대한영상의학회지 (Journal of the Korean Society of Radiology)

  • 제78권1호
  • /
  • Pages.30-34
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  • 2018
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  • 1738-2637(pISSN)
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  • 2951-0805(eISSN)
대한영상의학회 (The Korean Society of Radiology)
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성인환자에서 골수염으로 오인된 B 전구세포급성 림프모구 백혈병의 괴사성 골침범: 증례 보고

Necrotic Bone Involvement in an Adult Afflicted with B-Cell Precursor Acute Lymphoblastic Leukemia Mimicking Osteomyelitis: A Case Report

  • 김혜원 (가톨릭대학교 의과대학 여의도성모병원 영상의학교실) ;
  • 권순용 (가톨릭대학교 의과대학 여의도성모병원 정형외과학교실) ;
  • 정요셉 (가톨릭대학교 의과대학 여의도성모병원 병리학교실) ;
  • 박정미 (가톨릭대학교 의과대학 여의도성모병원 영상의학교실)
  • Kim, Hae Won (Department of Radiology, Yeouido St. Mary's Hospital, The Catholic University of Korea College of Medicine) ;
  • Kwon, Soon-Yong (Department of Orthopedic Surgery, Yeouido St. Mary's Hospital, The Catholic University of Korea College of Medicine) ;
  • Chong, Yosep (Department of Hospital Pathology, Yeouido St. Mary's Hospital, The Catholic University of Korea College of Medicine) ;
  • Park, Jeongmi (Department of Radiology, Yeouido St. Mary's Hospital, The Catholic University of Korea College of Medicine)
  • 투고 : 2017.07.19
  • 심사 : 2017.09.07
  • 발행 : 2018.01.01
⟨ 이전 논문 다음 논문 ⟩

초록

41세 여성이 왼쪽 골반과 엉덩이 통증을 주소로 내원하였다. 자기공명영상에서 좌측 장골, 천골 및 대퇴골에서 괴사 부위를 동반한 다발성 골수 신호 강도 변화가 있었다. 영상의학적 감별진단으로 다발성 결핵성 골수염을 우선적으로 고려하였으며 이후 골반 뼈 생검과 골수 생검을 통해 백혈병에서는 드문 광범위한 괴사를 동반한 B 전구세포 급성 림프모구 백혈병의 진단을 확진하였다. 근골격계 증상이 말초 혈액 이상보다 먼저 나타나고 자기공명영상에서 미만성의 신호 강도 변화가 아닌 다발성의 괴사성 병변으로 나타나는 경우 백혈병의 진단이 어렵다.

A 41-year-old female presented with complaint of left hip and buttock pain. Magnetic resonance imaging (MRI) showed multi-focal bone marrow signal intensity changes in left iliac bone, sacrum and femur with an area of necrosis. The primary radiological differential diagnosis was multi-focal tuberculous osteomyelitis. Subsequent pelvic bone biopsy and bone marrow biopsy confirmed the diagnosis of B-cell precursor acute lymphoblastic leukemia with extensive necrosis, which is infrequent in leukemia. When musculoskeletal symptoms precede peripheral blood abnormalities and MRI scanning reveals multi-focal necrotic lesions rather than diffuse signal change, it can be difficult to identify and/or advance leukemia as differential diagnosis.

키워드

참고문헌

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