2021年 · 第59卷第05期

Female, 72 years old, was admitted to our department on December 12, 2017 due to "physical examination found that pancreatic body occupied space". Physical examination showed no obvious positive signs. Laboratory tests: There were no abnormalities in blood routine and biochemical tests, and CA19-9, CA15-3 and carcinoembryonic antigen were all within the normal range. After admission, abdominal enhanced CT examination showed that the body of the pancreas occupied space, the size was about 2.1 cm ×1.6 cm. The enhanced scan showed low enhancement, secondary distal pancreatic duct dilatation, pancreatic tail atrophy, splenic vein involvement was not excluded, no lymph node metastasis was seen, and no metastatic lesions in the liver were seen (Figure 1）。 The results of chest CT examination showed that both lung fields were clear and no obvious abnormal density focuses were found. The patient underwent radical left mastectomy combined with left axillary lymph node dissection 34 years ago. The postoperative pathological examination showed invasive ductal carcinoma without lymph node metastasis, and was treated with adjuvant chemotherapy and sequential endocrine therapy. His father died of esophageal cancer, his brother died of ureteral cancer, and his sister died of lung cancer. Admission diagnosis: (1) Pancreatic neck and body occupy space, pancreatic cancer is likely; (2) Postoperative left breast cancer.

Male, 53 years old, was admitted to our hospital on November 27, 2003 because of "postoperative interventional treatment of primary massive liver cancer in the right lobe of the liver". The patient underwent local transcatheter hepatic arterial chemoembolization (TACE) on September 9 and October 14, 2003, and was admitted to our hospital for further treatment. Physical examination at admission: the abdomen was flat and soft, no intestinal shape and peristaltic wave, no mass, no liver and spleen under the costs, no percussion pain in the liver area, negative mobile voiced sound, and normal intestinal sound. Patients with previous history of type 2 diabetes and chronic hepatitis B, and no malignant tumors of the digestive tract in their families. Laboratory tests after admission: alpha-fetoprotein 1 580 μ g/L, carcinoembryonic antigen 2.89 μ g/L, CA125 29.5 U/L, CA19-9 11.48 U/L, normal liver function. CT examination showed that after embolization of liver cancer in the right lobe of the liver, there was an increase in radioactivity density in the area where the original tumor was located, which was caused by embolization agent. The embolization focus and the surrounding area of the right lobe of the liver were mild hypermetabolism, and the changes after liver cancer treatment were considered. Ultrasonography showed a substantial space-occupying lesion in the right lobe of the liver, with a size of approximately 74.8 mm ×42.7 mm, considering liver cancer; Small bulging lesions in the gallbladder, considering polyps of the gallbladder. Admission diagnosis: after interventional therapy for liver cancer; Type 2 diabetes; Chronic hepatitis B.

Female, 34 years old, was admitted to the hospital on June 20, 2020 due to "25 weeks of pregnancy, low back pain with left lower limb pain and numbness for 3 months, aggravated for 1 month". The patient developed low back pain with pain and numbness in the left lower limb 3 months ago (12 weeks of pregnancy), and was given strict bed rest, hot compress, infrared irradiation and other treatments. The symptoms gradually worsened, and the pain in the left lower limb was severe. Mannitol 250 ml and dexamethasone 10 mg were given intravenous drip for 6 days, but the symptoms were not satisfactory. Physical examination: pregnancy status; The physiological curvature of the spine becomes straighter and the waist movement is limited; L₅Spinous process tenderness, percussion pain, pain radiating to the left lower limb and plantar; Left dorsal lateral and plantar skin hypoesthesia; The reflex of left Achilles tendon was weakened, and the muscle strength of flexor longus hallucinus was grade 4; The left lower limb straight leg elevation test was 30° positive and the reinforcement test was positive. Lumbar spine MRI showed: L₅~ S₁The intervertebral disc protrudes to the left posterior and prolapses downward; L_3~5Intervertebral discocele (Figure 1）。 visual analogue scale (VAS) for lumbar pain was 4 points and left lower limb was 8 points; The Oswestry disability index (ODI) was 84%. Diagnosis: (1) 25 weeks gestation; (2) lumbar disc herniation (LDH).

Male, admitted to hospital on 10 Dec 2018 mainly for "perianal pain with pruritus for 6 months". Two months ago, I underwent incision and drainage of perianal abscess in an external hospital, and repeated perianal fluid after operation, and went to our hospital for treatment. MRI enhanced imaging of the anal canal revealed: anal fistula (transsphincteric fistula with abscess and secondary sinus type). Combined physical examination and MRI results, this case was judged to be a more complicated anal fistula (FIG. 1A）。 DICOM format images of MRI were exported and 3D reconstructed with IN COOL 3D (FIG. 1B), it can be seen that the lithotomy position is about 10 cm away from the anus in the 5 o'clock direction as the external opening, and the sinus tract runs to the cephalic side, forming an enlarged abscess cavity. The fistula continues to run forward on the outside of the external sphincter, forming an enlarged abscess cavity again, and forming multiple branches here; The first fistula runs down to the left and finally forms a blind end, the second fistula continues along the outside of the sphincter to the left front, and then enters the external sphincter, and the third fistula directly penetrates the external sphincter from the posterior median position, and bifurcates again between the internal and external sphincters, forming two horseshoe-shaped fistulas to the left and right; The left horseshoe fistula merges with the aforementioned second branch fistula in the form of a communicating branch (FIG. 1B), while the right horseshoe fistula enters the internal sphincter at the posterior median, and eventually penetrates the rectum near the dentate line to form an internal opening.

Male, 70 years old, was admitted on 21 November 2019 due to "fever with right groin pain for 1 week". One week ago, fever occurred without trigger, with the highest body temperature of 39.6℃, accompanied by general pain and discomfort, and obvious pain in the right inguinal area. Symptomatic treatment such as anti-inflammatory and antipyretic drugs was given to the local clinic, but the effect was not good. Past history: A history of hypertension for more than 5 years, self-administered nifedipine, and blood pressure control was acceptable; Three months ago, he underwent suppurative appendectomy and pelvic abscess drainage in an external hospital. He recovered well and was discharged successfully. Admission physical examination: body temperature 36.9 ℃, heart rate 88 beats/min, breathing 18 beats/min, blood pressure 101/70 mmHg (1 mmHg =0.133 kPa). Abdominal physical examination showed no obvious positive signs. The local skin of the right lower abdomen near the groin area is red and swollen, the skin temperature is increased, and it is tender (+). The superficial lymph nodes of the right groin can be palpable and swollen, and the movement of the right hip joint is limited. Emergency blood routine: white blood cell count 13.82×10⁹/L, the percentage of neutrophils was 91%. Pelvic CT scan: right pelvic abscess (FIG. 1A，1B）。 Combined with the patient's medical history, physical signs and auxiliary examination results, the clinical diagnosis: right pelvic abscess, postoperative suppurative appendicitis, and hypertension.