一例早期影像学不典型侵袭性肺炎克雷伯杆菌肝脓肿综合征病例报道

A Case Report of Early Imaging Atypical Invasive Klebsiella Pneumoniae Liver Abscess Syndrome

目的提高对肺炎克雷伯杆菌肝脓肿综合征(invasive Klebsiella pneumoniae liver abscess syndrome,IKLAS)早期不同影像学表现的认识,避免早期误诊,提高救治成功率。方法回顾性分析2021年5月12日常德市第一人民医院急诊重症监护室收治的1例早期影像学表现为单纯肝内积气影的肺炎克雷伯杆菌肝脓肿综合征的影像学变化、治疗经过及转归。结果多学科协作明确诊断后经过综合性治疗患者临床症状消失,影像学检查提示肝内脓肿明显吸收,肺部感染性病灶明显吸收,1月后本院复查腹部CT提示肝脓肿消失,肺部感染性病灶基本吸收。结论肺炎克雷伯菌感染所致的肝脓肿易引起肝外播散性病灶,好发于合并糖尿病及免疫缺陷人群,但早期影像学表现多样,易延误诊断延误治疗。因此,充分认识肺炎克雷伯肝脓肿综合征不同早期影像学表现有利于提高救治成功率。

Objective To improve the understanding of different imaging features in early stage of invasive Klebsiella pneumoniae liver abscess syndrome(IKLAS),avoid early misdiagnosis and improve the success rate of treatment.Methods The imaging changes,treatment course and outcome of a case of invasive Klebsiella pneumoniae liver abscess syndrome with simple intrahepatic air shadow admitted to the emergency EICU of Changde First People's Hospital on May 12,2021 were retrospectively analyzed.Results After the diagnosis was confirmed by multidisciplinary cooperation,the clinical symptoms of the patient disappeared after comprehensive treatment,and the imaging examination indicated obvious absorption of intrahepatic abscess and lung infectious lesions.Abdominal CT examination in the hospital 1 month later indicated that the liver abscess disappeared and the infectious lesions in the lungs were basically absorbed.Conclusion Liver abscess caused by Klebsiella pneumoniae infection is easy to cause extrhepatic spread,which is most common in people with diabetes and immune deficiency,but the early imaging manifestations are varied,which is easy to delay diagnosis and treatment.Therefore,a full understanding of the different early imaging manifestations of invasive Klebsiella pneumoniae liver abscess syndrome is conducive to improving the success rate of treatment.