologicManifestationsofALLinChildhoodMichaelGaies,HarvardMedicalSchoolYearIVGillianLieberman,MDMichaelGaies,HMSIVGillianLieberman,MDOurPatient17year-oldmalewithahistoryofALLinremissionfor10yearspresentswithtactilefevers,mala

2、ise,non-productivecough,SOB•WBC7.1•AllotherlaboratoryvaluesandPFTswereWNL2MichaelGaies,HMSIVGillianLieberman,MDOurPatientPACXRCourtesyofBoston33Children’sHospitalMichaelGaies,HMSIVGillianLieberman,MDRadiologicDiagnosis:MultiplePulmonaryNodules4CourtesyofBostonChildren’sHo

3、spitalMichaelGaies,HMSIVGillianLieberman,MDOurPatientLateralCXR55CourtesyofBostonChildren’sHospitalMichaelGaies,HMSIVGillianLieberman,MDDifferentialDiagnosis:MultiplePulmonaryNoduleswithIll-definedBorders1.Atypicalpneumonia–classicallyreticulonodular2.Fungusdisease3.Infar

4、ct4.Pneumoconiosis5.Tuberculosis6.Lymphoma7.Leukemia6MichaelGaies,HMSIVGillianLieberman,MDALL:ABriefReview•HematologicmalignancyofPre-BorPre-Tcells•Approximately2500newcases/yearincidenceis3-4per100,000inchildren<15yearsold•Clinicalcharacteristicsincludeabruptonsetoffati

5、gue,infection,bleeding,bonepain,and/orCNSsymptoms•Chemotherapycanachieveremissionin90%ofcaseswithcureinapproximately70%ofcases7OurpatienthasahistoryofALLsolet’sreviewtheimagingfindingsfromanumberofotherpatientswithmorecharacteristicabnormalitiesseenwithALL8MichaelGaies,HM

6、SIVGillianLieberman,MDRadiologicManifestationsofALL•Findingsatpresentationvs.relapse•Sitescommonlyinvolvedatpresentation1.Skeleton–mostcommon2.Chest3.Abdominalviscera•Sitescommonlyinvolvedatrelapse1.CNS2.Testes3.Kidney9MichaelGaies,HMSIVGillianLieberman,MDPatient#28year-o

7、ldfemalecametotheEDcomplainingofstomachachesfor1weekandbackpainsinceballetclassthepreviousday.Physicalexamremarkableforleftflankandepigastricpainonstraightlegraise.Abdominalradiographswereordered10MichaelGaies,HMSIVGillianLieberman,MDPatient#2:VertebralOsteoporosisNotethe

8、numerousflattenedlumbarvertebrae1111www.pediatricradiology.comMichaelGaies,HMSIVGillianLieberman