摘要
目的分析周围型肝内胆管细胞癌(PICC)临床及CT影像特点,探讨CT误诊原因及防范误诊措施。方法回顾性分析2021年2月至2022年1月收治的曾误诊的PICC患者8例的临床资料。结果8例中3例有胆道手术史,2例有肝内胆管结石史,1例有胆囊结石史;4例伴肝硬化。8例因上腹部闷胀不适或疼痛就诊,4例因有肝硬化,甲胎蛋白升高,CT扫描见肝内肿物假包膜征,初步诊断为肝细胞癌;2例因体温轻度升高,CT增强扫描动脉期病灶强化弱,门静脉期见病灶呈蜂窝样变,远端胆管扩张并见截断征,故初步诊断为肝脓肿;2例因CT增强扫描动脉期见病灶边缘呈条索状强化,门静脉期渐进强化,邻近胆管扩张,初步诊断为肝血管瘤。8例行经皮肝穿刺细胞学检查诊断为PICC,确诊后行左半肝切除5例、右半肝切除3例。组织学分型:5例低分化腺癌、3例中分化腺癌。出院后随访2年,患者均存活,均未见转移。结论PICC术前易与肝脓肿、肝细胞癌、肝血管瘤混淆而误诊。临床医生加强对本病临床及影像学特点的认识,多方面综合分析病情,必要时及早行穿刺活检或手术病理检查,可提高诊断率。
Objective To analyze the clinical and CT imaging features of peripheral intrahepatic cholangiocarcinoma(PICC),and to discuss the causes of CT misdiagnosis and preventive measures.Methods The clinical data of 8 patients with misdiagnosed PICC admitted from February 2021 to January 2022 were retrospectively analyzed.Results Of the 8 patients,3 had a history of biliary tract surgery,2 had a history of intrahepatic bile duct calculus,and 1 had a history of gallstone.Cirrhosis was present in 4 patients.Eight patients presented with epigastrial discomfort or pain,and 4 patients had liver cirrhosis.Alpha-fetoprotein was elevated,and CT scan showed false envelope sign of intrahepatic mass,which was initially diagnosed as hepatocellular carcinoma.In 2 patients,there was slight increase in body temperature,the lesion was weakly enhanced in arterial stage by enhanced CT scan,honeycomb lesion was found during portal phase,and distal bile duct dilation and amputation sign were found,so the initial diagnosis was liver abscess.Two patients were initially diagnosed as hepatic hemangioma due to cord-like enhancement of the lesion edge observed during the arterial phase,progressive enhancement during portal phase,and dilatation of adjacent bile duct on CT enhanced scan.Eight patients were diagnosed as PICC by percutaneous liver biopsy and cytology,and left hemihepatectomy was performed in 5 patients and right hemihepatectomy in 3 patients.As for histological type,there were 5 patients with poorly differentiated adenocarcinoma and 3 patients with moderately differentiated adenocarcinoma.All patients survived and no metastases were observed during 2-year follow-up after discharge.Conclusion PICC is prone to misdiagnosis due to confusion with hepatic abscess,hepatocellular carcinoma and hepatic hemangioma before operation.The clinicians should strengthen the understanding of the clinical and imaging characteristics of this disease,comprehensively analyze the condition in various aspects,and perform puncture biopsy or surgical and pathological examination as soon as necessary,which can improve the diagnosis rate.
作者
宋娜
李佳丽
李青菊
SONG NaLI Jiali;LI Qingju(Department of Imaging,the Sixth People's Hospital of Hengshui City,Hengshui,Hebei 053200,China;Department of ICU,the Sixth People's Hospital of Hengshui City,Hengshui,Hebei 053200,China)
出处
《临床误诊误治》
CAS
2024年第15期15-19,共5页
Clinical Misdiagnosis & Mistherapy
关键词
胆管上皮癌
胆管
肝内
误诊
癌
肝细胞
肝脓肿
肝血管瘤
病理学
诊断
鉴别
Cholangiocarcinoma
Bile ducts,intrahepatic
Misdiagnosis
Carcinoma,hepatocellular
Liver abscess
Hepatic hemangioma
Pathology
Diagnosis,differential
