Yamazoe Masami, Nakajima Kazutaka, Takezawa Chikako, Kojima Hiroshi, Yamada Gen, Abe Shosaku
Third Department of Internal Medicine, Obihiro Kyokai Hospital.
Nihon Kokyuki Gakkai Zasshi. 2004 Oct;42(10):903-8.
A 58-year old man was admitted to our hospital complaining of right back pain, fever, abdominal fullness and epigastralgia. Chest CT revealed a mass shadow in the right S6 together with destruction of the thoracic vertebrae. These findings suggested lung cancer and its spinal invasion. A transbronchial lung biopsy specimen showed inflammatory lymphocyte infiltration. MRI T2 image of the spine showed a high intensity at the Th7/8 disc space, suggesting pyogenic spondylitis. After broad-spectrum antibiotics including PAMP/BP and CLDM were administered, both the spinal lesion and the pulmonary lesion improved gradually. The clinical course suggested that the pulmonary inflammatory lesion had spread from pyogenic spondylitis. In our case, the pyogenic spondylitis was mimicking a spinal invasion of lung cancer. In addition, MRI is thought to be useful for diagnosing spinal lesions.
一名58岁男性因右侧背痛、发热、腹部胀满和上腹部疼痛入院。胸部CT显示右S6有肿块阴影,同时胸椎有破坏。这些发现提示肺癌及其脊柱侵犯。经支气管肺活检标本显示炎性淋巴细胞浸润。脊柱的MRI T2图像显示胸7/8椎间盘间隙有高强度信号,提示化脓性脊柱炎。在给予包括派拉西林/他唑巴坦和氯地霉素在内的广谱抗生素后,脊柱病变和肺部病变均逐渐改善。临床过程提示肺部炎性病变由化脓性脊柱炎蔓延所致。在我们的病例中,化脓性脊柱炎酷似肺癌的脊柱侵犯。此外,MRI被认为对诊断脊柱病变有用。