胆囊穿孔伴肝脓肿的超声造影表现

Contrast enhanced ultrasonographic manifestation of perforation of gallbladder with liver abscess

目的探讨CEUS诊断和鉴别诊断胆囊穿孔伴肝脓肿的应用价值。方法 4例经手术病理证实的胆囊穿孔合并肝脓肿的患者,术前接受常规及超声造影检查,观察造影前后在显示胆囊形态、穿孔部位和大小、炎症波及肝脏范围及显示病灶内血供的能力。结果常规超声显示,4例患者中1例囊壁局部"缺损",3例囊壁局部显示模糊;2例胆囊内伴结石。4例胆囊旁肝实质内均见包块,边界模糊;3例呈中、低混合回声,1例呈囊、实混合回声。2例胆囊旁可见积液。4例于CEUS动脉期均可见胆囊壁强回声带局部中断,清晰显示"缺损"部位和大小。肝内包块在动脉期表现为不均质蜂窝样略高增强,伴少许无增强区,门脉相造影剂减退,表现为不均质低增强,呈肝脓肿增强模式。结论 CEUS可通过显示胆囊壁的"缺损"及肝包块的血流灌注模式,对胆囊穿孔合并肝脓肿患者进行准确诊断,有较高的鉴别诊断价值。

Objective To discuss the clinical value of CEUS in diagnosis and differential diagnosis of gallbladder perforation with liver abscess.Methods Four cases of gallbladder perforation with liver abscess were performed examination on conventional ultrasound and CEUS.The contour of gallbladder,location and size of perforation,rang of liver mass and its blood perfusion pattern were observed.Results Conventional ultrasound showed gallbladder wall defect in 1 case,obscure of local gallbladder wall in 3 cases.Two cases had cholecystolithiasis.The pericholecystic masses were detected in all four cases： Iso-hypoechoic masses in 3 and cystic-solid mass in 1.Pericholecystic fluid collection visualized in 2 cases.On CEUS,the gallbladder wall was high-enhanced at arterial phase and showed defect in all cases.The location and size of defect detected clearly on CEUS.The pericholecystic masses were mild-hyper enhanced as honeycomb-like at arterial phase with a few no-enhanced area inside and revealed hypo-enhanced at portal phase which was a enhanced pattern of liver abscess.Conclusion CEUS can diagnosis gallbladder perforation with liver abscess by revealing the defect of gallbladder wall and the enhance pattern of pericholecystic masses.These features are useful for differential diagnosing.