病例来源：AmericanCollegeofRadiology
CaseAuthors：
MarcoMarangoni,MD;GabrielaAbrego,MD;BruceCurtGilbert,MD
A72-year-oldwomanpresentswithrapidlyprogressivehorizontalandverticaldiplopiaaswellaspainintherightforeheadandrightnasalregion
72岁女性，进行性水平及垂直方向复视，进展迅速，伴有右侧前额、鼻部疼痛。
Question
1.Whichofthefollowingarepresentontheseimages?(Checkallthatapply.)
此组图像的可见下列那种表现？（选择全部正确选项）
Orbitalapexinvolvement
眶尖部侵犯
Osseoussclerosis
骨质硬化
Mastoidaircelldestruction
乳突气房破坏
Sphenoidsinuscorticaldisruption蝶窦皮质破坏
正确选项：1、3、4
注释：
Thelesioninvolvesthelateralwallofthesphenoidsinusextendingintotherightorbitalapex,asdemonstratedbylossofnormalfatattenuationinthislocation.
此病变累及蝶窦外侧壁，侵入右侧眶尖，表现为此处正常脂肪消失。
Thewallsofthebilateralsphenoidsinusesarethickenedandsclerotic,asistheintersphenoidalseptum.Thesphenoidsinusisopacified.
双侧蝶窦壁及间隔增厚、硬化，蝶窦浑浊。
Thereisnoevidenceofadestructiveprocessinvolvingthemastoidaircellsontheprovidedimages.
所示图像并无证据表明乳突气房破坏。
Focalcorticaldisruptionofthelateralwalloftherightsphenoidsinusispresent.
可见右侧蝶窦外侧壁局部骨皮质破坏。
Question
2.BrainMRimagesdemonstratewhichofthefollowing?(Checkallthatapply)
颅脑MR图像的表现包括下列那种？（选择全部正确选项）
Sphenoidsinusopacification
蝶窦浑浊
Internalcarotidarteryocclusion
颈内动脉闭塞
Normalpatternofsphenoidsinusmucosalenhancement
蝶窦粘膜正常强化
Unilateralcavernoussinusexpansion
单侧海绵的膨胀
正确选项：1、4
注释：
Thecontrast-enhancedT1-weightedimagesshowdiffuselossofnormalaerationofthesphenoidsinuswithintrinsicT1hyperintensesignalandperipheralmucosalenhancement.Thereissomeassociatedleftsphenoidsinusexpansion,consistentwithearlymucocele-likechanges.
对比增强T1WI示蝶窦内气体弥漫缺失，周围粘膜强化，T1像呈高信号，相应左侧蝶窦膨胀，与黏液囊肿早期改变相符。
Thereisnoevidenceofinternalcarotidarteryocclusionintheseimages.
此组图像未见颈内动脉闭塞。
Atthesuperolateralmarginsofthebilateralsphenoidsinuses,thereislossofmucosalenhancementpattern,andnodularsoft-tissuethickeningispresent.
双侧蝶窦侧上方未见粘膜强化，并见结节样软组织增厚。
Asymmetricexpansionoftherightcavernoussinuswithsoft-tissueattenuationandoutwardconvexityofthelateralwalloftherightcavernoussinusareseen.
右侧海绵窦膨胀并见软组织信号，向右侧海绵窦侧壁外侵犯，与左侧不同。
Question
3.Whichofthefollowingsymptomscanbeexplainedbyacavernoussinussyndrome?(Checkallthatapply)
海绵窦综合征可引起下列哪些症状？（选择全部正确选项）
Diplopia
复视
Mandibulardeviationwithmouthopening
张口时下颌偏斜
Ptosis
上睑下垂
Foreheadparesthesia
前额感觉异常
Unilateralblindness
单侧盲
正确选项：1、3、4
注释：
Inthecavernoussinus,theabducensnerverunslateraltotheinternalcarotidarteryandmedialtotheoculomotorandtrochlearnerves,whicharecontainedwithinthelateralduralborderofthecavernoussinus.Lesionsaffectingthesecranialnervescanpotentiallyresultindiplopia.
海绵窦内外展神经在动眼神经及滑车神经之间，走形于颈内动脉外侧，为海绵窦硬脑膜包裹，当有病变累及这些颅神经时可导致复视。
Thethirddivision(V3)ofthetrigeminalnervesuppliesthemusclesofmastication.ThisbranchofthetrigeminalnerveexitsinferiorlythroughtheforamenovalefromMeckelcaveanddoesnotcoursethroughthecavernoussinus.
