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病例10-2018:一名患无痛性单侧睾丸肿胀的84岁男性
Case 10-2018 — An 84-Year-Old Man with Painless Unilateral Testicular Swelling


Ryan W. Thompson ... 其他 • 2018.03.29
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伪装者

 

李晶

首都医科大学附属北京朝阳医院

 

2017年3月22日NEJM.org发布了一个扑朔迷离的病例1。现在,谜底发表在3月29日出版的《新英格兰医学杂志》“麻省总医院病例”专栏中。虽然该病病原在美国已经非常少,在中国的发病率也大大降低,但我们可以从中学到如何剥茧抽丝、切中要害。

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病历陈述


Michael S. Abers医师(内科):在本院,1例84岁男性患者因无痛性右侧睾丸肿胀接受了评估。

在此次评估前6周,患者在淋浴时注意到右侧睾丸大约为左侧睾丸3倍大,此前患者一直处于他平常的健康状态。触摸时睾丸质软、无触痛,在前一日没有出现肿胀。

第二日,患者到当地医院急诊接受了评估。患者报告没有创伤、提重物、近期性生活、睾丸或阴囊疼痛、腹痛或背痛、皮肤变化或皮疹、梗阻性泌尿系统症状、血尿、排尿困难或分泌物。患者没有全身症状,如发热、盗汗或体重减轻。检查时,右侧睾丸后部有一个大而柔软的活动性肿块;左侧睾丸正常。推定诊断为鞘膜积液,并建议患者使用阴囊托带,如果出现疼痛,则服用非甾体抗炎药。计划在次日进行睾丸超声检查。

HeiShun Yu医师:次日,超声检查(图1)显示右侧睾丸明显不对称肿胀,并且血供丰富。睾丸纵隔中的低回声区很可能与感染或炎症引起的水肿相关。附睾也增大并且血供丰富。右侧出现伴有分隔和内部碎片的相关复杂鞘膜积液。这些发现符合右侧附睾睾丸炎。左侧睾丸回声正常,无局灶性病变。有一处偶发的左侧精索静脉曲张。





作者信息

Ryan W. Thompson, M.D., HeiShun Yu, M.D., Douglas M. Dahl, M.D., Rocio M. Hurtado, M.D., and Dipti P. Sajed, M.D., Ph.D.
From the Departments of Medicine (R.W.T.), Radiology (H.Y.), Urology (D.M.D.), and Pathology (D.P.S.), Massachusetts General Hospital, and the Departments of Medicine (R.W.T., R.M.H.), Radiology (H.Y.), Urology (D.M.D.), and Pathology (D.P.S.), Harvard Medical School - both in Boston.

 

参考文献

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