医院放射科第二届英语读片比赛病例及解 - 多发性脂肪瘤

TUhjnbcbe - 2021/2/15 21:28:00

54-year-oldmanwithlowerextremityspasticity

CASEOUTLINE

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HistoryandMRimages

OurappreciationisextendedtoDr.JamesX.Chen,UniversityofPennsylvaniaDepartmentofRadiology,forcontributingthiscase.

History:A54-year-oldmanpresentswithworseningchronicspasticityoftheleftlowerextremity.

ThoracicspineMRimagesareshownbelow.Clicktoenlarge.

Theabnormalityisextraduralinlocation.

True

False

Thequestionaboveaccountsfor10%ofyourtotalscoreforthiscase.

TheabnormalityisT1hyperintense.

True

False

Thequestionaboveaccountsfor10%ofyourtotalscoreforthiscase.

Theabnormalitydemonstratessignaldropoutonfat-suppressedimages.

True

False

Thequestionaboveaccountsfor10%ofyourtotalscoreforthiscase.

Thereisevidenceoftetheredspinalcord.

True

False

Thequestionaboveaccountsfor10%ofyourtotalscoreforthiscase.

Thereismyelomalaciaintheadjacentthoracicspinalcord.

True

False

Thequestionaboveaccountsfor10%ofyourtotalscoreforthiscase.

Thereisanassociatedmyelomeningocele.

True

False

Thequestionaboveaccountsfor10%ofyourtotalscoreforthiscase.

Whichofthefollowingisthemostlikelydiagnosis?

Dermoidcyst

Hemorrhagicspinalcordinfarct

Ependymoma

Paraganglioma

Lipoma

Thequestionaboveaccountsfor10%ofyourtotalscoreforthiscase.

54-year-oldmanwithlowerextremityspasticity

CASEOUTLINE

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AdditionalquestionsSpinallipomasdevelopasaresultofwhichofthefollowing?

Nondisjunctionofcutaneousectodermfromneuroectodermduringdevelopment

Vascularinsulttospinalcordduringorganogenesis

Neoplastictransformationofependymalcells

Radiation-inducedfattychange

Thequestionaboveaccountsfor10%ofyourtotalscoreforthiscase.

Spinallipomasareassociatedwithwhichofthefollowing?

Myelomeningocele

Lipomyelocele

Tetheredcord

Syringomyelia

Alloftheabove

Thequestionaboveaccountsfor10%ofyourtotalscoreforthiscase.

Duringwhichofthefollowingagegroupsdospinallipomastendtoexhibitthemostrapidgrowth?

Infancy

10to20years

20to30years

30to40years

Thequestionaboveaccountsfor10%ofyourtotalscoreforthiscase.

54-year-oldmanwithlowerextremityspasticity

CASEOUTLINE

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Findingsanddiagnosis

Findings

MRIofthethoracicspinedemonstratesanovoidintramedullarylesionalongtheleftaspectoftheT8-T9thoracicspinalcord,whichdemonstrateshyperintensityonT1-weightedimagesandsignaldropoutonfat-saturatedT2image,andisnonenhancingonpostgadoliniumT1-weightedimage.Thereisthinningofthethoraciccordcranialandcaudaltothelesion,andthereisathinrimofT2hyperintensityaroundthelesion,reflectingassociatedmyelomalacia.

Differentialdiagnosis:

Lipoma

Lipomyelocele

Dermoidcyst

Diagnosis:Spinalcordlipoma

54-year-oldmanwithlowerextremityspasticity

CASEOUTLINE

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Keypoints

Pathophysiology

Etiologyofspinallipomas:Resultofprematureseparationofcutaneousectodermfromneuroectodermduringdevelopment(nondisjunction).

Mesenchymaltissuesubsequentlydifferentiatesintofat.

Separationallowsinvaginationofmesenchymeintothespinalcanal,whichdisruptsnormalclosureoftheneuralfolds.

Associations:

Openandclosedspinaldysraphisms,includingtetheredcord.

Dermalsinustractsalsooccurasaresultofnondisjunctionduringdevelopment.

Physiology:Adipocyteswithinlipomatendtoenlargemostrapidlyduringinfancy,andtheywilldecreaseinsizewithweightloss.

Classification:Oldersystemclassifiedlesionsasintraduralorterminallipomas,butsystemhasbeenupdatedasfollows():

Dorsallipoma,caudallipomawithduraldefect

Transitionallipoma

Lipomyelocele

Lipomyelomeningocele

Intramedullarylipoma

Filumlipoma

Caudallipoma

Lipomawithoutduraldefect--nocutaneousabnormalities

Lipomawithduraldefect--associatedwithcutaneousabnormalities

Epidemiology

Intradurallipomasaremore