摘要
目的:探讨SAPHO综合征的临床及影像学特征,分析误诊、漏诊原因,提高诊断水平。方法:回顾性分析7例SAPHO综合征患者的临床及影像学表现、误诊漏诊情况及合并疾病,总结鉴别诊断要点。结果:7例患者中1例合并胰腺癌,1例HLA-B27阳性。临床表现上2例既有皮肤损害又有骨关节病变,5例仅有骨关节受累。影像检查中7例患者均有不同程度的前上胸壁受累,骨硬化及骨肥厚为特征性表现。脊柱为第二常见受累部位,以胸椎最多见,连续的椎角病变形成的半圆形模式具有一定特征性。骶髂关节受累以双侧髂骨硬化为主。7例患者中1例误诊为掌跖脓疱病,1例误诊为肋软骨炎,1例误诊为掌跖脓疱病和肋软骨炎,1例合并胰腺癌误诊为转移瘤,1例误诊为强直性脊柱炎,1例误诊为胸锁关节炎;1例合并胸椎压缩性骨折,早期漏诊。结论:SAPHO综合征的临床和影像表现多样,当出现典型皮肤损害而无骨关节表现时,应考虑本病可能;当仅有骨关节受累时,应充分了解骨骼病变出现的先后顺序及特征性影像学表现。
Objective:To discuss the clinical and imaging features of SAPHO syndrome(synovitis,acne,pustulosis,hyperostosis,osteitis)and analyze the cause of misdiagnosis and missed diagnosis.Methods:The clinical and imaging materials of seven patients with SAPHO syndrome were collected.The imaging characteristics,causes of misdiagnosis and missed diagnosis as well as the associated diseases were analyzed respectively,also,the differential diagnosis were studied.Results:Of the 7patients,there was one case had pancreatic cancer associated and one case with positive HLA-B27.Clinically,there were two cases had both skin and osteoarticular involvement;five patients had only osteoarticular lesions without skin involvement.All patients had different degree of anterosuperior chest wall involvement characterized by osteosclerosis and hyperostosis.Spine was the second most commonly affected site and the lesions were located predominantly at the thoracic spine.The semicircular pattern of continuous vertebral body corner involvement provided certain characteristic features.Sacroiliac joint involvement mostly shown as bilateral iliac sclerosis.Of the 7patients,the misdiagnosis included palmoplantar pustulosis,costal chondritis,palmoplantar pustulosis and costal chondritis,sternoclavicular arthritis,and ankylosing spondylitis for one case each.One case associated with pancreatic cancer was misdiagnosed as metastases,whereas one case with thoracic vertebral compression fracture was missed diagnosed.Conclusion:The clinical and imaging features of SAPHO syndrome varied.The possibility of this disease entity should be considered when a typical skin lesion appeared yet without osteoarthropathy.As only osteoarthropathy presented,fully understanding of the occurrence sequence of lesions as well as characteristics of imaging manifestations are required to obtain a correct diagnosis.
作者
张亚男
霍健伟
温庆祥
于梅艳
杨迎
崔璨
赵鲁卿
张秦
李俊秋
ZHANG Ya-nan;HUO Jian-wei;WEN Qing-xiang(Department of Radiology, Beijing Hospital of Traditional Chinese Medicine affiliated to Capital Medical University,Beijing 100010,China)
出处
《放射学实践》
北大核心
2019年第1期55-59,共5页
Radiologic Practice
关键词
SAPHO综合征
掌跖脓疱病
肋软骨炎
强直性脊柱炎
误诊
漏诊
SAPHO syndrome
Palmoplantar pustulosis
Costal chondritis
Ankylosing spondylitis
Diagnostic errors
Missed diagnosis
