Kuyumcu Gokhan, Zhang Yaxia, Ilaslan Hakan
From the Imaging Institute (G.K., H.I.) and Robert J. Tomsich Pathology and Laboratory Medicine Institute (Y.Z.), Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44106.
Radiology. 2019 Aug;292(2):501-502. doi: 10.1148/radiol.2019171254.
History A 92-year-old bedridden woman presented to the emergency department from an assisted living facility with fever, cough, and swelling over the right lateral hip. She had baseline dementia and frailty and had been bedridden for 4 years. She did not have any recent falls or history of trauma at the site of swelling. She had a history of diffuse large B-cell lymphoma that had been diagnosed and treated 7 years ago, and thoracoabdominal CT at last follow-up 3 years ago did not show any recurrence. Physical examination findings were unremarkable except for a painful hard and fixed mass measuring approximately 5 × 5 × 10 cm (in the transverse, anteroposterior, and craniocaudal directions, respectively) located at the right lateral superior thigh. The overlying skin was intact, without any color changes. Pertinent blood test results showed an increased white blood cell count of 13 000/μL (13 ×10/L) (normal range, 3700-11 000/μL [3.7-11 ×10/L]). The remaining hematologic and biochemical test results were normal. Abdominal and pelvic CT performed at presentation did not show any abnormal lymph nodes. Because chest radiography showed consolidation in addition to typical clinical picture, the patient was diagnosed with pneumonia and underwent antibiotic treatment for 3 weeks. US ( Fig 1 ) and Doppler US ( Fig 2 ) of the mass were performed. MRI was not performed because the patient had a pacemaker; instead, CT of the lower extremity was performed ( Fig 3a , 3b ). Figure 1: US image of the mass at the level of the greater trochanter. Figure 2: Doppler US image of the caudal portion of the mass. Figure 3a: Axial unenhanced CT image of the lesion at the level of the greater trochanter. Coronal unenhanced CT image of the mass at the level of the greater trochanter. Figure 3b: Axial unenhanced CT image of the lesion at the level of the greater trochanter. Coronal unenhanced CT image of the mass at the level of the greater trochanter.
一名92岁的卧床女性从辅助生活设施被送往急诊科，伴有发热、咳嗽和右外侧髋部肿胀。她患有基线痴呆和虚弱，已卧床4年。她近期没有在肿胀部位跌倒或外伤史。她有弥漫性大B细胞淋巴瘤病史，7年前被诊断并接受治疗，3年前最后一次随访时的胸腹CT未显示任何复发迹象。体格检查结果无异常，只是在右大腿外侧上方有一个约5×5×10厘米（分别为横径、前后径和头尾径）的疼痛性硬肿块，质地固定。覆盖的皮肤完好无损，没有任何颜色变化。相关血液检查结果显示白细胞计数增加至13000/μL（13×10⁹/L）（正常范围为3700 - 11000/μL [3.7 - 11×10⁹/L]）。其余血液学和生化检查结果正常。就诊时进行的腹部和盆腔CT未显示任何异常淋巴结。由于胸部X线除典型临床表现外还显示有实变，该患者被诊断为肺炎，并接受了3周的抗生素治疗。对肿块进行了超声检查（图1）和多普勒超声检查（图2）。因患者有心脏起搏器，未进行MRI检查，而是进行了下肢CT检查（图3a、3b）。图1：大转子水平肿块的超声图像。图2：肿块尾部的多普勒超声图像。图3a：大转子水平病变的轴位平扫CT图像。大转子水平肿块的冠状位平扫CT图像。图3b：大转子水平病变的轴位平扫CT图像。大转子水平肿块的冠状位平扫CT图像。
