IgG4相关硬化性肿块型胰腺炎影像学表现及误诊分析  

Imaging Findings of IgG4-related Sclerosing Mass Pancreatitis and Analysis of Misdiagnosis

作　　者：杨超[1] 李进 张优仪[2] 阳波[1] YANG Chao;LI Jin;ZHANG You-yi;YANG Bo(Department of Radiology,the Fourth People's Hospital of Sichuan,Chengdu 610016,China;Department of Radiology,Sichuan Academy of Medical Sciences,Sichuan Provincial People's Hospital,Chengdu 610072,China)

机构地区：[1]四川省第四人民医院放射科,成都610016 [2]四川省医学科学院·四川省人民医院放射科,成都610072

出　　处：《临床误诊误治》2021年第1期13-16,共4页Clinical Misdiagnosis & Mistherapy

摘　　要：目的总结IgG4相关硬化性肿块型胰腺炎的影像特征及误诊原因、防范措施。方法对曾误诊的IgG4相关硬化性肿块型胰腺炎4例的临床资料进行回顾性分析。结果本组4例,临床表现为皮肤和巩膜黄染1例,口干、多饮和多尿1例,腹部不适2例。CT和MRI检查表现为单纯软组织肿块,CT平扫3例呈等或稍低密度;MRI平扫T2W信号增高、T1W信号减低,增强呈相对较弱延迟强化。2例误诊为胰头癌,1例误诊为间质瘤,1例误诊为胆总管胰腺段癌。误诊时间9~17 d。4例均行手术治疗,均经术后病理检查和免疫组织化学检查确诊为IgG4相关硬化性肿块型胰腺炎,给予糖皮质激素治疗2周后,临床症状明显好转;3个月后随访,影像学检查示肿块消失,预后良好。结论IgG4相关硬化性肿块型胰腺炎虽具有一定影像学特征,但极易误诊,及时行血清IgG4水平检测及病理检查,有助于确诊。Objective To investigate the imaging characteristics,causes of misdiagnosis and preventive measures of IgG4-related sclerosing mass pancreatitis.Methods A retrospective analysis of 4 cases of IgG4-related sclerosing mass pancreatitis was performed to summarize the imaging features.Results Of 4 patients in this group,clinical manifestations included yellowish skin and sclera in 1 case,dry mouth,polydipsia and polyuria in 1 case,and abdominal discomfort in 2 cases.CT and MRI examinations showed simple soft tissue masses.CT plain scan of 3 cases showed equal or slightly low density;MRI plain scan revealed increased T2W signal and decreased T1W signal,and the enhancement showed relatively weak delayed enhancement.Two cases were misdiagnosed as pancreatic head cancer,1 as stromal tumor,and 1 as cholangiopancreatic carcinoma.The duration of misdiagnosis was 9-17 d.All 4 cases underwent surgical treatment,and all were diagnosed as IgG4-related sclerosing mass pancreatitis by postoperative pathological examination and immunohistochemical examination.After 2 weeks of treatment with glucocorticoid,the clinical symptoms were relieved significantly.At 3-month follow-up,imaging examination showed that the mass disappeared and the prognosis was good.Conclusion IgG4-related sclerosing mass pancreatitis has certain imaging characteristics,which,however,is more likely to be misdiagnosed.Timely serum IgG4 level examination and clinical pathology are conductive to confirmation of the diagnosis.

关 键 词：胰腺炎 影像表现 误诊 胰腺肿瘤 

分 类 号：R576[医药卫生—消化系统]