第九章 HistoryTeenagerwithleukemiaandweakness.docVIP

History: Teenager with leukemia and weakness. Click these T2W images to enlarge them. 病史：一名白血病和乏力的青年患者 请点击这些T2W图像观看大图 Which ONE of the following best characterizes the findings? A. Both the lesion and the ependyma of the R lateral ventricl enhance briskly. B. Neither the lesion nor the ependyma enhances. C. Lesion enhances, ependyma does not. D. Lesion shows little/no enhancement, ependyma does enhance. 以下对发现的描述哪项最正确？ 病灶和右侧侧脑室的室管膜迅速强化。 病灶或室管膜均不强化。 病灶强化，室管膜不强化。 病灶几乎没有/没有显示强化，室管膜强化。 Findings: T2 weighted intraparenchymal masses in the right temporal lobe and in the right superior frontal gyrus extending across the corpus callosum. There is ependymal enhancement of the right lateral ventricle. There is very minimal enhancement of the masses. 发现：沿着胼胝体 Differential diagnosis: CNS leukemia CNS aspergillosis CNS bacterial infection Metastasis Septic emboli 鉴别诊断： 中枢神经系统白血病 中枢神经系统曲霉病 中枢神经系统细菌感染 转移癌 脓毒性栓子 Diagnosis: CNS fungal aspergillosis. 诊断：中枢神经系统真菌性曲霉病 Key points: 关键点： Aspergillosis is the 2nd most common fungal CNS infection in an immunocompromised host after cryptococcus. 曲霉病是免疫低下宿主第二常见的真菌性中枢神经系统感染，仅次于隐球菌引起的感染。 Risk factors: Transplant recipients: renal liver heart. 1-4 months post transplant. Recent transplant rejection +/- retransplantation. Leukopenia. Associated with CMV infection. Reported nosocomial spread in some cases. Lung is commonest source then sinuses. 危险因素： 移植受体：肾 肝 心。 移植后1-4个月。 近期出现移植排斥+/-再次移植。 白细胞减少 与巨细胞病毒感染有关。 部分病例报道了医院内传播 肺是最常见的感染来源，其次是鼻窦。 Imaging: 影像： 最大发现：由于感染具有侵袭血管性，因此多发性梗塞或出血病灶不规则分布。约25%的病灶有出血。T2加权MR图像上通常可见病灶周围有低强度信号。 Multiple ring enhancing lesions, although more commonly there is mild/vague enhancement. Dural enhancement with enhancement in adjacent paranasal sinus. Mycotic aneurysms may be seen on angiography. 有多发性环状强化病灶，虽然轻度/模糊强化更为常见。硬脑膜强化，伴有邻近的鼻旁窦强化。血管造影可能可见感染性动脉瘤。 Locations of involvement a felt to be secondary to predilection for the lenticulostriate and thalamoperforator vessels: basal ganglia and thalamus, corpus callosum. The corp