医学影像英文读片病例分析.pptx

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1、Casereport2013-07Case1A15-year-oldgirlpresentedwithrecurrentepistaxisandbilateralprogressivenasalobstructionof9monthsduration.Epistaxiswassevereandrequiredanteriornasalpackingononeoccasion.Onrhinoscopy,thenasalcavitywascrowdedwiththickeningofthenasalseptumandinferior

2、turbinatesonbothsides.Figure1(A-C):A15-year-oldfemalewithrecurrentepistaxisandnasalobstruction.MRIT2Waxialandcoronal(A,B)imagesrevealedT2-hypointensesofttissuethickening(arrowsinA,B)involvingthenasalseptumandrightlateralnasalwall,withextensionintotherightmaxillarysin

3、us(arrowinB).Post-contrastT1Waxialimage(C)revealedheterogeneousenhancementoflesion(arrow)withcentralhypoenhancingregions.BiopsywithimmunohistochemistryoflesionandraisedserumIgG4levelsconfirmedthediagnosisofIgG4-relateddiseaseParotid,pituitary,lacrimal,andsubmandibula

4、rglandswerenormal.SerumIgG4levelswereraised(206mg/dl;95thpercentilerange=6-112mg/dl).Endoscopicexaminationwasdoneundergeneralanesthesiawhichconfirmedtheimagingfindings.HistopathologyshoweddensefibrosiswithlymphoplasmocyticinfiltrateandimmunohistochemistryrevealedIgG4

5、plasmacellsconstituting50%ofIgGplasmacells,confirmingthediagnosisofIgG4-RD.Case2A15-year-oldgirlpresentedwithrecurrentright-sidedbloodstainednasaldischargeof7yearsdurationandright-sidedfacialswellingwithdifficultyinopeninghermouthfor3months.Shealsocomplainedofintermi

6、ttentabdominalpain.Onclinicalexamination,shehadasaddlenosedeformitywithathickenedseptum.Mildrighteyeproptosiswasalsonoted,buthervisualacuitywasnormal.Figure2(A-E):MRIT2WandT1high-resolutionisotropicvolumeexamination(THRIVE)coronalimages(A,B)showedT2-hypointense(arrow

7、inA),T1-isointense(arrowinB)sheet-likesofttissuethickeningextendingalongtherightlateralnasalwall,nasalseptum,andrightmaxillarysinus.Post-contrastT1Wcoronalimage(C)showedhomogenouscontrastenhancement(arrow).T2Wcoronalimage(D)showedsofttissueextensionintotherightcavern

8、oussinus(arrow).Onfollow-upMRIimagingafter4months,T2Wcoronalimage(E)showedincreaseinsofttissuethickeninginrightcavernoussinuswithna