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这世界，你最珍贵~2017.01.11晴小房子.目录CONTENTS简要病史图片说明CasePoint010305QuestionDiagnosisDiscussion020406复视！！??→诊断→总结要点•A72-year-oldwomanpresentswithrapidlyprogressivehorizontalandverticaldiplopiaaswellaspainintherightforeheadandrightnasalregion【简要病史】72岁女性，进行性水平及垂直方向复视，进展迅速，伴有右侧前额、鼻部疼痛。Question:No.1Whichofthefollowingarepresentontheseimages?(Checkallthatapply.)此组图像的可见下列那种表现？（选择全部正确选项）A.Orbitalapexinvolvement眶尖部侵犯B.Osseoussclerosis骨质硬化C.Mastoidaircelldestruction乳突气房破坏D.Sphenoidsinuscorticaldisruption蝶窦皮质破坏正确选项：A.C.D•注释：•Thelesioninvolvesthelateralwallofthesphenoidsinusextendingintotherightorbitalapex,asdemonstratedbylossofnormalfatattenuationinthislocation.•此病变累及蝶窦外侧壁，侵入右侧眶尖，表现为此处正常脂肪消失。•Thewallsofthebilateralsphenoidsinusesarethickenedandsclerotic,asistheintersphenoidalseptum.Thesphenoidsinusisopacified.•双侧蝶窦壁及间隔增厚、硬化，蝶窦浑浊。•注释：•Thereisnoevidenceofadestructiveprocessinvolvingthemastoidaircellsontheprovidedimages.•所示图像并无证据表明乳突气房破坏。•Focalcorticaldisruptionofthelateralwalloftherightsphenoidsinusispresent.•可见右侧蝶窦外侧壁局部骨皮质破坏。•Question:No.2•BrainMRimagesdemonstratewhichofthefollowing?(Checkallthatapply)颅脑MR图像的表现包括下列那种？（选择全部正确选项）A.Sphenoidsinusopacification蝶窦浑浊B.Internalcarotidarteryocclusion颈内动脉闭塞C.Normalpatternofsphenoidsinusmucosalenhancement蝶窦粘膜正常强化D.Unilateralcavernoussinusexpansion单侧海绵的膨胀正确选项：A.D•注释：•Thecontrast-enhancedT1-weightedimagesshowdiffuselossofnormalaerationofthesphenoidsinuswithintrinsicT1hyperintensesignalandperipheralmucosalenhancement.Thereissomeassociatedleftsphenoidsinusexpansion,consistentwithearlymucocele-likechanges.•对比增强T1WI示蝶窦内气体弥漫缺失，周围粘膜强化，T1像呈高信号，相应左侧蝶窦膨胀，与黏液囊肿早期改变相符。•Thereisnoevidenceofinternalcarotidarteryocclusionintheseimages.•此组图像未见颈内动脉闭塞。•注释：•Atthesuperolateralmarginsofthebilateralsphenoidsinuses,thereislossofmucosalenhancementpattern,andnodularsoft-tissuethickeningispresent.•双侧蝶窦侧上方未见粘膜强化，并见结节样软组织增厚。•Asymmetricexpansionoftherightcavernoussinuswithsoft-tissueattenuationandoutwardconvexityofthelateralwalloftherightcavernoussinusareseen.•右侧海绵窦膨胀并见软组织信号，向右侧海绵窦侧壁外侵犯，与左侧不同。•Thisaxialcontrast-enhancedCTofthebraininbonewindowshowscorticaldisruptionofthelateralwalloftherightsphenoidsinus(arrow)withapermeativepatternofbonedestruction.•此骨窗轴位增强颅脑CT示右侧蝶窦外侧壁骨皮质中断（箭），呈穿凿样骨质破坏。•ThisaxialcontrastenhancedCTimagedepictsasymmetricsoft-tissueattenuationwithintherightcavernoussinusandorbitalapex(arrows).•此轴位增强颅脑CT示右侧海绵窦及眶尖软组织密度影（箭），与左侧不对称。•ThisT1coronalpostcontrastMRimageshowshyperintensemucosalenhancementofthesphenoidsinuswithdisruptionoftheenhancementpatternsuperolaterallybyanodularmass(arrow)thatislessintensethanadjacentmucosal.