Li Wei, Tang Yan-Fen, Yang Xue-Feng, Huang Xiang-Yu
The Affiliated Nanhua Hospital, Department of Radiology, Hengyang Medical School, University of South China, Hengyang 421002, Hunan Province, China.
The Affiliated Nanhua Hospital, Department of Gastroenterology, Hengyang Medical School, University of South China, Hengyang 421002, Hunan Province, China.
World J Clin Cases. 2021 Nov 6;9(31):9662-9669. doi: 10.12998/wjcc.v9.i31.9662.
Hepatic tuberculosis (TB) is uncommon clinically. Because of a lack of specific signs, characteristic symptoms and clinical manifestations and because pathological samples are difficult to obtain, hepatic TB is easily missed or misdiagnosed.
A 62-year-old Chinese man presented with jaundice for 1 wk and no abnormal laboratory tests other than elevated bilirubin, aminotransferases and C-reactive protein. Computed tomography (CT) of the abdomen showed a mass in the left lobe of the liver and hepatic hilum with striped calcified foci. Mild enhancement was visible at the edges, along with extensive intrahepatic biliary ductal dilatation in the right lobe of the liver. In the arterial phase of both CT and magnetic resonance imaging, the main trunk and right branch of the portal artery were partially visualized. Magnetic resonance cholangiopancreatography (MRCP) indicated that the left lobe of the liver and most of the bile ducts in the hilum were not visible. Pathological examination revealed coagulative necrosis, and granulomatous nodules were seen around areas of necrosis; therefore, TB was considered.
Hepatic tuberculosis is easily misdiagnosed or missed on imaging. Percutaneous puncture biopsy is the most useful tool for definitive diagnosis.
肝结核在临床上并不常见。由于缺乏特异性体征、特征性症状和临床表现，且病理样本难以获取，肝结核很容易被漏诊或误诊。
一名62岁中国男性因黄疸1周就诊，除胆红素、转氨酶和C反应蛋白升高外，实验室检查无异常。腹部计算机断层扫描（CT）显示肝左叶和肝门区有一肿块，伴有条纹状钙化灶。边缘可见轻度强化，同时肝右叶肝内胆管广泛扩张。在CT和磁共振成像的动脉期，门静脉主干和右支部分显影。磁共振胰胆管造影（MRCP）显示肝左叶及肝门区大部分胆管未见显影。病理检查显示凝固性坏死，坏死区域周围可见肉芽肿结节，因此考虑为结核。
肝结核在影像学上容易被误诊或漏诊。经皮穿刺活检是明确诊断的最有用工具。
