肝内胆管腺瘤超声及SonoVue超声造影误诊分析  

Misdiagnosis Analysis of Intrahepatic Bile Duct Adenoma by Ultrasound and SonoVue Contrast-enhanced Ultrasound

作　　者：王惠 WANG Hui(Department of Ultrasound,the 960th Hospital of Joint Logistics Support Force of the PLA,Jinan 250031,China)

机构地区：[1]中国人民解放军联勤保障部队第九六〇医院超声诊断科,济南250031

出　　处：《临床误诊误治》2025年第1期16-20,共5页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨肝内胆管腺瘤的超声图像、SonoVue超声造影表现以及误诊原因、防范措施。方法结合相关文献,回顾性分析2022年10月1例曾误诊的肝内胆管腺瘤患者的临床及影像资料。结果患者因体检超声发现肝左叶结节2 d就诊。肝功及肿瘤标志物均无异常。上腹部磁共振成像、CT平扫及增强扫描均示肝左叶异常表现,不除外小肝癌可能。超声检查于肝左外叶下段近被膜处见一等回声结节伴有低回声晕,边界尚清,内部回声尚均匀,大小1.2 cm×1.1 cm,略向被膜外凸,因诊断不明确,在患者知情同意下进行SonoVue超声造影检查,肝内结节动脉期呈高增强,门静脉期与延迟期呈等增强。超声考虑为肝内富血供实性结节(肝细胞癌不除外)。临床行腹腔镜下肝结节切除+胆囊切除术,术后病理示:(肝左叶)上皮性肿瘤,(肝内)胆管腺瘤。误诊时间10 d。患者随访2年情况良好。结论肝内胆管腺瘤临床及实验室检查一般无特异性,多为偶然发现;肿瘤体积较小,多发生于肝被膜下,单发,无包膜。超声造影表现多样,磁共振成像、CT及超声图像均不具有特异性。影像医师应提高对肝内胆管腺瘤影像学特点的认识,注意结合临床症状及实验室检查结果,对病变进行全面的评估。Objective To explore the ultrasound images,and SonoVue contrast-enhanced ultrasound(CEUS)features of intrahepatic bile duct adenoma(BDA),as well as the causes of misdiagnosis and preventive measures.Methods Combined with relevant literature,the clinical and imaging data of 1 patient who had been misdiagnosed intrahepatic BDA in October 2022 were retrospectively analyzed.Results The patient presented with the left lobe nodule detected by ultrasound during physical examination 2 days before.There were no abnormalities in liver function and tumor markers.Upper abdominal magnetic resonance imaging(MRI),CT plain scan and enhanced scan showed abnormal manifestations of the left lobe of the liver,without excluding the possibility of small liver cancer.In ultrasound examination,a first class echo nodule was found near the capsule in the lower part of the left external lobe of the liver with a low echo halo,clear boundary and even internal echo,with a size of 1.2 cm×1.1 cm,slightly convex to the outside of the capsule.Due to unclear diagnosis,SonoVue CEUS was performed with the informed consent of the patient,and the intrahepatic nodule showed high enhancement at the arterial stage.The portal vein stage and the delayed stage showed equal enhancement.Based on ultrasound results,solid nodules with rich blood supply in the liver(except hepatocellular carcinoma)was considered.Laparoscopic hepatic nodule resection and cholecystectomy were performed in clinical practice.Postoperative pathology showed epithelial tumors(left lobe of the liver)and cholangiocarcinoma(intrahepatic).The misdiagnosis lasted 10 d.The patients were well followed up for 2 years.Conclusion The clinical and laboratory examination of intrahepatic BDA is generally non-specific,and most of them are found by chance.The tumor is small in size,mostly under the liver capsule,and single,without capsule.The findings of CEUS are varied,and MRI,CT and ultrasound images are not specific.Radiologists should improve their understanding of the imaging features of intrah

关 键 词：肝内胆管腺瘤 超声检查 SONOVUE超声造影 误诊 肝细胞癌 磁共振成像 体层摄影术 螺旋计算机 

分 类 号：R735.7[医药卫生—肿瘤]