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患者男,33岁、胸背部胀痛,双下肢酸软无力1年,加重半月入院,体格检查:一般情况良好,B超:肝、脾、胰腺及肾脏未见异常。 CT检查:后下纵隔左侧脊柱旁沟相当于胸11椎平面见4cm×6cm团块状软组织影。CT值24Hu,中心区见点状钙化影。肿块边缘光滑,有浅分叶与邻近组织分界清楚,与纵隔缘交角呈钝角,肿块与隔角面交界面光滑(图1),并将纵隔胸膜推起。相邻胸椎肋骨未见骨质破坏、增生。CT诊断:左后纵隔神经源性肿瘤。 行CT导向下经皮穿刺活检术:右侧卧位,取左侧第10肋间隙距后正中线处定位,局麻后,水平向前进针约4cm达肿瘤2/3处,负压吸引旋转抽吸组织涂片送病检。病理诊断:
The patient was male, 33 years old, with chest and back pain, and weakness in his lower extremities for 1 year. He was admitted to the hospital half an month later. His physical examination was generally good. B-ultrasound: No abnormalities were found in the liver, spleen, pancreas and kidneys. CT examination: posterior mediastinum left paravertebral groove is equivalent to chest 11 vertebral plane see 4cm × 6cm mass lump soft tissue shadow. CT value 24Hu, the central area of point-like calcification. The lumps are smooth, and there are clear boundaries between the shallow lobule and the adjacent tissue, an obtuse angle at the intersection with the septum, and a smooth interface between the lumps and the septum (Figure 1), and the mediastinal pleura is pushed up. There was no bone destruction or hyperplasia in the adjacent thoracic ribs. CT diagnosis: left posterior mediastinal neurogenic tumor. CT-guided percutaneous biopsy: right lateral decubitus position, taking the left side of the 10th intercostal space from the posterior midline, after local anesthesia, horizontal forward needle about 4cm up to 2/3 of the tumor, negative pressure to attract rotation Aspiration tissue smears were sent for examination. Pathological diagnosis: