頸部結核3KeyWordstuberculosis[tj?,b??kj?'l??s?s]n.肺結核；結核病larynx['l?r??ks]n.[解剖]喉；喉頭thyroid['θa?r??d]n.甲狀腺；甲狀軟骨；adj.甲狀腺的；盾狀的pathogenesis[,p?θ?'d??n?s?s]n.發病機理；發病原KeyWordshaematogenous[hi:m?‘t?d?in?s]血源性的，造血的granulomasn.肉芽腫mucosa[mj?'kos?]n.[解剖]粘膜antiseptic[?nt?'sept?k]adj.防腐的，抗菌的；n.防腐劑，抗菌劑IntroductionThepurposeofthisstudyistodescribetheimagingfeaturesoftuberculousinvolvmentinthefollowingneckregions:larynx;thyroidgland;neckspaces.Thepathogenesisandimagingfindingsoftuberculousinvolvementintheneckregionwillbediscussed.簡介

本研究主要描述頸區域（喉、甲狀腺、頸間間隙）結核病變的影像特征。討論頸部區域結核的發病機制和影像學表現。LarynxPathogenesisPrimaryinvolvementisrareandoccursbydirectinfectionofthemucosaviaaerosolizedparticles.Secondaryinvolvementoccursviaexpectorationofhighlyinfectioussputumfromthetracheo-bronchialtree,viahaematogenousspreadfromsitesotherthanlungs,orvialymphaticspread,whichisrare.喉發病機制

原發性喉結核較為罕見，主要是通過霧化微粒直接感染粘膜所致。繼發性喉結核是由來自氣管支氣管樹具有高度傳染性的痰、來源于肺組織以外其他部位結核的血源性播散、或是淋巴擴散所引起,而淋巴播散較為罕見。ImagingfindingsCTandMRIfindingsintheacutestageincludediffusebilateralglotticthickening,withorwithoutanassociatedmass。Thecommonestfindinginthechronicstageisalocalizedlesiongranulomamimickingamass.影像表現

CT和MRI發現在急性期雙側聲襞彌漫性增厚，伴或不伴有腫塊形成。在慢性期最常見的表現是類似腫塊的局部肉芽腫性病變。Fig1AxialCECTofthelarynxshowsalarge,enhancing,tumourlikegranulomatousmassinpre-epiglotticspace(blackarrow)withcaseatingrightcervicallymphnode(whitearrow).圖1、喉部軸位CT圖像顯示，會厭前間隙可見體積較大、明顯強化、類似腫瘤的肉芽腫腫塊(黑色箭頭)和右頸部干酪樣壞死淋巴結(白色箭頭)。ThyroidPathogenesisTuberculousinvolvementofthethyroidisrareandisduetosecondaryinvolvementeitherbyhaematogenousspread,orbycontiguousspreadfromadjacentinfectedlarynxandlymphnodes.Tubercularthyroidinvolvementisrarebecausethethyroidglandisenvelopedbyatoughcapsuleprotectingitfromcontiguousspreadofinfectionandthehighiodineconcentrationwithintheglandwhichactsasanaturalantiseptic.甲狀腺發病機制

甲狀腺的結核比較罕見,甲狀腺結核主要是通過血源性播散或通過臨近感染的喉及淋巴結的直接蔓延所引起的繼發感染。原發性甲狀腺結核罕見是因為甲狀腺體有被膜包繞使它免于臨近感染的播散，腺體內的高濃度碘成為天然的抗菌劑。ImagingfindingsCTdemonstratemultiple,small,focallesionsintheentireglandresemblingmiliaryTB(Fig.7).Caseatinggranulomascancauseenlargementoftheglandwithcoldabscessformationwithorwithoutsinusformation.影像表現

CT顯示在整個腺體中表現為類似粟粒狀肺結核的多發小而局灶的病變(圖7)。干酪樣肉芽腫能增大已形成冷膿腫（伴有或不伴有竇道的形成）的腺體。Figure.2Axialimageofthethyroidgland.Miliarylowdensitynodules(openarrows)intheentirethyroidgland.圖2、甲狀腺軸位圖像顯示在整個甲狀腺中多發粟粒狀的低密度結節影(空心箭頭)。NeckabscessPathogenesisSecondarylymphaticinvolvementiscommonduetoacutetubercularpharyngitis/mastoiditisorchronictuberculousinfectionofcervicalspineorcervicallymphnodes.Itcommonlyoccursintheretropharyngealspacemostlyduetoinfectionintheretropharyngealnodes.頸部膿腫發病機制

繼發性淋巴感染主要是由于急性結核性咽炎/乳突炎或慢性頸椎或頸部淋巴結結核性感染引起。它通常發生在咽后間隙，主要是由咽后淋巴結感染引起。ImagingfindingsCTandMRIshowvariable-sized,ill-defined,thick-walledmasseswithcentralnecrosisandrimenhancementfollowingcontrastmediuminjection(Fig.4).影像表現

CT和MRI顯示為形態多樣、邊界不清、伴有中央壞死和注射對比劑后邊緣強化的厚壁腫塊。（圖4）Figure3、CoronalCTimageoftheneckshowingalarge,peripherallyenhancing,centrallyliquefied,multiseptate,transpatialcoldabscess(whitearrows)withairway(whitearrowheads)andvascularmasseffect.圖3、頸部冠位CT示：體積較大、周邊強化、中心液化壞死、跨間隙生長的冷膿腫，伴氣道(白色箭頭)和血管(白色箭頭)的占位效應。ConclusionTuberculousinfectionaffectsmanysitesintheneck,andhasavarietyofimagingappearances,mimickingbenignandmalignantlesions.ThediagnosisofTBcanbesuggestedbasedonspeci?cimagingfeatures.Earlycom