Oliva A, Duarte B, Jonasson O, Nadimpalli V
Department of Surgery, University of Illinois College of Medicine, Chicago.
J Clin Gastroenterol. 1990 Apr;12(2):166-73. doi: 10.1097/00004836-199004000-00011.
Local hepatic tuberculosis without active pulmonary or miliary tuberculosis is an uncommon diagnosis. Even less common is the finding of tuberculoma or tuberculous liver abscess without clinical evidence of tuberculosis elsewhere. Since 1950, 21 cases of isolated tuberculoma or tuberculous abscess of the liver have been reported in the world literature. We report an additional two cases, one tuberculoma and one with multiple tuberculous abscesses. The case reports illustrate the difficulty in reaching the correct diagnosis, unsuspected in nearly all cases and most often confused with carcinoma of the liver. The correct diagnosis was made by histology, identification of acid-fast organisms by smear, and by cultures of Mycobacterium tuberculosis, but required laparotomy in 19 of the 23 cases. A greater awareness of this rare clinical entity may prevent needless surgical intervention since the vast majority of patients respond well to antituberculous chemotherapy.
无活动性肺结核或粟粒性肺结核的局限性肝结核是一种罕见的诊断。更少见的是发现肝结核瘤或肝结核脓肿，而其他部位无结核病的临床证据。自1950年以来，世界文献报道了21例孤立性肝结核瘤或肝结核脓肿病例。我们报告另外2例，1例为结核瘤，1例为多发性结核脓肿。这些病例报告说明了做出正确诊断的困难，几乎所有病例都未被怀疑，且最常与肝癌混淆。正确诊断通过组织学、涂片鉴定抗酸菌以及结核分枝杆菌培养做出，但23例中有19例需要剖腹手术。对这种罕见临床实体的更多认识可能会避免不必要的手术干预，因为绝大多数患者对抗结核化疗反应良好。
