髋关节巨大包囊虫病临床影像特征一例报告并文献复习

Clinical and imaging features of giant cysticercosis of the hip joint:a case report and literature review

目的报告髋关节巨大包囊虫病1例,复习文献17篇共18例,探讨骨关节包囊虫病的临床影像特征。方法介绍并分析本院经治的1例由细粒棘球绦虫的幼虫(棘球蚴echinococcus granulosus),引起的右髋关节巨大囊型包虫病合并病理性骨折和髋关节半脱位患者的临床影像特点。检索中英文数据库,包括发病部位、影像特征、流行病学特征,对检索文献进行分析。结果髋关节包囊虫X线和CT无特征性,分别误诊为骨关节结核、恶性骨肿瘤,MRI呈典型多囊多房(含母囊和子囊)结构且子囊T2WI信号高于母囊等特征性表现,CTA、MRA均显示由右侧髂内动脉供血、远端血管被包埋。18例中15例见囊性膨胀性骨质破坏,2例呈虫蚀样蜂窝状骨质破坏,1例呈葡萄状骨质破坏,14例囊中见小囊,14例无骨膜反应,4例出现轻微骨膜反应。结论MRI对骨关节包囊虫有一定的影像特征,结合流行病史、临床表现,以及血清学IgG、IgM抗体检查(血清包虫试验)可明确诊断。

Objective To report one case of giant cystic disease of the hip joint and review literature on 17 cases,and to explore the clinical imaging characteristics of bone and joint cysticercosis.Methods The clinical imaging characteristics of a case of right hip giant cystic hydatid disease complicated with pathological fractures and hip subluxation caused by the larvae of echinococcus granulosus in our hospital was introduced and analyzed.Retrieve Chinese and English databases,including the location of the disease,imaging features,and epidemiological features,and analyze the retrieved literature.Results Hip joint hydatid cyst was misdiagnosed as bone and joint tuberculosis and malignant bone tumor without characteristic features on X-ray and CT,respectively.MRI showed typical multi cystic and multi locular structures(including mother’s and daughter’s cysts),and the T2W signal of the daughter’s cyst was higher than that of the mother’s cyst.CTA and MRA both showed blood supply from the right internal iliac artery and embedding of distal blood vessels.Seven articles were retrieved from 17 cases,including one case in this article,totaling 18 cases.Among the 18 cases of bone and joint hydatidosis,15 cases showed cystic expansive bone destruction,2 cases showed worm-like and honeycomb-like bone destruction,1 case showed grape-like bone destruction,14 cases showed small cysts in the cysts,14 cases showed no periosteal reaction,and 4 cases showed mild periosteal reaction.Conclusions MRI has certain imaging features for bone and joint hydatid cysts.Combined with epidemiological history,clinical manifestations,and serum IgG and IgM antibody tests(serum hydatid test),a clear diagnosis can be made.