血管穿行征——肺炎克雷伯菌不典型肝脓肿的MSCT征象及鉴别诊断  

Vascular Penetrationsign:MSCT Sign and Differential Diagnosis of Klebsiella Pneumoniae Atypical Liver Abscess

作　　者：袁涛[1] 钟唐力[1] YUAN Tao;ZHONG Tangli(Department of Radiology,Mianyang Central Hospital,Mianyang,Sichuan Province 621000,P.R.China)

机构地区：[1]绵阳市中心医院放射科,621000

出　　处：《临床放射学杂志》2024年第9期1519-1522,共4页Journal of Clinical Radiology

摘　　要：目的探讨肺炎克雷伯菌(Klebsiella pneumoniae,KP)不典型肝脓肿的多层螺旋CT(multi-slice spiral computed tomography,MSCT)征象。方法搜集经穿刺或手术确诊的KP不典型肝脓肿患者41例,全部行肝脏MSCT双期增强扫描,并分析其MSCT征象。结果41例不典型肝脓肿中,共有病灶70个。7个病灶内可见血管穿行,并伴血管增粗、边缘模糊及形态不规则等受侵改变,其中2个病灶被误诊为原发性肝淋巴瘤(primary hepatic lymphoma,PHL);另外,34个病灶表现为“蜂窝征”、“花瓣征”或“簇形征”,27个病灶出现“病灶缩小征”,46个病灶动脉期观察到周围肝实质一过性异常强化。结论血管穿行伴炎性受侵是诊断KP不典型肝脓肿的重要征象之一,正确认识此征象可减少误诊。Objective To investigate the multi-slice spiral computed tomography(MSCT)features of atypical liver abscess caused by Klebsiella pneumoniae(KP).Methods 41 patients with KP atypical liver abscess confirmed puncture or surgery were reviewed retrospectively.All patients were performed dual-phases enhanced CT scan,MSCT findings were analyzed.Results In 41 cases of KP atypical liver abscess,70 lesions were identified.Vascular penetration was noted in 7 lesions,characterized by vascular thickening,indistinct margins and irregular invasive changes.2 cases were initially misdiagnosed as primary hepatic lymphoma(PHL).Additionally,34 lesions displayed imaging patterns such as the"honeycomb,""petal,"or"cluster"signs,27 lesions demonstrated"lesion shrinkage"sign.Transient abnormal enhancement in hepatic parenchyma were observed in 46 lesions.Conclusion Vascular penetration with inflammatory infiltration was an important sign in the diagnosis of atypical liver abscess of KP,correctly recognize this sign could reduce misdiagnosis.

关 键 词：肝脓肿 肺炎克雷伯菌 血管穿行征 体层摄影术 

分 类 号：R575.4[医药卫生—消化系统] R816.5[医药卫生—内科学]