Kumar R, Reddy S N, Thulkar S
Departments of Nuclear Medicine, Surgery and Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India.
Br J Radiol. 2002 Mar;75(891):271-4. doi: 10.1259/bjr.75.891.750271.
Intrabiliary rupture is the most common complication of hepatic hydatid cyst yet it is unusual, occurring in only 3-17% of cases. The diagnosis is rarely difficult on ultrasound and CT when typical radiological features are present. In rare cases of complete evacuation, when characteristic findings of hydatid cyst are absent or when there is no evidence of the previous existence of liver hydatid cyst, the diagnosis may be difficult. In difficult cases, MRI, MRCP, ERCP and (99)Tc(m)-mebrofenin hepatobiliary scintigraphy are employed. We present a rare case of surgical obstructive jaundice due to rupture of a liver hydatid cyst into the biliary tract and gall bladder, with complete evacuation of its contents leading to misdiagnosis on CT and ultrasound. MRCP and (99)Tc(m)-mebrofenin hepatobiliary scintigraphy were able to establish a firm pre-operative diagnosis.
肝内胆管破裂是肝包虫囊肿最常见的并发症，但并不常见，仅发生于3% - 17%的病例中。当出现典型的影像学特征时，超声和CT诊断很少困难。在罕见的完全排空病例中，当不存在包虫囊肿的特征性表现或没有证据表明先前存在肝包虫囊肿时，诊断可能会很困难。在疑难病例中，会采用磁共振成像（MRI）、磁共振胆胰管造影（MRCP）、内镜逆行胰胆管造影（ERCP）和锝（99）Tc（m）-美罗芬宁肝胆闪烁显像。我们报告一例罕见病例，因肝包虫囊肿破裂进入胆道和胆囊导致手术性梗阻性黄疸，其内容物完全排空，导致CT和超声误诊。磁共振胆胰管造影（MRCP）和锝（99）Tc（m）-美罗芬宁肝胆闪烁显像能够在术前做出明确诊断。
