肝脏异位妊娠影像学诊断

Imaging diagnosis of ectopic pregnancy in the liver

目的报告国内首例肝脏异位妊娠病例,提高对本病的认识。方法患者因急性腹痛伴阴道流血14天,加重半天入院,主诉停经49天,无早孕反应,血清HCG8988miu/ml。先后采用超声、CT和MRI平扫及增强扫描发现肝左叶病变。结果超声显示盆腔少量积液;CT平扫显示肝左叶多边形稍高密度影,增强CT未见强化;MRI平扫T1WI呈类圆形低信号,T2WI呈高信号,增强后静脉期病灶内见轻度不规则斑片状强化;手术切除病灶,镜下见绒毛膜组织,病理诊断为肝脏异位妊娠。结论肝脏异位妊娠的CT和MRI平扫及增强为良性肿瘤样表现,结合阴道流血、停经史、血清HCG明显升高等比较容易诊断。

Objective To report the first ectopic pregnancy in the liver in China and deepen the understanding of the disease. Methods A patient was admitted to hospital for acute abdominal pain with a 14-day history of vaginal bleeding. The presenting symptoms included a 49-day menolipsis, no morning sickness with human chorionic gonadotrophin （HCG） miu/ml in the serum. Ultrasound, computed tomography （CT） and magnetic resonance imaging （MRI） plain scan and enhanced scan revealed the pathological changes of the left liver lobe. Results Ultrasound revealed a bit of effusion in the pelvic cavity. Computed tomography（CT） plain scan displayed a polygonal, moderate density shadow of the left liver lobe. Enhanced CT had no sign of intensification. MRI plain scan was performed. On T1WI, the lesion appeared to be round low signals） on T2WI, the lesion appeared to be high signals. With enhanced MRI, it showed irregular mild plaquelike intensification during the venous phase. It was excised by operation and chorionic tissuews were seen under a microscope. Ectopic pregnancy in the liver was diagnosed pathologically. Conclusion Ectopic pregnancy in the liver is demonstrated to be benign tumor with CT and MRI plain and enhanced scans, and is easily diagnosed according to vaginal bleeding, a history of menolipsis and an obvious HCG increase in the serum.