腹腔多发合并胸壁细粒棘球蚴病1例

A case of multiple intraperitoneal cystic echinococcosis complicated with chest wall involvement

患者,男,67岁,汉族,甘肃农民。2023年5月12日因“发现右侧胸壁包块2月余”就诊于新疆医科大学第一附属医院。患者30余年前有肝细粒棘球蚴感染史,2021年12月曾因肺细粒棘球蚴感染行右肺下叶切除术+右肺上叶楔形切除术,有家畜、犬类密切接触史。入院查体,右上胸部近腋窝处触及一大小约30 cm×20 cm、柔软的实性包块,质韧、边界清、压痛阳性。血常规示嗜酸粒细胞升高。血清学检查示棘球蚴和弓形虫抗体IgG阳性。腹部增强CT、腹部B超示肝脏、左上腹腔、脾周、右侧腹腔及胸壁多发囊性病灶,右侧胸壁下病灶局部通过肋间隙突入胸壁皮下,部分病灶钙化。诊断为“腹腔多发合并胸壁细粒棘球蚴病”,行手术摘除包囊。术后病灶组织切片HE染色显示,病灶部分区域见均质红染,散在分布棘球蚴样结构伴部分钙化。术后患者恢复良好,6月13日出院。患者即出院日起口服阿苯达唑片剂,10~15 mg/(kg·d),早、晚餐后分服,继续治疗6个月。术后3月复诊,患者未诉特殊不适,腹部、盆腔增强CT平扫未见明显异常。

A 67-year-old male farmer of Han ethnicity from Gansu presented to the First Affiliated Hospital of Xinjiang Medical University on May 12, 2023, with a complaint of a mass on the right chest wall that had been present for over two months. He had a historical diagnosis of hepatic echinococcosis more than 30 years ago and had undergone a right lower lung lobectomy and right upper lung wedge resection for pulmonary echinococcosis in December 2021. His medical history also included close contact with livestock and dogs. Upon admission, a physical examination revealed a soft, mass approximately 30 cm × 20 cm in size in the vicinity of the axillary region of the right upper chest. The mass was firm, with clear boundaries and positive tenderness. Blood tests showed elevated eosinophil counts. Laboratory serology revealed positive IgG antibodies for Echinococcus and Toxoplasma. Enhanced abdominal CT and abdominal ultrasound identified multiple cystic lesions in the liver, left upper abdominal cavity, perisplenic area,right abdominal cavity, and chest wall. Notably, the lesion beneath the right chest wall extended into the subcutaneous tissue through the intercostal space, with areas of partial calcification. The patient was diagnosed with“multiple intraperitoneal echinococcosis with chest wall involvement”. Later, the patient underwent surgical removal of the cysts. Postoperative histological examination with HE staining showed homogeneous red staining in some regions of the lesion,along with scattered echinococcal structures and partial calcification. Postoperatively, the patient exhibited satisfactory recovery and was discharged in improved condition on June 13. Upon discharge, he was prescribed oral albendazole tablets at a dose of 10-15 mg/(kg·d), administered in divided doses after breakfast and dinner, continuing for six months. At the three-month follow-up, the patient reported no specific discomfort, and enhanced abdominal and pelvic CT scans indicated postoperative changes without significant abnormalities.