Anomalous systemic arterial supply to the left basal segment is a rare congenital vascular anomaly, particularly when complicated by dissection of the feeding artery. This case report aims to present a unique instance of this condition and to review relevant literature. We present a young patient who was hospitalized with sudden chest pain, leading to the discovery of an anomalous artery originating from the thoracic aorta that supplied blood to the basal segment of the left inferior lobe of the lung, accompanied by dissection of the feeding artery. The patient underwent successful surgical resection of the anomalous vessel via thoracotomy, and postoperative recovery was unremarkable during follow-up evaluations. This case highlights the importance of recognizing anomalous systemic arterial supply as a potential cause of acute chest pain and underscores the need for timely surgical intervention.

患者 女,75岁.因"记忆力减退1年余,乏力纳差3天"入院.查体无特殊阳性体征.实验室检查为阴性.全腹部CT增强检查:胃窦部胃壁不规则增厚,管腔狭窄,增强扫描不均匀强化,周围脂肪间隙模糊,见多发肿大淋巴结,环形强化,大网膜浑浊(图1A～1D);盆腔前腹壁下团块影,大小约7.4 cm× 3.8 cm,与前腹壁分界不清,CT值约47 HU,内密度欠均匀,见少许斑片状低密度区(CT值-35 HU),增强扫描呈轻度较均匀强化(图1E～1H).影像诊断:胃窦部胃癌伴周围淋巴结肿大,腹盆腔转移,请结合胃镜检查.胃镜检查:胃窦可见巨大溃疡增殖性病灶,延及胃角、幽门、十二指肠球部,考虑胃癌伴幽门梗阻;病理结果为胃癌.

Background Solitary fibrous tumor of the pleura (SFTP) is a rare mesenchymal tumor that arises at various sites and typically originates from the pleura. Most patients with SFTPs are asymptomatic, unless the tumor is large. Approximately 20% of SFTP cases are malignant. There are few reports on imaging diagnoses and interventional treatments of SFTP. Here, we report a case of a giant SFTP that exhibited malignant behavior and underwent successful resection after embolization of the main supply artery of the tumor. Case presentation We report a clinical case of a giant SFTP in a 66-year-old Chinese female patient complaining of chest tightness and cough for more than 2 months. Ten years ago, the patient had undergone a chest CT scan at a local hospital for cough. Computed tomography (CT) had revealed a mass in the right thoracic region, which was misdiagnosed as a pulmonary abscess by CT-guided biopsy. Therefore, the patient did not receive appropriate/complete treatment at that time. She was hospitalized again, because CT showed significant enlargement of the right thoracic mass, which caused her obvious symptoms of discomfort. The pathological results of CT-guided biopsy at our hospital confirmed SFTP. Considering the large size of the tumor and the rich blood supply, some of the main blood vessels were treated with embolization before surgical resection. A large tumor, about 23 cm × 16 cm × 15 cm in size, was then successfully removed by thoracic surgery. The diagnosis of malignant SFTP was confirmed by surgical pathology and immunohistochemistry. Conclusion Imaging findings of SFTPs are not characteristic, especially when a tumor is large, the diagnosis is difficult, and the final diagnosis still depends on histological and immunohistochemical examinations. The two-stage surgical treatment described here, which involves first embolization of the main supplying artery of the large tumor and then complete surgical resection, is effective and safe for SFTPs. Whether needle biopsy or vascular embolization is performed, intervention plays a crucial role in the diagnosis and treatment of patients with SFTPs.

病例 男,59 岁,因"腹痛5 天,发现腹腔占位3 天"入院.查体未见特殊阳性体征.实验室检查:补体C3153.0 mg/dL, IgG42.890 g/L.肿瘤标志物:铁蛋白535.3 ng/mL,其它肿瘤标志物CA125、CA199、CEA、AFP等及生化检查均为阴性.