•此冠状位增强T1MR像示蝶窦粘膜强化呈高信号，侧上方可见结节样肿块（箭），强化信号低于临近粘膜。•ThisT1coronalpostcontrastimageshowshyperintensemucosalenhancementofthesphenoidsinus.Thereisdiffusemass-likeinfiltrationintotherightcavernoussinuswithsinusexpansionandconvexityofthelateralwall(arrow).•此冠状位增强T1WI示蝶窦粘膜强化呈高信号，右侧海绵窦膨胀，并见弥漫肿块样病变侵入海绵窦及其外侧壁（箭）。•ThisnonenhancedT1MRimageinthecoronalplaneshowsasymmetricT1isointensesignalandexpansionoftherightcavernoussinussecondarytoanintracavernousmass(arrow).•此T1WI冠状位平扫MR像示右侧海绵窦肿块（箭）呈等信号，致海绵窦膨胀，与左侧海绵窦不对称。•ThisT2coronalimagedemonstratesthattheT2signaloftherightcavernoussinuslesionisisointensetograymatter.Themassencasesthecavernoussegmentoftherightinternalcarotidarterywithoutapparentluminalnarrowing(arrow).•此T2WI示右侧海绵窦病变与脑灰质呈等信号，此肿块包绕右侧颈内动脉海绵窦段，而管腔无明显狭窄（箭）。•ThisT2axialimageshowshyperintensematerialoccupyingthesphenoidsinusandhypointenseirregularlesionsalongthelateralwallofthesphenoidsinus,extendingtotheposteriorethmoidcells(arrowhead).Thelesionextendstotheorbitalapex(arrow).Thereisexpansionoftheipsilateralcavernoussinusrelatedtothelesion.•此T2轴位像示蝶窦高信号病变，沿海绵窦外侧壁见不规则低信号病变，并侵入筛窦后部蜂房（箭头）及眶尖（箭），病变导致同侧海绵窦膨胀改变。DiagnosisBilateralnon-Hodgkinlymphomaofthesphenoidsinuswithextensionintotherightcavernoussinusandorbitalapex双侧蝶窦非何杰金氏病淋巴瘤累及右侧海绵窦及眶尖•CasePoints•Lymphomaisanuncommoncauseofcavernoussinussyndromeandusuallyarisesfrommetastaticdepositsordirectinfiltration.•淋巴瘤并非海绵窦综合征的常见原因，其常为转移性或直接侵润。•MRfindingsofaT2-weightediso-to-hypointensecontrast-enhancingcavernoussinusmasswithdiffusionrestriction,permeativeboneremodeling,andduralinfiltrationarefindingsinlinewithlymphoma.•MRT2WI呈等-低信号，增强扫描海绵窦强化肿块并扩散受限，骨质呈穿凿样重构，硬膜浸润等表现与淋巴瘤相符。Approximately50%ofpatientswithmalignantlymphomaclinicallypresentwithheadandneckinvolvement,withthemajorityofcasesshowingnodaldisease.Extranodalinvolvementoftheheadandneckispresentinapproximately10%ofcasesandmostcommonlyoccursintonsillartissue,sinonasalcavities,andthethyroid.Sinonasallymphomaisfoundmostcommonlyinthenasalfossaandmaxillarysinuseswithrarefrontalandsphenoidsinusinvolvement.•约50%恶性淋巴瘤患者临床表现为头部及颈部侵犯，主要表现为淋巴结病变。头颈部淋巴瘤约10%病例为淋巴结外侵犯，常发生于扁桃体，鼻前庭，甲状腺。鼻腔、鼻窦淋巴瘤最常发生于鼻前庭、上颌窦，而额窦及蝶窦罕见。•Itmaypresentasnodularorinfiltrativeenhancingmucosalmasses,usuallyofiso-to-hypointenseT2signalcomparedtograymatter.Diffusionrestrictionmaybeidentified.•常见表现为结节样或侵润性粘膜强化肿块，T2像与灰质比多呈等-低信号。因扩散受限可以诊断。•ThereisoftendisruptionoftheexpectedthinT2-brightmucosalsignalandahyperintenseenhancementpatternbyMRI.CToftenrevealsremodeli