342例。

IF 12.1 1区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
Radiology Pub Date : 2025-06-01 DOI:10.1148/radiol.243263
Shehbaz Ansari, Brian H Mu, John Findley, Sudeep H Bhabad, Miral D Jhaveri
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引用次数: 0

摘要

病史:70岁女性,2个多月来腰痛逐渐加重,呈放射状分布至下肋骨。起初,疼痛只发生在夜间,但最终开始在白天持续,随着坐下和躺下而恶化。疼痛严重,对扑热息痛和非甾体抗炎药无反应。她报告没有肠道或膀胱问题,没有虚弱、麻木或创伤史。双下肢均无神经根病。她没有发烧,体重减轻,或使用血液稀释剂的历史。她曾吸烟,既往经支气管活检发现肺结节恶性肿瘤或感染阴性。她的一个妹妹被诊断出患有卵巢癌。体格检查生命体征正常;保留了对人、地点和时间的定位;以及完整的短期和长期记忆。她的步态和协调性正常。四肢的肌肉力量被评为5分,感觉完好。深肌腱反射评分为2或更高。未见冠状胬肉,Hoffmann征阴性。在床边进行腰椎穿刺。脑脊液(CSF)分析(表)显示蛋白水平升高(379 mg/dL [3790 mg/L];参考范围:7-35 mg/dL [70-350 mg/L])和轻度降低的葡萄糖水平(41 mg/dL [2.3 mmol/L];参考范围:45-70 mg/dL [2.5-3.9 mmol/L])。脑脊液淋巴细胞计数升高(94个细胞/µL;参考范围,0-10 cells/µL)。脑脊液细胞学检查和流式细胞术显示小淋巴样细胞无免疫表型异常,提示无克隆性增殖。在脑脊液中存在两个寡克隆带(在同期血清样品中不存在),低于寡克隆带阳性的阈值(四个带)。脑脊液培养、巨细胞病毒和eb病毒DNA检测、单纯疱疹病毒1、2和水痘带状疱疹病毒聚合酶链反应检测以及自身免疫性脑病检测均为阴性。血清和脑脊液血管紧张素转换酶水平均在正常范围内。在最初的表现中,脊柱和椎管的成像包括胸椎的未增强CT(图1)和胸椎的增强MRI(图2)。脑部MRI增强扫描(未显示),除了慢性微血管缺血改变外,无明显变化。具体来说,没有发现硬脑膜增厚或颅内增强病变。胸部、腹部和骨盆(未示)增强CT未见明显变化,未见肺结节、原发性恶性肿瘤或淋巴结病变。偶然发现包括肺气肿,可能与患者的吸烟史有关。患者随后接受了T6椎板切除术,并接受糖皮质激素和利妥昔单抗治疗。随访胸椎MRI(图3)于首次就诊后2个月进行。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Case 342.

History: A 70-year-old woman presented with progressively worsening midback pain over 2 months, radiating in a wraparound distribution to the lower ribs. Initially, the pain was confined to the night but eventually began to persist during the day, worsening with sitting and lying down. The pain was severe and unresponsive to paracetamol and nonsteroidal anti-inflammatory drugs. She reported no bowel or bladder issues and no weakness, numbness, or history of trauma. There was no radiculopathy in either lower extremity. She had no fever, weight loss, or history of using blood thinners. She was a former smoker with a prior transbronchial biopsy for a pulmonary nodule that was negative for malignancy or infection. She had a sister diagnosed with ovarian cancer. Physical examination demonstrated normal vital signs; preserved orientation to person, place, and time; and intact short-term and long-term memory. She had normal gait and coordination. Muscle strength was rated five of five for all four extremities, with intact sensation. Deep tendon reflexes were rated two or higher throughout. No clonus was present, and Hoffmann sign was negative. A lumbar puncture was performed at the bedside. Cerebrospinal fluid (CSF) analysis (Table) revealed an increased protein level (379 mg/dL [3790 mg/L]; reference range: 7-35 mg/dL [70-350 mg/L]) and a mildly decreased glucose level (41 mg/dL [2.3 mmol/L]; reference range, 45-70 mg/dL [2.5-3.9 mmol/L]). There was an elevated CSF lymphocyte count (94 cells/µL; reference range, 0-10 cells/µL). CSF cytologic examination and flow cytometry revealed small lymphoid cells without immunophenotypic abnormalities, suggesting an absence of clonal proliferation. Two oligoclonal bands were present in the CSF (absent in the concurrent serum sample), which was below the threshold for oligoclonal band positivity (four bands). CSF culture, DNA tests for cytomegalovirus and Epstein-Barr virus, polymerase chain reaction tests for herpes simplex virus 1 and 2 and varicella-zoster virus, and autoimmune encephalopathy panels were negative. Both serum and CSF angiotensin-converting enzyme levels were within normal limits. At initial presentation, imaging of the spine and spinal canal included unenhanced CT of the thoracic spine (Fig 1) and contrast-enhanced MRI of the thoracic spine (Fig 2). Contrast-enhanced MRI of the brain was also performed (not shown), which was unremarkable aside from chronic microvascular ischemic changes. Specifically, no dural thickening or intracranial enhancing lesion was identified. Contrast-enhanced CT of the chest, abdomen, and pelvis (not shown) was unremarkable, showing no pulmonary nodules, features of primary malignancy, or lymphadenopathy. Incidental findings included emphysema, likely related to the patient's smoking history. The patient subsequently underwent T6 laminectomy followed by treatment with glucocorticoids and rituximab. Follow-up thoracic spine MRI (Fig 3) was performed 2 months after the initial presentation.

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来源期刊
Radiology
Radiology 医学-核医学
CiteScore
35.20
自引率
3.00%
发文量
596
审稿时长
3.6 months
期刊介绍: Published regularly since 1923 by the Radiological Society of North America (RSNA), Radiology has long been recognized as the authoritative reference for the most current, clinically relevant and highest quality research in the field of radiology. Each month the journal publishes approximately 240 pages of peer-reviewed original research, authoritative reviews, well-balanced commentary on significant articles, and expert opinion on new techniques and technologies. Radiology publishes cutting edge and impactful imaging research articles in radiology and medical imaging in order to help improve human health.
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