This paper focuses on the practical necessity of discipline-integrated PBL curriculum in cultivating clinical thinking ability of college students majoring in clinical medicine. Through the teaching process of group discussion of some real and complete cases, this paper explains in detail how to cultivate medical students' clinical thinking ability by discipline-integrated PBL curriculum, discusses the implementation of ideological and political education associated with clinical medicine by heuristic teaching from close touching with clinical case and implicitly infiltration of the socialist core values such as dedication and integrity, and elaborates the humanistic quality and psychological comfort levels of medical students by being close to clinical patients. After five years of teaching practice, the teaching effect of discipline-integrated PBL curriculum has been approved by the national clinical medicine professional certification experts and praised by students. We believes that the development of discipline integrated PBL curriculum in medical college can strengthen students' problem-based autonomous learning ability, significantly improve the two-way integration ability between basic medical courses and basic medicine, and significantly build students' clinical thinking and clinical decision-making ability.

目的:探讨在本科医学影像技术专业中开设"影像技术质量控制"课程的必要性.方法:总结我校在医学影像技术本科专业中开设"影像技术质量控制"课程的情况.结果:通过开设"影像技术质量控制"课程,增强了学生对影像技术质量控制重要性的认识,在实习及工作中能正确开展影像技术质量控制工作.结论:在本科医学影像技术专业中开设"影像技术质量控制"课程非常必要.

BACKGROUND:Pulmonary Cryptococcosis is a common fungal infection mainly caused by Cryptococcus neoformans/C.gattii species in immunocompromised patients. Cases of pulmonary cryptococcosis in patients with normal immune function are increasingly common in China. Clinical and radiographic features of pulmonary cryptococcosis are various and without obvious characteristics, so it is often misdiagnosed as pulmonary metastatic tumor or tuberculosis. When coexisting with malignant lung tumors, it was more difficult to differentiate from metastatic lung cancer, although the coexistence of pulmonary cryptococcosis and central type lung cancer is rare. Reviewing the imaging manifestations and diagnosis of the case and the relevant literature will contribute to recognition of the disease and a decrease in misdiagnoses.CASE PRESENTATION:A 72-year-old immunocompetent Han Chinese man had repeated dry cough for more than half a year. CT examination of chest showed an irregular mass at the left hilum of the lung, and two small nodules in the right lung, which were considered as the left central lung cancer with right lung metastasis. However, the patient was diagnosed with pulmonary cryptococcosis coexisting with central type lung cancer based on the results of laboratory examination, percutaneous lung biopsy, fiberoptic bronchoscopy, and surgical pathology. The patient underwent surgical resection of the left central type lung cancer and was placed on fluconazole treatment after a positive diagnosis was made. Five years after the lung cancer surgery, the patient had a recurrence, but the pulmonary cryptococcus nodule disappeared.CONCLUSION:Our case shows that CT findings of central type lung cancer with multiple pulmonary nodules are not necessarily metastases, but may be coexisting pulmonary cryptococcosis. CT images of cryptococcosis of the lung were diverse and have no obvious characteristics, so it was very difficult to distinguish from metastatic tumors. CT-guided percutaneous lung biopsy was a simple and efficient method for identification.

目的 探讨金属内固定拆除部位出现金属伪影的原因.方法 收集29例内固定拆除后患者临床资料,均行X线摄片或CT、MRI影像检查.结果 29例患者行X线摄片或CT平扫,在内固定拆除区域均未发现金属致密影,14例在MRI检查图像中出现少许点状金属伪影,基本上分布在内固定拆除后遗留骨道区域或周围骨痂形成区域.结论 MRI检查对内固定拆除术后出现金属伪影有较高敏感性,对于金属伪影产生的原因分析有重要意义,可以避免不必要的医疗纠纷.

骨脂肪瘤是起源于成熟脂肪组织的良性肿瘤,根据发生部位可分为骨内脂肪瘤和骨旁脂肪瘤,但发生于颅骨的骨旁脂肪瘤十分罕见.骨脂肪瘤瘤体由成熟的脂肪组织构成,而脂肪组织具有明显的影像学特征.骨内脂肪瘤CT表现为骨内脂肪性透亮影或骨质缺损区,MRI上病灶为脂肪信号;骨旁脂肪瘤虽仍具典型表现,但因位置特殊,需要与其它疾病鉴别,且骨脂肪瘤也存在着继发或者转变为恶性的可能.本文报道1例手术确诊病例,复习其影像特点、临床诊疗经过,以期提高对颅骨骨旁脂肪瘤的认识.

