肝内胆管错构瘤的超声诊断及误诊、漏诊分析

Ultrasonic diagnosis, misdiagnosis and missed diagnosis of bile duct hamartoma

目的:探讨肝内胆管错构瘤(BDH)的超声诊断特征,并分析误诊、漏诊原因。方法:收集2014年6月-2017年3月我院收治的经MRI诊断及实验室检查确诊的20例BDH病例,总结其超声表现特征,并对误诊、漏诊情况进行分析。结果:20例BDH患者,经超声检查,4例(20%)诊断为BDH,9例(45%)诊断为多发性肝囊肿,3例(15%)诊断为慢性肝病、肝硬化,4例(20%)诊断为肝实质弥漫性病变;超声诊断符合率为20. 00%。超声表现:13例表现为肝内多发小囊性病变,直径<1. 5 cm者居多,呈不规则形态,囊壁厚度较大,并可合并肝内多发小片状强回声并伴彗星尾征或肝内多发大小不等高回声小结节。另7例表现为肝实质粗大强回声,合并有肝内多发小片状强回声并伴彗星尾征或肝内多发大小不等高回声小结节。彩超示所有病变均无明显异常的血流信号。结论:BDH超声表现具有一定特征性,熟悉其典型表现对提高该病超声诊断率有重要意义。

Objective: To explore the ultrasonic diagnosis features of bile duct hamartoma(BDH) and analyze the causes of misdiagnosis and missed diagnosis.Methods: Twenty cases of BDH diagnosed by MRI and laboratory examination in our hospital from June 2014 to March 2017 were retrospectively collected. The ultrasonic features were summarized, and the misdiagnosis and missed diagnosis were analyzed.Results: Among the 20 cases of BDH patients by ultrasound examination, there were 4 cases(20%) diagnosed with BDH, 9 cases(45%) diagnosed with hepatic multiple cysts, 3 cases(15%)diagnosed with chronic liver disease and liver cirrhosis, and 4 cases(20%) diagnosed with diffuse parenchymal liver lesions. The coincidence rate ofultrasound diagnosis was 20%. Ultrasound showed that there were 13 cases with multiple intrahepatic cystic lesions, and most of them were less zhan 1. 5cm in diameter with irregular shape and thick wall, and they could be combined with strong echo of multiple intrahepatic small patch with coma tail sign or different sizes of multiple intrahepatic high echo nodules. The other 7 cases showed thick and strong echo of liver parenchyma, and they could be combined with strong echo of multiple intrahepatic small patches with comet tail sign or multiple intrahepatic high echo nodules at unequal size. Color Doppler ultrasound showed there was no obvious abnormal blood flow signals in all lesions.Conclusion: Ultrasound performance of BDH has certain characteristics, and being familiar with its typical performance is of great significance to improve the ultrasound diagnosis rate of the disease.