History:A44-year-oldmanpresentsforachestradiographfollowingapositivepurifiedproteinderivative(PPD)skintestfortuberculosis.Patienthasnorespiratoryorconstitutionalsymptoms.
病史:44岁男性,因结核皮肤反应试验PPD阳性行胸部正侧位平片,患者无呼吸系统或全身症状。
Posteroanteriorandlateralchestradiographsareshownbelow.
胸部后前位及侧位片如下所示。
ChestCTandMRIwereattainedforfurthercharacterizationoftheanteriormediastinallesionseenontheradiographs.
平片发现前纵隔病变,进一步行胸部CT和MRI检查。
Findings表现
Chestradiographs:Bestseenonthelateralchestradiographwallisasmoothlymarginatedanteriormediastinalopacityintheretrosternalclearspace,whichmeasuresuptoapproximately4cminlength.Thelungsareclearandwithoutanyevidenceoftuberculosis.Therightparatrachealstripeiswithinnormallimits.
胸部平片:在侧位片上更易发现一边缘光滑的前纵隔阴影,位于胸骨后间隙内,病变长度约4cm,肺野清晰,未见肺结核相关表现。右侧气管旁线位置正常。
ChestCT:Contrast-enhancedaxialandsagittalchestCTimagesdemonstrateawell-circumscribed,oval,hypoattenuatinganteriormediastinallesion,correspondingtotheabnormalityseenonchestradiograph.Thewallofthelesionisthinandnoncalcified.Thelesionistotheleftofmidline,anteriortotheascendingaortaandmainpulmonaryartery.Theadjacentfatplanesbetweenthelesionandtheascendingaortaandmainpulmonaryarteryarepreserved.Thelungsareclear.胸部CT:轴位及矢状位胸部CT增强扫描可见一边界清楚,类圆形,低密度前纵隔病变,可对应胸片上发现的异常。病变壁薄、无钙化,位于中线左侧,位于升主动脉及肺动脉干前方,其间的脂肪间隙尚存在。肺野清晰。
ChestMRI:Thewell-circumscribedanteriormediastinallesionseenonCTdemonstrateshomogeneousT2-andT1-hyperintensecontent,withasmallamountofdependentT2-hypointensecontent,correspondingtolayeringdebris.Onthepostgadoliniumimage,thereisnosignificantmuralenhancementandnoenhancingmuralnodularityorinternalsolidenhancing北京看白癜风好点的医院治疗皮肤白癜风专家