目的 讨论黄色肉芽肿性胆囊炎影像学特征,提高黄色肉芽肿性胆囊炎的诊断水平.方法 方收集5例黄色肉芽肿性胆囊炎病例术前影像学检查,观察胆囊改变(壁增厚和强化的方式、胆囊壁内囊性结节灶、黏膜线是否完整和是否伴有结石)、胆囊邻近组织受累改变.结果 5例患者均出现胆囊壁增厚,3例为弥漫性增厚,2例为局部增厚.5例患者均可见胆囊壁内串珠样结节灶,表现为低密度灶及长T1长T2信号灶,1例壁内结节灶部分融合.1例患者胆囊黏膜线有中断,黏膜线明显强化.5例患者均伴有结石,均出现周围肝实质动脉期异常灌注.结论 胆囊壁增厚、胆囊壁内串珠样结节、黏膜线中断、邻近肝实质动脉期异常灌注为黄色肉芽肿性胆囊炎形成的常见影像学特征.

Objective To summarize the nursing requirements of patients with PET/CT examination. Methods The nursing process and data of 2616 patients with routine successful 18F-FDG PET/CT examination in 2016 were retrospectively analyzed. Results After careful nursing,98.9％(2588/2616)patients successfully completed the examination,and 1.1％(28/2616)patients completed the examination with auxiliary nursing for a variety of reasons. Conclusion Perfect and targeted wholeprocess nursing is an important guarantee to complete PET/CT examination and obtain high quality image.

Objective To inverstigate the MRI manifestations of synvial sarcoma in limbs and to improve its diagnostic accura-cy.Methods The imagining and clinical data of 13 cases of synvial sarcona proved by pathlolgy were analyzed retrospectively . All cases had been performed contrast-enhancement MRI .Results Thirteen were detected in 13 synvial sarcona , whith were lo-cated in the upper limb in 5 cases, in the thigh in 5 cases, in the heel in 3 cases.8 cases lesions showed oval shape , and 7 le-sions showed round shape .The lesions ranged in maximum diameter from 3.5 to 16 cm, with a mean of 7.9 cm.Their MRI ap-pearance was usually heterogeneous , seta, hemorrhage and necrotic or cystic changes were frequently seen .The enhancement of synovial sarcoma was usually pronounced and inhomogeneous .Conclusion MRI can demonstrate the location , site and relation-ship with surrounding tissue of synovial sarcoma clearly .The characteristics of MRI findings are specific .But small synvial sarco-ma can demonstrate relatively homogeneous signal intensity with well circumscribed margin , still require biopsy to confirme .

Objective To compare the CT manifestations and pathological findings of gastric cancer and gastric lymphoma.Methods A total of 34 patients with gastric cancer and gastric lymphoma, who were admitted to our hospital from June 2011 to may 2016, were selected and the CT and pathological manifestations of these patients were retrospectively analyzed in this work.Results 15 cases (83.3%) gastric cancer appeared "white line sign" and all patients with gastric lymphoma did not presented with "white line sign";There were significant differences between the two (P<0.05).The enhanced scan at dynamic venous phase and portal venous phase in all patients with gastric lymphoma showed homogeneous enhancement;7 patients with gastric cancer appeared the perigastric lymph node enlargement and 2 cases appeared the peritoneal lymph node enlargement in renal hilum, 6 patients (37.8%) with gastric lymphoma appeared the peritoneal lymph node enlargement in renal hilum;There were significant differences between the two (P<0.05).Conclusion The CT manifestations and pathological findings of gastric cancer and gastric lymphoma are quite distinct from each other.Whether there are the "white line sign" of the gastric mucosa and the enlargement of peritoneal lymph node in renal hilum or not can provide an important basis for the differential diagnosis between the two disorders.

