上腹部腹膜后结核肉芽肿声像图特征

Ultrasonic imaging features of tuberculous granulomas in upper retroperitoneal lymph nodes

目的探讨上腹部腹膜后结核性肉芽肿的超声图像特征,为临床诊疗方案选择提供影像学依据。方法对我院收治的1例上腹部腹膜后结核肉芽肿患者的影像学资料进行回顾,在万方医学网和PubMed医学网查阅国内外相关超声医学文献并分析。结果本例因上腹部隐痛不适1个月就诊。彩超提示:上腹膜后囊实性包块伴钙化,结核病未除外;上腹膜后实性结节。CT示:上腹部实性病变伴钙化,临近多发稍大淋巴结伴钙化,考虑实性肉芽肿性病变,结核可能。患者结核菌素试验阴性,血沉无升高,2年前曾查CT提示“肺结核”。最终确诊为腹膜后结核病,病灶内已经出现钙化,向好转归,随访观察。半年后肿块无增大,1年后复查超声,上腹膜后囊实性包块明显缩小,上腹膜后实性结节消失。结论上腹膜后结核肉芽肿极其少见,声像图具有特征性表现,结合病史可以明确诊断,为临床诊疗方案提供精准的影像学依据,大大降低漏诊、误诊、误治的发生,有效减轻患者的身心痛苦和经济负担。

Objective To investigate the ultrasonic imaging features of retroperitoneal tuberculous granulation in upper retroperitoneal lymph nodes,so as to provide the imaging basis for clinical diagnosis and treatment.Methods The ultrasonic imaging data of one patient with upper retroperitoneal lymphatic tuberculosis granuloma admitted to our hospital were retrospectively analyzed,and the domestic and foreign imaging documents closely related to retroperitoneal tuberculosis were reviewed and analyzed in Wanfang and Pubmed medical network.Results In this case,the patient went to the hospital because of dull pain and discomfort in the upper abdomen for 1 month.Color dopper ultrasonography showed upper retroperitoneal cystic solid mass with calcification,tuberculosis was not excluded.There were solid nodules posterior to upper peritoneum.CT showed solid lesions in the upper abdomen with calcification,and multiple larger lymph nodes with calcification.Solid granulomatous lesions and tuberculosis were considered.OT test of the patient was negative,blood sedimentation rate did not rise,CT examination 2 years ago suggested tuberculosis.Finally,the patient was diagnosed as retroperitoneal tuberculosis with calcification in the lesion.After consultation of a number of clinical experts was recommended follow-up observation,after half a year,no obvious enlargement in the mass size,continued to follow up observation.Ultrasound examination 1 year later showed that the size of the cystic solid mass in the upper retroperitoneum significantly reduced,and the solid nodules in the upper retroperitoneum disappeared.Conclusions Retroperitoneal tuberculous granuloma is extremely rare,with characteristic ultrasonic imaging features,providing clear imaging basis for clinical diagnosis and treatment,greatly reducing the incidence of misdiagnosis,misdiagnosis and mistreatment,and effectively reducing the physical and mental pain and economic burden of patients.