老年女性,突发颈部肿物伴呼吸困难半日

2020-03-25 影像园 影像园

老年女性,突发颈部肿物伴呼吸困难半日

【所属科室】

内分泌科

【基本资料】

女,52岁

【主诉】

突发颈部肿物伴呼吸困难半日

【现病史】

患者发现甲状腺双叶多发肿物1年余,肿物逐渐增大,未予重视。昨晚无明显诱因肿物突然增大,位于颈部右侧,约5x5cm,质韧,光滑,与周围组织分界清,随吞咽上下活动。伴有压痛,伴轻度呼吸困难,无吞咽困难。

【影像图片】

【讨论问题】诊断?

【讨论】

评论:双侧甲状腺形态不对称,气管尚居中,右侧甲状腺体积增大,呈欠规则结节状稍高密度影,边界尚清。左侧甲状腺见小结节状稍低密度影,边界模糊。增强扫描右侧甲状腺病变未见强化,左侧甲状腺病变轻度强化。考虑:1)甲状腺肿;2)腺瘤

【结果】

(右侧甲状腺及肿物)结节性甲状腺肿伴出血、囊性变。
(左甲状腺)结节性甲状腺肿。

【病例小结】

甲状腺肿主要是由于缺碘引起的甲状腺代偿性增生,不伴由明显的甲状腺功能异常。初期甲状腺增大为弥漫性,可逐渐发展为结节状。

弥漫性甲状腺肿的病因可能是饮食中缺碘或甲状腺功能亢进或炎症。地方性甲状腺肿主要流行于碘缺乏区,女性居多,发病高峰为青春期。随时间推移,单纯性甲状腺肿可以发展为多结节性甲状腺肿,表现为甲状腺非对称性增大,可伸向胸骨后或上纵隔。75%~80%的胸骨后甲状腺肿起源于甲状腺下极或峡部。甲状腺内可见多发结节,并有局灶性出血、钙化、囊性变和瘢痕形成。

CT:单纯性甲状腺肿表现为甲状腺弥漫性肿大。甲状腺组织的CT值多在70HU以上。多结节性甲状腺肿则表现为甲状腺非对称性增大,伴有退行性变,出血、囊变、坏死或片状钙化则致密度不均。增强扫描,甲状腺组织增强,囊变坏死区不强化。

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    2020-12-25 LSJ120
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    2020-03-30 不会冬眠的熊熊

    学习了

    0

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