脑结核临床较少见，由于缺乏特异性的临床表现，易误诊，近年来由于结核杆菌基因突变、抗痨药物研制相对滞后等原因，结核病发病率有升高趋势[1]。我院收治粟粒性脑结核患者1例，现报道如下。

Objective To investigate the value of air bronchogram and vacuole sign coexistence in CT diagnosis of non-nodular or mass type pulmonary cryptococcosis. Methods The CT images of 65 PC patients were retrospectively analyzed which were confirmed by biopsy or surgical pathology,the CT characteristics of PC patients were evaluated,especially air bronchogram and vacuole sign coexistence. Results Of the 65 PC patients,41 cases were non-nodular or mass type,the air bronchogram and vacuole sign coexistence were found in 10 cases in CT images,the occurrence rate was 24.4%.According to the CT images,the PC could be divided into 3 types:nodule or mass type,patchy infiltration type,mixed type.The phenomenon were presented in patchy infiltration type 6 cases and in mixed type 4 cases,did not appear in the nodule or mass type. These lesions were located in the right lower lobe and the left lower lobe,each had 5 cases(n=5).When air bronchogram appeared,the bronchial wall was smooth without local expansion,narrow or tortuosity. When vacuole sign appeared,7 cases had single vacuole and 3 cases had multiple vacuoles.2 cases with vacuoles were scattered distributed,1 case with vacuoles was partially fused in the others.The relationship between the two was that the vacuoles were located in the distal end of the bronchus in 7 cases,proximal in 1 case,parallel in 2 cases.The vacuoles and the bronchus were not connected.The diameter of the vacuole was greater than bronchial lumen. Conclusion Air bronchogram and vacuole sign coexistence may be a special CT sign of non-nodular or mass type PC,which may have a great value in differential diagnosis of PC and the other pulmonary lesions.

OBJECTIVE To investigate the value of CT imaging in diagnosis of pulmonary invasive fungal infection in patients with hematological malignancies .METHODS A total of 68 cases of patients with hematological malig-nancies from Jan .2012 to May 2016 in our hospital were selected .All patients were examined by CT imaging . The comparison of invasive pulmonary fungal infection rate between X-ray diagnosis and CT diagnosis ,pulmonary fungal infection types ,pathogenic bacteria distribution ratio ,and the CT imaging features of patients were ana-lyzed .RESULTS There were 35 patients occurred pulmonary invasive fungal infection .with the infection rate of 51 .47% .The types of pulmonary fungal infection included :diffuse type ,aspergilloma type ,consolidation type , and nodular type ,accounting for 7 .14% ,25 .71% ,22 .86% ,and 14 .29% ,respectively .In accordance with the "National Clinical Practice"for etiological diagnosis ,35 patients were all positive ,with the positive rate of 100 . 00% .Totally 8 cases were positive by X-ray diagnosis ,with the positive rate of 22 .85% ,and 31 cases were posi-tive by CT imaging diagnosis ,with the positive rate of 88 .57% .The positive rate of X-ray diagnosis was signifi-cantly higher than that of X ray (P<0 .05) .The distribution of pathogenic bacteria was mainly composed of As-pergillus spp ,and followed by Candida spp and Cryptococcus spp .CONCLUSION The CT imaging has a very important significance in the diagnosis of pulmonary invasive fungal infections in patients with hematologic malig-nancies .It can provide effective diagnostic basis ,especially in the early treatment of pulmonary fungal infection . Combined with the patient's clinical underlying disease ,it can be a preliminary diagnosis of pulmonary fungal infection .It has a good clinical reference value ,and is worth to be widely spread in clinical practice .

