类鼻疽伯克霍尔德菌肝脾脓肿超声造影表现1例  

Contrast-enhanced ultrasound findings of liver and spleen abscesses due to infection with Burkholderia pseudomallei:A case report

作　　者：高玲 时莹瑜[1] 卢强[1] Ling Gao;Ying-Yu Shi;Qiang Lu(Department of Medical Ultrasound,West China Hospital of Sichuan University,Chengdu,610041,Sichuan Province,China)

机构地区：[1]四川大学华西医院超声医学科,四川省成都市610041

出　　处：《世界华人消化杂志》2021年第7期378-382,共5页World Chinese Journal of Digestology

摘　　要：背景类鼻疽伯克尔德菌(Burkholderia pseudomallei)是类鼻疽病(Melioidosis)的病原菌,对常用抗生素普遍耐药,感染后病情较重,病死率较高,临床表现多样化,诊断困难,多数伴有多处化脓性病灶,超声造影检查在脓肿的评估中可起重要作用.病例简介本例患者来自海南省,为该病菌流行地区,患有糖尿病,因发热半月就诊,常规超声检查发现肝脾内多发分隔囊性占位,团块内分隔较多,呈放射状排列;造影后动脉期周边呈厚环状高增强,分隔可见强化,门脉及实质期呈稍低增强,内可见片状无增强区,通过血培养诊断为类鼻疽伯克尔德菌感染.根据药敏抗感染治疗后病灶明显缩小.结论本文报道了一例经血培养证实为类鼻疽伯克霍尔德菌感染引起肝脾脓肿的病例,其超声造影表现具有一定的特征性,表现为肝、脾多发分隔囊性占位,动脉期周边厚环状高增强,内部分隔呈高增强,门脉期、实质期呈稍低增强,且其内部分隔呈放射状排列,这一特征符合该病的CT表现“项链征”.此外,超声造影可明确脓肿内坏死范围.超声造影检查可作为类鼻疽病肝、脾脓肿的筛查手段,有助于辅助非流行地区的超声诊断.BACKGROUND Burkholderia pseudomallei is the pathogen of melioidosis.It is generally resistant to commonly used antibiotics.Burkholderia pseudomallei infection is usually severe,with a high mortality rate.Moreover,the clinical manifestations are diverse,leading to a difficult diagnosis.Most of the cases are accompanied by multiple purulent lesions,and ultrasonography can play an important role in the detection and evaluation of abscesses.CASE SUMMARY The patient was from Hainan Province,an epidemic area of Burkholderia pseudomallei infection.He had a history of diabetes and had suffered from a fever for half a month.Routine ultrasonography revealed multiple mixed lesions in the liver and spleen.The mass has multiple septations with characteristic radial arrangement.On contrastenhanced ultrasound,thick ring hyperenhancement was demonstrated in the arterial phase.Enhancement of the septations can also be observed with irregular flaky non-enhanced area inside.The patient was diagnosed as having Burkholderia pseudomallei infection by blood culture.After anti-infective treatment based on drug sensitivity,the lesions were significantly reduced.CONCLUSION We have reported a case of liver and spleen abscesses due to infection with Burkholderia pseudomallei,which was confirmed by blood culture.Routine ultrasonography revealed multiple mixed lesions in the liver and spleen.On contrast-enhanced ultrasound,thick ring hyperenhancement was demonstrated in the arterial phase,while slightly low enhancement in the portal phase and parenchymal phase and the characteristics of radial arrangement were consistent with the reported typical CT findings.Contrast-enhanced ultrasound could help ascertain necrotic area of the abscesses.The recognition of the purulent nature by conventional and contrast-enhanced ultrasound,and the feature of radial septations could assist in ultrasound diagnosis of melioidosis abscess in non-endemic areas.

关 键 词：类鼻疽伯克尔德菌 类鼻疽病 超声 超声造影 

分 类 号：R445.1[医药卫生—影像医学与核医学] R575.4[医药卫生—诊断学] R551.1[医药卫生—临床医学]