肝内胆管细胞癌CT误诊肝脓肿六例临床分析

Clinical Analysis of 6 Patients with Intrahepatic Cholangiocarcinoma Misdiagnosed by CT as Hepatic Abscess

目的探讨肝内胆管细胞癌(intrahepatic cholangiocarcinoma,ICC)CT特点、误诊为肝脓肿的原因,提高对ICCCT特点的认识,降低误诊率。方法对2021年10月至2023年1月收治的6例CT误诊为肝脓肿的ICC患者资料进行回顾性分析。结果6例主要表现为食欲下降、间断发热、上腹部疼痛和不适。患者中呕吐2例、皮肤瘙痒3例、间断发热1例、体质量减轻4例,上腹部疼痛伴食欲缺乏6例;CT平扫显示不规则低密度灶,轮廓不清晰,增强CT显示轻度到中度的环状强化,病灶内部不均匀强化,6例均误诊为肝脓肿,均接受抗感染治疗,患者治疗后病情仍反复发作,遂行肝穿刺活检,病理诊断为ICC,误诊时间15~42d。2例具有手术指征行手术切除,其余4例进行全身化疗同时联合放疗、局部治疗。术后随访1年,2例手术者1例无复发、1例死亡,4例化疗患者中3例死亡、1例存活。结论ICC临床表现无特异性,病灶中心出现坏死和液化时CT表现不典型,极易误诊为肝脓肿。接诊医师应该加强对ICC相关知识的了解,分析其与肝脓肿的鉴别点,必要时行肝穿刺活检,提高对ICC的确诊率。

Objective To explore the CT features of intrahepatic cholangiocarcinoma(ICC)and the causes of misdi-agnosis as liver abscess,so as to improve the understanding of the CT features of ICC and reduce the misdiagnosis rate.Methods The data of 6 ICC patients who were misdiagnosed with liver abscess by CT from October 2021 to January 2023 were retrospectively analyzed.ResultsThe main manifestations of 6 patients were decreased appetite,intermitent fever,up-per abdominal pain and discomfort.Among the patients,there were 2 cases of vomiting,3 cases of skin itching,1 case of fe-ver,1 case of reduced body mass and 6 cases of upper abdominal pain and loss of appetite.Plain CT revealed irregular low-density lesion with unclear contour,and enhanced CT showed mild to moderate annular enhancement and uneven internal en-hancement of the lesion.All 6 patients were misdiagnosed with liver abscess,and received anti-infective therapy.The disease continued to recur after treatment,and liver biopsy was performed;the pathological diagnosis was ICC,and misdiagnosis last-ed 15 to 42 d.Two patients had indications for surgery and underwent surgical resection,while the remaining four patients re-ceived systemic chemotherapy,combined with radiotherapy and local treatment.After 1-year follow-up,1 of the 2 patients had no recurrence and 1 died,3 of the 4 patients receiving chemotherapy died and 1 patient survived.Conclusion The clinical manifestations of ICC are nonspecific,and CT findings are not typical when necrosis and liquefaction occur in the focal center;therefore,it is more likely to be misdiagnosed as liver abscess.Attending physicians should strengthen their understanding of ICC,analyze the differential points between ICC and liver abscess,and perform liver puncture biopsy when necessary to im-prove the diagnosis rate of ICC.