咽食管憩室对甲状腺结节热消融治疗的威胁及其口服超声造影快速诊断

Potential threat of pharyngo-esophageal diverticulum to thermal ablation treatment of thyroid nodule and rapid differential diagnosis through swallow contrast-enhanced ultrasonography

目的探讨咽食管憩室的误诊对甲状腺结节热消融治疗的潜在风险及其快速有效的确诊方法。方法回顾5例误诊为甲状腺结节并被推荐行热消融治疗的咽食管憩室诊疗过程,分析其误诊的原因、疑诊的时机与线索以及口服超声造影快速确诊的优势。结果对咽食管憩室声像图缺乏认识和警惕性是误诊的直接原因。5例误诊为甲状腺结节的咽食管憩室均系消融术第一术者于热消融治疗前发现,通过口服超声造影获得确诊,避免了误消融;需要治疗的真正甲状腺结节均获得安全消融。结论咽食管憩室易被误诊为甲状腺结节。提高对其声像图的识别能力和警惕性,在实施甲状腺结节消融术时严格落实第一术者超声复核检查制度,运用口服超声造影检查,可迅速纠正诊断,避免消融误治。

Objective To explore the potential risk of misdiagnosis of pharyngeal esophageal diverticulum(PED) for the treatment of thyroid nodules with thermal ablation and its rapid and effective method of diagnosis. Methods The process of diagnosis and treatment were reviewed on 5 cases of PEDs which had been misdiagnosed as thyroid nodules and recommended for thermal ablation therapy. A comprehensive analysis was carried out for the reasons of misdiagnosis, the timing and clues of the diagnosis as well as the advantage of swallow contrast-enhanced ultrasonography(sCEUS) in achieving rapid and correct diagnosis. Results The lack of recognition and vigilance to the acoustic image of PED were the direct causes of misdiagnosis. Five cases of PED misdiagnosed as thyroid nodules were all discovered by the same chief operator before thermal ablation. They were confirmed through sCEUS and mistreatment by ablation were fortunately avoided, but all true thyroid nodules requiring treatment were safely ablated. Conclusions PED is easily misdiagnosed as thyroid nodule.Improving the recognition and vigilance of the ultrasonic features of PED, strictly implementing the reconfirming ultrasound examination by the chief operator, and promptly conducting sCEUS are sensible measures to quickly correct the diagnosis and prevent wrong ablation of PED.