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患者女,1岁。间断发热5天,步态异常20余天入院。体检:右大腿肿胀,压痛,局部不红,无波动感,右下肢活动受限。全身皮肤黏膜无皮疹,表浅淋巴结未及肿大,无外伤史。实验室检查:白细胞17.9×109/L,中性粒细胞0.2184,淋巴细胞0.7054。影像表现:X线平片示右股骨近端骨髓腔溶骨性骨质破坏,其内似可见骨嵴,右股骨干外侧骨皮质增厚、破坏伴层状骨膜反应、Codman三角(图1)。CT扫描示右股骨近端骨髓腔溶骨性骨质破坏,骨皮质中断,远端可见厚的骨膜反应(图2、3)。MRI
Female patient, 1 year old. Intermittent fever 5 days, abnormal gait 20 days admitted. Physical examination: Right thigh swelling, tenderness, local red, no fluctuations, right lower extremity activity is limited. No skin rash of systemic mucosa, superficial lymph nodes did not enlarge, no history of trauma. Laboratory tests: leukocytes 17.9 × 109 / L, neutrophils 0.2184, lymphocytes 0.7054. Imaging: X-ray showed osteolytic bone destruction in the proximal femoral medullary cavity. The bone crest appeared to be thick inside the right femoral shaft, and the cortical periosteum was destroyed with Codman’s triangle (Figure 1). The CT scan showed osteolytic osteolysis of the proximal femoral medullary cavity, disruption of the cortical bone, and thick periosteal reaction at the distal end (Figs. 2, 3). MRI