三叉神经第三支(V3)支配咀嚼肌，从Meckel腔经卵圆孔出颅，并不经海绵窦走形。
Theoculomotornerveinnervatesthelevatorpalpebraesuperiorismuscleand,whenaffectedbyalesionofthecavernoussinus,canresultinptosis.
动眼神经支配提上睑肌，当海绵窦病变累及时可致上睑下垂。
Theophthalmicnerve(V1),thefirstdivisionofthetrigeminalnerve,runsthroughthelateralduralborderofthecavernoussinusandcarriessensoryinformationfromthescalp,forehead,uppereyelid,conjunctivaandcorneaoftheeye,andnose.Whenaffected,thismayresultinparesthesiasoftheseareas.
三叉神经第一支即眼支(V1)，穿行于海绵窦硬脑膜，传递头皮、前额、上眼睑、结膜及角膜、鼻部的感觉信息，当受累及时可导致这些区域感觉异常。
Theopticnerveisnotlocatedinthecavernoussinusandisnotaffectedinacavernoussinussyndrome.
视神经不从海绵窦走形，不受海绵窦综合征的影响。
图片说明：
Thisaxialcontrast-enhancedCTofthebraininbonewindowshowscorticaldisruptionofthelateralwalloftherightsphenoidsinus(arrow)withapermeativepatternofbonedestruction.
此骨窗轴位增强颅脑CT示右侧蝶窦外侧壁骨皮质中断（箭），呈穿凿样骨质破坏。
ThisaxialcontrastenhancedCTimagedepictsasymmetricsoft-tissueattenuationwithintherightcavernoussinusandorbitalapex(arrows).
此轴位增强颅脑CT示右侧海绵窦及眶尖软组织密度影（箭），与左侧不对称。
ThisT1coronalpostcontrastMRimageshowshyperintensemucosalenhancementofthesphenoidsinuswithdisruptionoftheenhancementpatternsuperolaterallybyanodularmass(arrow)thatislessintensethanadjacentmucosal.
此冠状位增强T1MR像示蝶窦粘膜强化呈高信号，侧上方可见结节样肿块（箭），强化信号低于临近粘膜。
ThisT1coronalpostcontrastimageshowshyperintensemucosalenhancementofthesphenoidsinus.Thereisdiffusemass-likeinfiltrationintotherightcavernoussinuswithsinusexpansionandconvexityofthelateralwall(arrow).
此冠状位增强T1WI示蝶窦粘膜强化呈高信号，右侧海绵窦膨胀，并见弥漫肿块样病变侵入海绵窦及其外侧壁（箭）。
ThisnonenhancedT1MRimageinthecoronalplaneshowsasymmetricT1isointensesignalandexpansionoftherightcavernoussinussecondarytoanintracavernousmass(arrow).
此T1WI冠状位平扫MR像示右侧海绵窦肿块（箭）呈等信号，致海绵窦膨胀，与左侧海绵窦不对称。
ThisT2coronalimagedemonstratesthattheT2signaloftherightcavernoussinuslesionisisointensetograymatter.Themassencasesthecavernoussegmentoftherightinternalcarotidarterywithoutapparentluminalnarrowing(arrow).
此T2WI示右侧海绵窦病变与脑灰质呈等信号，此肿块包绕右侧颈内动脉海绵窦段，而管腔无明显狭窄（箭）。
ThisT2axialimageshowshyperintensematerialoccupyingthesphenoidsinusandhypointenseirregularlesionsalongthelateralwallofthesphenoidsinus,extendingtotheposteriorethmoidcells(arrowhead).Thelesionextendstotheorbitalapex(arrow).Thereisexpansionoftheipsilateralcavernoussinusrelatedtothelesion.
此T2轴位像示蝶窦高信号病变，沿海绵窦外侧壁见不规则低信号病变，并侵入筛窦后部蜂房（箭头）及眶尖（箭），病变导致同侧海绵窦膨胀改变。
Diagnosis
Bilateralnon-Hodgkinlymphomaofthesphenoidsinuswithextensionintotherightcavernoussinusandorbitalapex双侧蝶窦非何杰金氏病淋巴瘤累及右侧海绵窦及眶尖
CasePoints
Lymphomaisanun