PHILIPS每日一例:肝脓肿影像诊断一例

2022-08-26 放射沙龙 华夏影像诊断中心

肝脓肿临床上较常见的肝脏占位性疾病,主要包括细菌性和阿米巴性肝脓肿两大类,有时也见于肝结核和霉菌感染。

病史临床:男性,38岁。右侧腹部疼痛一月余。时有发热、寒战。

影像图片:

影像表现:CT平扫显示为肝右叶顶部类圆形低密度区,病灶内部密度均匀。增强后显示为圆形或类圆形低密度区伴环状强化,脓肿壁外围可见低密度环形“双靶征”或“双环征”,反映了脓肿形成期,外围低密度环为脓肿周围充血水肿带,此型为肝脓肿之典型征象。

结果:患者入院后行经皮肝穿刺引流术,抽出脓液60ml。脓液常规检查:淡黄色,混浊,有凝块,白细胞(++++),红细胞(++),李凡它试验(-)。细菌培养(-)。

出院诊断:肝脓肿。

点评:肝脓肿是临床上较常见的肝脏占位性疾病,主要包括细菌性和阿米巴性肝脓肿两大类,有时也见于肝结核和霉菌感染。细菌性肝脓肿较为多见,临床症状重,死亡率高,主要感染途径有胆道、门静脉、肝动脉、邻近器官的化脓性炎症的直接蔓延。肝脓肿的形成大致可分为化脓性炎症期、脓肿形成初期和脓肿形成期,化脓性炎症期病理改变为肝组织的局部炎症、充血、水肿,脓肿形成初期肝组织开始坏死,部分液化,脓肿形成期脓腔坏死液化彻底,脓肿壁形成,脓肿壁由纤维肉芽组织或炎症充血带形成,脓肿周围肝组织往往伴有充血水肿。病变不同阶段有不同的CT表现,同一病例病灶不同部位因病变阶段不同,CT表现各异,加之近年来抗生素的广泛应用,使本病的临床表现趋于不典型,易与其他病变相混。

肝脓肿的CT表现大致可归纳为三类:

1 圆形或类圆形低密度区伴环状强化,脓肿壁外围可有低密度环形“双靶征”或“双环征”,反映了脓肿形成期,外围低密度环为脓肿周围充血水肿带,此型为肝脓肿之典型表现。

2 多房或蜂窝状低密度区,增强扫描时病灶内房隔及细小脓肿壁均可有强化,可呈“簇状征”或“花瓣征”,反映了细菌性肝脓肿形成初期,或多个脓肿融合,或化脓性炎症破坏后的增生反应。

3 边界不清、密度不均的低密度肿块,可有不同程度的强化,延时扫描时部分病灶呈等密度,反映了化脓性炎症期,或脓肿不完全液化残存肝组织的炎性反应。

肝脓肿增强扫描动脉期病灶轻度强化或无明显强化,而病灶周围片状或楔形一过性强化,反映了脓肿周围肝组织炎症充血,局部灌注增多,此征为肝脓肿在动脉期的重要征象。门脉期表现簇状征、蜂窝征或花瓣状征有相似的病理基础,见于肝脓肿形成初期,病变肝组织充血水肿伴不完全坏死,低密度区的边缘及房隔明显强化。边缘强化征系脓肿壁肉芽组织有丰富的新生血管所致。病灶缩小征反映了化脓性炎症期或脓肿不完全液化残存肝组织的炎症反应,表现为增强后病灶较平扫缩小,甚或不能明显显示。延时期强化表现系肝脓肿炎性肉芽组织内造影剂缓慢向外渗透而廓清较慢所致。

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    2021-11-10 chengjn
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    2021-11-10 hunizi009

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