Objective To investigate the spiral CT features of solid pseudopapillary tumor of pancreas (SPTP).Methods Spiral CT features of 34 SPTP cases confirmed by surgery and pathology were analyzed retrospectively.Results There were 30 females and 4 males.Tumors located in the tail,head,body and neck of the pancreas were respectively in 14,11,6 and 3 cases.The maximum diameter was 2.0-20.0 cm,with an average of 6.5 cm.There were 29 cases of solid-cystic mass with a CT value of 12.6-21.3 HU and 5 cases of solid mass with a CT value of 24.5-42.8 HU;Complete capsule were observed in 24 cases,while incomplete capsule were observed in 10 cases;15 cases were found with tumor calcification,13 with hemorrhage and 2 cases with liver metastasis.After dynamic enhancement,the solid part and capsule showed progressive and slight enhancement in the arterial phase with a CT value of 30.1-43.6 HU,and slight enhancement in portal phase with a CT value of 41.2-68.9 HU,and persistent enhancement in delayed phase with a CT value of 48.2-63.8 HU.Conclusions Spiral CT features of SPTP are characterized by progressive enhancement of solid mass in enhanced scan.

目的 研究松果体钙化(PC)对首发精神分裂症(FES)患者的临床诊断价值.方法 回顾性分析220例经临床确诊的FES患者的脑部CT图像,观察FES患者的松果体有无钙化,同时测量其钙化大小,并与对照组(n=200)进行对照研究.按照临床分型患者组分两亚组:偏执型组和非偏执型组.经统计学处理后分析:①PC在患者组与对照组之间的差异.②PC在偏执型组与非偏执型组中的差异.③PC在患者组与对照组男女之间的差异.④患者组中PC发生率及钙化大小与年龄相关性.结果 ①患者组PC 139例,其中男性71例,女性68例,发生率为63.18％(139/220);对照组PC 90例,其中男性41例,女性49例,发生率45％(90/200).FES患者PC发生率明显高于对照组(x2 =13.97,P=0.001).②偏执型组与非偏执型组PC发生率差异无统计学意义(x2=0.28,P=0.60).③PC在患者组与对照组男女性别之间差异无统计学意义(x2=0.88,P=0.35;x2=0.25,P=0.62).④患者组钙化大小在18岁之前随患者年龄增加而增大,呈正相关(r=0.96,P＜0.001),与对照组相比,松果体在FES患者中存在过早钙化.结论 FES患者PC的发生率高于对照组,PC对FES早期临床诊断具有一定参考价值.

目的 分析HIV阴性患者肺隐球菌病(PC)的临床与CT影像表现特点,以期提高肺隐球菌临床诊治水平.方法 回顾性分析1998年1月至2013年12月经病理证实的65例HIV阴性PC患者的临床资料.结果 65例PC患者中,33例患者有临床症状,主要表现为呼吸系统症状,出现胸痛9例.32例患者无症状,包括2例外伤后检查发现.有基础疾病27例,有无基础疾病的两组PC患者影像学分型比较差异无统计学意义(p＞0.05).PC的伴随征象复杂,主要出现空气支气管征16例,空洞/空泡12例,分叶征11例,晕征4例,其中同一病灶内出现空气支气管征和小局灶坏死区10例.有无基础疾病的两组PC患者影像学上出现主要征象的差异有统计学意义(P＜0.05).结论 PC的临床症状不典型,中青年人群发病多见.CT影像表现复杂,常以结节和片状浸润影出现,病灶多为单肺叶分布,在肺下叶和外围带为主.多发混合型的多种形态病灶存在有一定特征性;单发结节型诊断困难.PC伴随征象复杂,晕征对其诊断价值有限;同一病灶内空气支气管征和小局灶坏死区并存可能为PC一特殊征象.

目的 探讨位于胰腺内的异位副脾(intrapancreatic accessory spleen,IPAS) CT和MRI影像学特征.方法 回顾性分析经手术病理证实的5例IPAS患者的病例资料,其中5例行CT平扫和增强检查,2例同时行MRI平扫和动态增强检查.结果 5例胰腺异位副脾均位于胰尾,主要表现为信号强度或密度与脾脏相似,增强后病灶均匀强化,与脾脏实质强化程度相似,3例同时伴有脾门区或脾脏周围副脾.结论 IPAS为胰腺少见病变,易造成误诊,但其位置、CT及MRI平扫及动态增强具有一定影像学特征.