Takashima Seiki, Nakano Hideharu, Minamoto Kanji, Misao Takahiko, Shiota Kunihiko
Department of Surgery, Kagawa Prefectural Central Hospital, Takamatsu,, Japan.
Acta Med Okayama. 2005 Aug;59(4):165-70. doi: 10.18926/AMO/31954.
A 67-year-old male visited his physician because of a 2-month history of cough and sputum. An abnormal shadow at the left upper mediastinum on chest x-ray film was detected, and the patient was referred to our department for further examination. Chest x-ray film revealed a round shadow at the left upper posterior mediastinum. Computed tomography(CT)revealed a uniform iso density mass about 4 cm in diameter, with a well-defined border. After the intravenous contrast administration, a slight peripheral enhancement was seen around the mass. On magnetic resonance imaging, the mass was hypointense in T1-weighting and hyperintense in T2-weighting. The contrast pattern was the same as that observed in the CT scan. On sagittal and coronal sections, the mass was adjacent to the aortic arch. Although a benign tumor was mostly suspected based on imaging findings, a malignant tumor was also possible. Accordingly, we resected this mass with video-assisted thoracoscopy. Findings at operation were a cystic mass. The pathological findings were compatible with benign parathyroid cyst, which was suspected to be the cystic degeneration of a parathyroid adenoma.
一名67岁男性因咳嗽、咳痰2个月前往就医。胸部X线片发现左上纵隔有异常阴影,患者被转诊至我科进一步检查。胸部X线片显示左上后纵隔有一圆形阴影。计算机断层扫描(CT)显示一个直径约4厘米的均匀等密度肿块,边界清晰。静脉注射造影剂后,肿块周围可见轻微的周边强化。在磁共振成像上,肿块在T1加权像上呈低信号,在T2加权像上呈高信号。造影模式与CT扫描所见相同。在矢状面和冠状面上,肿块与主动脉弓相邻。尽管根据影像学表现大多怀疑为良性肿瘤,但也有可能是恶性肿瘤。因此,我们通过电视辅助胸腔镜切除了这个肿块。手术所见为囊性肿块。病理结果与良性甲状旁腺囊肿相符,怀疑是甲状旁腺腺瘤的囊性变。