| 摘要: |
| 报道1例70岁女性胸椎结核并右髋臼无症状性结核早期根据同位素骨扫描和CT扫描误诊为转移瘤的病例。患者无肺结核病史,否认结核病人接触史、从肋间神经痛开始前后,无午后低热、盗汗等常见的结核全身症状,化验检查示血沉及C反应蛋白正常,同位素骨扫描提示胸椎及右侧骨盆放射性浓聚,随后的胸椎及骨盆CT平扫横断面图像提示胸椎椎体破坏,右侧骨盆骨质密度不均匀降低及骨破坏,加之其X线片可见的T8-9椎间隙变窄,左侧一过性胸腔积液被忽视,导致患者早期误诊为转移瘤。提示在老年人中间出现脊椎病变时,影像资料应全面,要考虑到脊柱结核的可能。同位素骨扫描在骨结核患者中可表现为放射性浓聚。 |
| 关键词: 脊柱结核 肋间神经痛 髋臼结核 误诊 骨转移瘤 X线计算机体层摄影术 发射型计算机体层摄影术 |
| DOI：10.16781/j.0258-879x.2016.12.1582 |
| 投稿时间：2016-05-03修订日期：2016-10-16 |
| 基金项目:海军总医院创新培育基金（CXPY2014-13）. |
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| Tuberculosis of thoracic spine and acetabulum misdiagnosed as malignant metastatic tumor in an old female patient |
| HOU Li-sheng*,HE Qing,RUAN Di-ke,LI Hai-feng,CHENG Shi |
(Department of Orthopaedic, Navy General Hospital, Beijing 100048, China
* Corresponding author) |
| Abstract: |
| To report one 70-year-old female who developed symptomatic thoracic spinal tuberculosis with asymptomatic right acetabular tuberculosis but was initially misdiagnosed as bony metastasis based on emission computed tomography(ECT) and transverse images of computed tomography scanning at relative regions. The patient had no history of pulmonary tuberculosis, no history of exposure to tuberculosis. Before and from the onset of her intercostal neuralgia, she had nogeneral symptoms of afternoon low-degree fever, night sweets. Blood test results revealed normal blood sedimentation rate and C-protein reaction. Following ECT indicated increased tracer uptake involving T9 vertebral body and right acetabular region, and transverse images of CT scanning at thoracic spine and pelvic region detected bony destruction at T9 vertebra and irregular low bony density at right acetabular region with lesion, she was initially misdiagnosed as bony metastasis. The neglected evidences of narrowed T8-9 intervertebtral disc space and blunt left costophrenic by X-ray also were responsible for the misdiagnosis. The case implied that when spinal lesion happened in an old patient, one should keep in mind that spinal tuberculosis might not be ruled out. Increased tracer uptaking might be found in bony tuberculosis when ECT was done. |
| Key words: spinal tuberculosis intercostal neuralgia acetabular tuberculosis diagnostic errors bony metastasis X-ray computed tomography emission-computed tomography |
