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1 临床资料患者女,43岁,农民,于13年前患右颈部淋巴结核和肺结核,治愈1个月后突然出现双眼球明显突出于双下睑,随即去当地医院诊治,诊为“眼球突出征”,给予包扎和消炎,激素药物治疗,但眼球一直突出伴有头痛,且视力呈进行性下降.间断于抗炎治疗无效.于1997年10月14日患者突然双目失明,1997年11月3日来我院诊治,门诊以“眶内肿瘤”收治.检查:一般情况尚可,心肺听诊无异常.T36,7℃,P78次/min.胸透:心肺膈正常.心电图示:窦性心律,大致正常心电图,检验:TT476.6ng/ml,TT3<0.5ng/ml,TC4.0%,TM7.8%,FT418Pmol/L.血常规查:Hb112g/L,WBC5.4×10~9/L,No,82,LO.18.如NO.82,L0.18.Hertel突眼计测量:双眼眶距95mm,眼球突出度20mm.CT扫描:脑实质密度未见异常,脑室对称、脑沟、脑裂、眼池不宽,中线不偏,鞍上视交叉区骨质结构异常,眼球双侧明显突出、眼环不大眼球不大,增厚,后壁与球后组织分界不清;球后组织密度明显增高不均与视神经、内外直肌密度近视而分辨不清,球后容积增大,眶壁骨质无破坏,筛窦正常.CT扫描提示:头颅未见异常;重度突眼征;眼球后弥漫性组织增生.经内分泌科会诊,排除甲亢疾病,耳鼻喉科会诊;考虑上颌窦粘膜肥厚;口腔科会诊意见:双侧眶下区麻
1 Clinical data Female, 43 years old, farmer, suffering from right neck lymph node and tuberculosis 13 years ago, suddenly appeared two months after the cure of his eyes suddenly prominent in the double lower eyelid, then went to the local hospital for diagnosis and treatment, diagnosed as “eyeball Prominent sign ”, given bandaging and anti-inflammatory, hormone drug treatment, but the eye has been accompanied by a prominent headache, and visual acuity was progressive decline in the anti-inflammatory treatment is invalid .In October 14, 1997 the patient suddenly blindness, 1997 November 3 came to our hospital for diagnosis and treatment, out-patient to “orbital tumors.” Check: the general situation is acceptable, no abnormal heart and lung auscultation. T36, 7 ℃, P78 times / min. Sinus rhythm, roughly normal ECG test: TT476.6ng / ml, TT3 <0.5ng / ml, TC4.0%, TM7.8%, FT418Pmol / L. Blood test: Hb112g / L, WBC5.4 × 10 ~ 9 / L, No, 82, LO.18. Such as NO.82, L0.18.Hertel exophthalmeter measurement: binocular orbital distance 95mm, 20mm eyeball protrusion .CT scan: no abnormal brain parenchymal density, ventricular symmetry , Sulci, cerebral fissure, eyelid is not wide, the center line is not partial, the suprasellar region of the suprasellar bone structure abnormalities, prominent bilateral eye, eye ring is not large, thickening, posterior wall and the ball after the organizational boundaries Clear The density of weaving increased obviously and unevenly and the optic nerve, the density of myopia of inner and outer rectus were indistinguishable, the volume of the ball increased, the orbital bone was not damaged and the ethmoid sinus was normal.CT scan showed no abnormalities in the skull, Diffuse hyperplasia of the eye after endocrine consultation, rule out hyperthyroidism, otolaryngology consultation; consider the maxillary sinus mucosa hypertrophy; stomatological consultation see: bilateral infraorbital area