血管内乳头状内皮细胞增生的超声表现及误诊分析

Ultrasonic Manifestation and Misdiagnosis Analysis of Patients with Intravascular Papillary Endothelial Hyperplasia

目的分析血管内乳头状内皮细胞增生(IPEH)的超声表现及误诊原因,以提高超声医生对本病的认识。方法回顾性分析2010年6月—2019年11月经手术活组织病理检查证实的26例IPEH超声误诊病例资料。结果本组误诊率为100%,8例既往下肢深静脉血栓患者、4例肾衰竭透析患者及2例糖尿病患者,随诊既往疾病时发现肢体皮下病变;11例无症状者,自行发现病灶部位皮下结节,来院就诊检查;1例外伤患者触及外伤处皮下包块来院就诊。26例分别误诊为血栓14例、血管肉瘤5例、纤维瘤4例、皮下结节2例、静脉壁间血肿1例,均行手术治疗,手术病理证实为IPEH。结论超声对单纯型IPEH的诊断有特异性,特别是静脉管腔内出现边界清楚、血供丰富的实质性结节时,应想到本病的可能,进一步确诊需病理检查。

Objective To analyze ultrasound manifestations and misdiagnosed causes of patients with intravascular papillary endothelial hyperplasia(IPEH)in order to improve understanding of the disease by radiologists.Methods Clinical data of 26 misdiagnosed patients with IPEH who had confirmed by surgical biopsy during June 2010 and November 2019 was retrospectively analyzed.Results The misdiagnosed rate was 100%.Among the misdiagnosed patients,8 patients with previous deep vein thrombosis,4 patients with renal failure undergoing hemodialysis and 2 patients with diabetes were found to have subcutaneous lesions of the limbs during follow-up of previous diseases;11 asymptomatic patients visited for self-reported subcutaneous nodules at the site of the lesion;1 injured patient visited for subcutaneous mass at the site of the trauma.Of the 26 misdiagnosed patients,there were 14 patients misdiagnosed as having thrombosis,5 as having angiosarcoma,4 as having fibroma,2 as having subcutaneous nodules and 1 as having venous intermural hematoma.All the patients were treated with surgeries,and IPEH was confirmed by surgical pathology results.Conclusion Ultrasound is specific in diagnosis of pure IPEH,especially when there are substantial nodules with clear boundaries and abundant blood supply in the venous lumen.The possibility of this disease should be considered,and further diagnosis requires pathological examination.