九例肝结核的CT表现分析  

CT manifestations of 9 hepatic tuberculosis patients

作　　者：王立非[1] 张倩倩[1] 赵延震 陆普选[1] 曹义[1] 

机构地区：[1]广东医科大学附属深圳市第三人民医院放射科,518112

出　　处：《结核病与肺部健康杂志》2016年第3期191-196,共6页Journal of Tuberculosis and Lung Health

摘　　要：目的分析肝结核的CT表现，进一步探讨CT表现在肝结核诊断及鉴别诊断中的价值。方法回顾性分析2013年1月至2015年12月经广东医科大学附属深圳市第三人民医院诊治的9例肝结核患者的临床特点及CT表现。9例患者中以持续发热人院者4例，以咳嗽、咯血、胸痛等症状入院者5例；其中2例患者并发腹痛症状。9例患者中，1例诊断为胆管型肝结核并发肺结核；1例浆膜型肝结核并发左侧结核性胸膜炎；4例结核性肝脓肿（3例为单发脓肿，1例为多发脓肿。其中2例单发脓肿和1例多发脓肿患者均为AIDS初次新发肺结核患者；另1例单发脓肿并发膝关节结核、肺结核）；其余3例为肝实质多灶多形型并发肺结核患者。结果9例患者病灶区均未出现钙化，其中有3例肝脏内（非病灶区）有斑点、结节样钙化。1例胆管型肝结核，肝右叶散在低密度区，增强后动脉期低密度区强化；1例浆膜型肝结核，CT平扫显示肝右叶浆膜下有一椭圆形低密度区，边界清晰，肝脏右叶受压；4例患者CT增强扫描显示环形强化，其内可见不规则小斑片状延迟强化区及分隔强化；3例肝实质多灶多形型患者CT平扫显示肝内多发斑片状、类圆形低密度区。结论肝脏结核CT表现形态多样，型别多样，病灶内钙化不一定是诊断肝结核的特征性改变；结核性肝脓肿可有强化，脓肿内不规则小斑片状延迟强化区及分隔强化可能是与其他疾病的鉴别点。Objective To analyze the CT features of hepatic tuberculosis and discuss its value of the diagnosis and differential diagnosis in hepatic tuberculosis. Methods The CT manifestations and clinical features of 9 cases of hepatic tuberculosis which were hospitalized in Shenzhen Third People＇s Hospital from January 2013 to December 2015 were retrospectively analyzed. Among the nine patients, there were some symptom such as fever （4 cases）, sputum, hemoptysis and chest pain （5 cases） ; abdominal pain （2 cases）. One patient was diagnosed bile duct type hepatic tuberculosis and pulmonary tuberculosis, one case was serohepatic type of hepatic tuberculosis with left tu- berculous pleurisy; 4 cases were tuberculosis of liver abscess （3 cases solitary abscess,1 case multiple abscess, from which suffered AIDS with pulmonary tuberculosis in 3 cases. Solitary hepatic abscess with knee joint and lung tuber- culosis was found in 1 case） ; 3 cases were Multiple parenchymal hepatic tuberculosis. Results No calcification of the lesion area were observed in 9 cases, in which liver spots, nodular calcification were observer in 3 cases. There was some low density area in the right lobe of the liver and was enhanced in the arterial phase in one bile duct type of hepatic tuberculosis patient. The CT scan showed in 1 case that the right lobe of the subserosa liver had an oval low density area, the boundary was clear and the right lobe of the liver was compressed. Ring enhancement and small spots delayed reinforcement area and septal enhancement were found in 4 cases of tuberculosis of liver abscess. Mul- tiple patchyand round-like low density areas were observed in 3 cases of multiple parenchymal hepatic tuberculosis. Conclusion The morphology and type of hepatic tuberculosis was diverse. The intralesional calcification was not necessary for the diagnosis of hepatic tuberculosis. The tuberculous abscess of the liver could be enhanced. The irregular small piece of delayed enhancement region and septal enhancement were the

关 键 词：结核 肝 体层摄影术 X线计算机 诊断 鉴别 

分 类 号：R525[医药卫生—内科学]