鼻咽纤维血管瘤的影像表现及临床 .ppt

读书报告会;患者：男，26岁 主诉：右鼻出血2天;影像图像;影像图像;影像图像;影像图像;患者：男，26岁 主诉：右鼻出血2天 现病史：患者输2天前无明显诱因出现右鼻出血，为鲜血，呈滴状，先从左前鼻孔出，后亦从口中、右鼻流出，数分钟后停止，反复出现多次，总量约为100ml，无鼻塞，流涕，嗅觉正常。无头痛、发热、咳嗽、打鼾，无耳鸣、而鼻塞感，无听力下降。于当地医院治疗，予以鼻腔填塞，症状好转。在中山陈星海医院，予以电子喉镜检查“右鼻腔肿物，性质待查”。 既往史：否认肝炎???结核、疟疾病史，否认高血压、心脏病史，否认糖尿病、脑血管疾病史，否认手术、外伤、输血史，否认食物、药物等过敏史，否认吸烟、饮酒史，否认毒物接触史。;Abstract ;Background;It originates from the posterolateral wall of the nasopharynx and from this site usually extends to the nasopharynx, nasal cavity, paranasal sinuses, sphenoid-palatine foramen and infratemporal fossa. In 10–20 % of the cases tumor invades the cranial cavity 。;Nasal tumor underwent CT, which demonstrated homogenous mass, with contrast enhancement ranging from strong to intermediate (Fig. 1).In one case, signs of bony destruction with tumor invasion to the ethmoid sinus were visible. The patient with the tumor of the infratemporal fossa underwent CT, (MRI) and carotid arteriography with preoperative embolization. The lesion showed intensive contrast。 ;Fig. 1 Computed tomography, coronal plane, shows homogenous tumor mass in the right nasal cavity;Histologic section of the tumor (HE stain) shows fibrous stroma with ectatic, thin-walled vascular channels;Enhancement on CT and MRI as well as signal-void areas on MR images, typical for high flow vessels (Fig. 2). Arteriography revealed abundant vascularity with main blood supply from the internal maxillary artery. ;Histopathological appearance typical for NA consists of numerous wide, irregular vessels with a single layer of endothelial cells, embedded in fibrous stroma. The abundant vascular component is responsible for excessive bleeding during surgery or following biopsies. It also contributes to certain characteristic radiological features of NAs, including strong contrast enhancement on CT and MR images, signal-void areas representing tumor vessels visible on MR images, as well as intensive vascular blush demonstrated on angiography . ;Selective angiography is a useful diagnostic me