【双语病例】Cavernous Sinus Hemangioma 海绵窦血管瘤

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Steve Martin, Victor Cuvinciuc
Department of Radiology
Section of Neuroradiology
Geneva University Hospital
Switzerland

双语学影像授权发布

Description

A 47-year-old man without significant clinical history presented to the emergency room for progressive visual disturbances. On examination, a horizontal diplopia worsening in the left lateral gaze was noted.

47岁男性，既往体健，因渐进性视力障碍就诊。体检左侧注视时水平复视。

Legends

Axial T2WI demonstrates a mass lesion isointense to the gray matter in the region of the left cavernous sinus. Contrast-enhanced axial T1WI, obtained sequentially as early as 6 minutes and 15 min following gadolinium enhancement, demonstrate progressive pooling of contrast within the left cavernous sinus lesion. RBC-tagged scintigraphy demonstrates increased uptake in the region of the left cavernous sinus.

横断位T2WI示左侧海绵窦肿块，与大脑灰质呈等信号。

横断位T1WI增强扫描，及6分钟、15分钟延迟扫描示左侧海绵窦病灶渐进性强化。

核素标记RBC闪烁扫描示左侧海绵窦区摄取增加。

Cavernous Sinus Hemangioma

海绵窦血管瘤

• Cavernous sinus hemangiomas (CSHs) are uncommon benign lesions. They account for fewer than 1% of parasellar masses, with a ratio F:M = 7:1, and are seen mainly in the fourth decade of life.

  海绵窦血管瘤（CSHs）是一种少见的良性肿瘤，约占所有鞍旁肿瘤的不足1%，女性发病率约为男性的7倍，好发于30-40岁。

• Symptoms range from headaches and retro-orbital pain to cranial nerve palsies with ophthalmoplegia.

  临床症状包括头疼、球后疼痛、颅神经麻痹、眼肌瘫痪等。

Key Diagnostic Features

• CSHs are assessed by MRI, for characterization, location, and relationship with the surrounding structures. The MR image findings are of a well-defined mass with low to isointensity on T1-weighted images, and marked hyperintense signal on T2-weighted images. CSHs show a progressive enhancement with a centripetal fill-in pattern.

  MRI能较好反映CSHs的特征性影像学表现、位置、与周围结构的关系。病灶一般表现为边界清楚的肿块，T1WI呈低至等信号，T2WI呈明显高信号，增强扫描病灶呈渐进性强化、逐渐向内填充。
  

• The diagnosis can be confirmed by a labeled red cell blood pool scintigraphy.

  核素标记红细胞闪烁造影可以证实诊断。

DDx

• Meningioma 脑膜瘤

• Chordoma 脊索瘤

• Chondroma/chondrosarcoma 软骨瘤/软骨肉瘤

• Metastasis 转移瘤

• Swhwannoma 许旺氏细胞瘤

• Lymphoma 淋巴瘤

• Atypical vascular neoplasm of the cavernous sinus

  海绵窦不典型脉管源性肿瘤

Rx

Surgery, preoperative radiation therapy — gamma knife surgery

手术治疗，术前可进行放疗-伽马刀治疗。