痛风结节并胫骨远端骨质破坏1例并文献复习

A Case of Gout Nodule with Distal Tibial Bone Destruction and Literature Review

患者,男,30岁,10个月前活动后发现左内踝不适;X线示:左胫骨远端内侧见囊性病变,其中有分隔,边界清晰;CT平扫示:左胫骨远端内侧见一轻度膨胀性囊样低密度影,界清,大小约为2.2 cm × 1.2 cm × 2.3 cm,边缘局部密度较高,内有分隔和气体影;MR平扫示:左胫骨远端内侧见类圆形稍长T1长T2信号影,其内见多发线样分隔影,边缘清,见浅分叶征;影像诊断:考虑骨巨细胞瘤或动脉瘤样骨囊肿;超声示:左侧小腿皮肤层及脂肪层内不均质回声区,CDFI示其内可见点状血流信号,考虑炎性改变;血尿酸:744 μmol/L,病理诊断:考虑痛风改变伴坏死。Patient, a male, 30 years old, found left medial malleolar discomfort after exercise 10 months ago;X-rays showed cystic lesions in the medial distal part of the left tibia, which was separated and had clear boundaries. CT plain scan showed a mild dilatant cystoid low-density shadow with clear boundary at the medial end of the left tibia, with a size of about 2.2 cm × 1.2 cm × 2.3 cm, high local density at the edge, and there were partitions and gas shadows. MR Plain scan showed that a circular, slightly longer T1 and T2 signal shadow was seen on the medial side of the left tibia distal, and multiple linear dividing shadows were seen inside, with clear edges and shallow lobed signs. Imaging diagnosis: giant cell tumor of bone or aneurysmal bone cyst was considered. The ultrasonography showed that there were uneven echo areas in the skin layer and fat layer of the left leg. CDFI showed that punctated blood flow signal could be seen in the area, and inflammatory changes were considered. Blood uric acid: 744 μmol/L. Pathological diagnosis: gout changes with necrosis were considered.