本期试题：
关于颈部淋巴结核的处理，下列哪项是错误的d
a．活动的淋巴结应完整手术切除
b．形成寒性脓肿尚未破溃时，可穿刺吸脓
c．继发感染形成脓肿后，需行切开引流术
d．寒性脓肿破溃者，刮除感染灶，缝合伤口
e．口服抗结核药物2年
最近事物繁忙，公众平台更新缓慢了，先对大家说声抱歉！！！但是新内容也会不断更新的，谢谢大家一直对公众平台的支持！谢谢大家！我会继续努力完善！！！
病例1
患者基本信息：患者女性，27岁，泌乳3余年
检查方法：MRI
影像特征：
图1 T1WI冠状位显示垂体右翼混杂信号影
图2 T2WI显示垂体右翼病变呈不均匀短T2信号影
图3-4 动态增强MR T1WI冠状位显示病灶强化晚于、弱于正常腺体
图5 延迟增强MR T1WI冠状位显示病灶相对于正常腺体强化减低，病灶右缘呈结节状突向海绵窦，边界较锐利
拟诊：垂体微腺瘤
诊断要点：垂体瘤是发生于腺垂体的良性肿瘤，绝大多数为单发病变，占所有颅内肿瘤的10%-15%，是成年人鞍内最常见的肿瘤。约75%的垂体腺瘤患者伴有激素分泌水平异常，常见的如泌乳素、生长激素、促肾上腺皮质激素、促甲状腺释放激素等，直径＜10mm的为微腺瘤。与正常腺体相比，垂体微腺瘤在MR T1WI上显示呈低信号影，多呈圆形或卵圆形，也可由于出血呈高信号影。大部分垂体微腺瘤在MR T2WI上呈高信号影，但也可呈等信号至低信号影。其他征象还包括鞍底侵蚀、局限性鞍隔上抬及垂体柄偏移。也有些腺瘤平扫与垂体呈等信号影，仅在增强图像或动态增强图像上可显示。多数垂体瘤强化晚于、弱于正常腺体。
Diagnosis: pituitary tumor is benign tumor in the adenohypophysis, most for single lesion, accounted for 10% of all intracranial tumors - 10%, is the saddle of the most common tumor in adults. About 75% of the patients with pituitary adenomas associated with abnormal hormone secretion level, common such as prolactin and growth hormone release, adrenocorticotropic hormone, thyroid stimulating hormone, such as diameter of < 10 mm for micro adenoma. Compared with the normal glandular, micro pituitary adenomas displayed on the MR T1WI low signal shadow, assumes the circular or ovoid, may also be because of the bleeding has high signal. Most of the micro pituitary adenoma in MR has high signal on T2WI shadow, but can also be a signal to low signal. Other signs include saddle bottom erosion, limitations saddle up and pituitary stalk migration. Also some adenoma scan with pituitary signal such as shadow, only in the enhanced image or dynamic enhanced image can be displayed. Most of pituitary adenoma developed later than, weaker than normal glands.
鉴别诊断：
Differential diagnosis:
1、Rathke裂囊肿：通常位于垂体前、后叶之间，增强后无明显强化等。
1, Rathke cleft cyst: between before and after the leaves are usually located in the pituitary gland, no obvious enhancement, etc.
2、淋巴细胞性垂体炎：通常垂体弥漫增大，垂体后叶及垂体柄受累等。
2, lymphocytic pituitary gland inflammation: usually pituitary diffuse enlargement, posterior lobe, involvement of pituitary stalk, etc.
3、颅咽管瘤：通常病变中心位于鞍上，常有钙化等。
3, craniopharyngioma: usually the lesion center is located in the saddle, often calcified, etc.
病例2
患者基本情况：患者女性，28岁，甲状腺功能减退、泌乳
检查方法：MRI
影像特征：
图1 增强MR T1WI冠状位显示垂体均匀强化，上缘膨隆，视交叉受压上抬
图2 增强MR T1WI矢状位显示垂体均匀强化，上缘膨隆 图3 患者行补充甲状腺素治疗3个月后复查，MR T1WI 矢状位显示垂体上缘位置较前下移，垂体体积较前明显减小。
拟诊：垂体增生
诊断要点：垂体增生可分为生理性或病理性增生。生理性垂体增生在青春期、妊娠期、哺乳期及绝经期等情况下短暂出现，可自行恢复。病理性垂体增生多由于垂体终末器官（如甲状腺、肾上腺皮质、卵巢等）功能低下，尤其是甲状腺功能减退多见，也可见于神经内分泌肿瘤。MRI典型表现为垂体增大，上缘膨隆。均匀等信号影，均匀强化。
Diagnosis: pituitary hyperplasia can be divided into the physiologic or pathologic hyperplasia. Physiology of pituitary hyperplasia in puberty, pregnancy, lactation, and the brief case of menopause, such as, can restore itself. Pathological of pituitary hyperplasia due to more pituitary end-organ (such as thyroid, adrenal cortex, ovarian function is low, especially the hypothyroidism, is also visible in neuroendocrine tumor. Typical MRI for pituitary increases, on the edge of peng. Even signals such as shadow, uniform reinforcement.
鉴别诊断：
Differential diagnosis:
1、垂体瘤：微腺瘤可见与正常垂体组织之间信号强度及强化差异；大腺瘤因信号及强化均匀，鉴别有难度，需结合临床。
1, pituitary tumor: micro visible and normal pituitary adenoma tissue signal intensity and strengthen the differences between; Large adenoma by signal and strengthen the uniform, identification difficult, should be combined with clinical.
2、淋巴细胞性垂体炎：可有垂体柄受累及垂体后叶受累，激素冲击治疗后体积缩小。
2, lymphocytic pituitary gland inflammation, can have involvement of pituitary stalk and pituitary lobe dysfunction after hormone shock shrinkage after treatment.
