腹膜后纤维化九例超声误漏诊分析

Analysis of Misdiagnosis and Missed Diagnosis of Nine Cases of Retroperitoneal Fibrosis with Ultrasound

目的通过分析腹膜后纤维化(retroperitoneal fibrosis,RPF)超声误漏诊原因,提高超声科医师对本病的认识。方法回顾性分析2010年5月—2017年6月我院超声影像科首诊并误漏诊的9例RPF病例资料。结果9例均出现腰腹部不适、疼痛及血尿,7例肾区叩击痛,6例少尿,4例下肢水肿,1例触诊有腹部包块。超声检查9例均见腹主动脉外侧壁有低回声病灶包绕,边界不清,3例向下延续至髂血管,6例下腔静脉亦被包绕;彩色多普勒血流显像(CDFI)示病灶内未见明显血流信号。9例均伴肾积水、输尿管扩张,5例为双侧,4例为单侧,病灶侵犯以下段输尿管显示不清;1例肾门处见低回声团块包绕,CDFI示肾血管亦被包埋。9例超声首诊均误诊,考虑肾或输尿管肿瘤和腹部包块性质待查各3例,肾积水或输尿管上段扩张2例,腹主动脉大动脉炎1例,后经手术病理或穿刺活检证实RPF。结论当患者超声检查发现包绕腹膜后血管的异常回声病灶,并伴有肾积水、输尿管扩张时,应考虑RPF的可能,确诊需行病理检查。

Objective The causes of misdiagnosis and missed diagnosis of retroperitoneal fibrosis （ RPF） with ultra-sound were analyzed, objective to improve the awareness of ultrasound doctors in this disease. Methods 9 cases of RPF in our hospital misdiagnosis and missed diagnosis by ultrasound initial diagnosis were reviewed and analyzed retrospectively from May 2010 to June 2017. Results All the 9 patients had symptoms of lumbar and abdominal discomfort, pain and hematuria. 7 patients suffered from knocking pain, 6 with oliguria, 4 with edema of lower extremities, and 1 with abdominal mass; Ultra-sonographic features 9 patients showed abdominal aorta lateral wall surrounds the hypoechoic lesion, the boundary is not clear, there are 3 cases of downward continuation to the iliac vessels, 6 cases of inferior vena cava is wrapped around, CDFI showed no obvious blood flow signal. All of 9 cases were associated with urinary tract positive signs, 5 cases were bilateral, 4 were unilateral, the invasion of the ureter below the lesion is unclear, 1 cases of renal hilum showed a hypoechoic mass around, CDFI showed renal vascular also buried; all the 9 cases were misdiagnosed at ultrasound first visit, consider the kid-ney or ureter tumor and abdominal tumor in 3 cases, hydronephrosis or upper ureteral dilatation in 2 cases, 1 case of arteritis in abdominal aorta, all the cases were confirmed by surgery, pathology or biopsy was RPF. Conclusion The possibility of RPF may be considered when ultrasound reveals abnormal echogenic masses surrounding the retroperitoneal vessels with hydro-nephrosis and ureteral dilatation, the diagnosis should be confirmed by pathological examination.