  This is a great case. This is a patient with myeloma with abdominal pain. What's the best diagnosis? Well, what you look at is you see that the patient's, it looks like the cecum or ileum, it's hard to say what it is, this bowel on the right low quadrant，that's markedly thickened. There's high density looks like it's bleeding. And in fact this patient presented with GI bleeding and it's mass like. Of course you can say maybe this is lymphoma, maybe it's sarcoma, maybe it's a giant adenocarcinoma. That's all possibilities. But the patient has myeloma. we don't want to give them a second diagnosis, and we have the bleeding. Well it's not ischemic bowel and it really doesn't look like diverticulitis. If you told me it was small bowel lymphoma I would have a hard time arguing with you. But this was typhlitis. Typhlitis involves the cecum. It's immunosuppressed patient which this was, and it can perforate and high morbidity，high mortality. This patient did survive, but it was not easy. And you can see the areas of hemorrhage which are a bit unusual in typhlitis. 这是一例不错的病例。该骨髓瘤患者伴腹痛。最佳诊断是什么？可以那么说，观察病人的盲肠或回肠，很难确定病变到底是什么。右下腹肠道明显增厚。其高密度似为出血。实际上，胃肠造影显示为肿块样的出血。当然，这也可以诊断为淋巴瘤、肉瘤、或是巨大腺癌。这些都是可能的诊断。但是该病人患有骨髓瘤，我们可以毫不犹豫的做出该诊断。该病变还伴有出血，因此并不是肠道缺血或憩室炎。如果你告诉我这是小肠淋巴瘤，我很难去反对。但是这是盲肠炎。盲肠炎累及盲肠。这是一名免疫抑制的病人，该病可以引起穿孔，发病率和病死率均较高。该病人虽然存活，其过程并不轻松。病变中的出血并不常见于盲肠炎。 Notes 1. myeloma [,maɪə'lomə] n. 骨髓瘤 2. cecum 同caecum ['sikəm] n.盲肠 3. lymphoma n. 淋巴瘤 4. sarcoma n. 肉瘤 5. diverticulitis [,daɪvɚtɪkjʊ'laɪtɪs] n.憩室炎 6. typhlitis [tɪf'laɪtɪs] n.盲肠炎 7. immunosuppressed adj.免疫抑制的 8. perforate ['pɝfə'reit] v.穿孔 9. morbidity [mɔr'biditi] n. 发病率 10.mortality [mɔr'tæləti] n. 致死率 来源：每天朗读一段医学影像学英语文章 圈主 深圳市人民医院放射科副主任医师杨敏洁 |
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