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患儿女,1.5岁,12天前发现左侧腮腺肿胀,无发热,拟诊“流行性腮腺炎”。门诊给予病毒唑、维生素C治疗一周无效。腮腺部继续肿大,伴疼痛、低热,外周血白细胞10.6×10~9/L,N75%,L25%。修正诊断为“化脓性腮腺炎”,用青霉素肌注5天,仍无好转而入院。入院查体:T37.5℃,以耳垂为中心,左腮腺区明显肿胀,可扪及一约5×5cm~2大小的肿块,质硬,边界不清,不活动,有轻触痛,无波动感。口腔粘膜光滑,腮腺管开口处无红肿。心肺正常。肝脾和浅表淋巴结无肿大。肿块B超检查提示45.5×32.8×36.4mm低回声肿块,周边不规整,呈花瓣状。下颌骨X线片示左侧下颌骨升支受压移位,无骨质破坏,胸部X线检查和腹腔B超均无异常发现。入院后采用新青霉素Ⅱ、氨苄青霉素和灭滴灵抗感染,曾用12号针头作肿块穿刺,未抽出脓液。住院第6天左耳内溢出血性液体,同时肿块继续增大,且出现同侧眼睑、
Children, 1.5 years old, 12 days ago found the left parotid swelling, no fever, proposed diagnosis of “mumps.” Outpatient given ribavirin, vitamin C treatment for one week is invalid. Parotid gland continued to enlarge, with pain, fever, peripheral leukocytes 10.6 × 10 ~ 9 / L, N75%, L25%. Modified diagnosis of “suppurative parotitis,” intramuscular injection of penicillin 5 days, still no improvement and admission. Admission examination: T37.5 ℃, the earlobe as the center, the left parotid gland area was swollen, palpable and about 5 × 5cm ~ 2 size of the mass, hard, borderless, inactive, tenderness, no Fluctuation. Oral mucosa smooth, no swelling of the parotid duct opening. Cardiopulmonary normal. Liver and spleen and superficial lymph nodes without swelling. B-ultrasound examination prompted 45.5 × 32.8 × 36.4mm hypoechoic mass, the surrounding irregular, was petal-like. Mandibular X-ray showed left mandibular ascending ramus compression displacement, no bone destruction, chest X-ray examination and abdominal B-no abnormal findings. After admission with new penicillin Ⅱ, ampicillin and metronidazole anti-infection, had used 12 needle for mass puncture, did not remove the pus. On the sixth day of hospitalization left ear spill hemorrhagic fluid, while the mass continues to increase, and the ipsilateral eyelid,