Farina Renato, Clemenza Mariangela, Borzì Santo Riccardo, Basile Antonio
Department of Surgical and Medical Sciences, Advanced Technologies GF Ingrassia, University of Catania, Catania, Italy.
J Med Ultrasound. 2022 Oct 7;31(4):318-322. doi: 10.4103/jmu.jmu_62_22. eCollection 2023 Oct-Dec.
Sarcoidosis is a multisystemic disease of unknown etiology that can involve lungs, abdominal organs, and lymph nodes. The incidence of sarcoidosis is highest between the ages of 20 and 40 years, and it affects both sexes equally. The most frequent localization is in the lungs, and about half of the affected patients are generally asymptomatic but can involve in small percentages of various other parts such as the biliary tract, pancreas, stomach, and urinary tract. Hepatic and splenic localization is infrequent, and lesions are often mistaken for metastases due to their morphologic similarity. The histological lesion of sarcoidosis is a noncaseous granuloma always associated with high levels of angiotensin-converting enzyme, hypercalcemia, hypercalciuria, and, in a significant percentage of cases (35%-40%), liver enzyme alteration. The pathological evolution of granulomas is fibrosis, and the most severe cases of hepatic sarcoidosis can develop into cirrhosis or portal hypertension. Imaging is essential for lesion localization and is represented by ultrasound, computed tomography (CT), magnetic resonance imaging, and positron emission tomography/CT. The differential diagnosis is very difficult and is almost always histological. We describe a case of hepatic sarcoidosis in an asymptomatic patient with elevated liver enzymes.
结节病是一种病因不明的多系统疾病，可累及肺部、腹部器官和淋巴结。结节病的发病率在20至40岁之间最高，且男女发病率相同。最常见的发病部位是肺部，约一半的患病患者通常无症状，但也有小部分患者会累及其他各个部位，如胆道、胰腺、胃和泌尿道。肝脏和脾脏受累较少见，由于其形态相似，病变常被误诊为转移瘤。结节病的组织学病变为非干酪样肉芽肿，常伴有血管紧张素转换酶水平升高、高钙血症、高钙尿症，且在相当比例的病例（35%-40%）中会出现肝酶改变。肉芽肿的病理演变是纤维化，最严重的肝脏结节病病例可发展为肝硬化或门静脉高压。影像学检查对于病变定位至关重要，包括超声、计算机断层扫描（CT）、磁共振成像和正电子发射断层扫描/CT。鉴别诊断非常困难，几乎总是需要组织学检查。我们描述了一例无症状但肝酶升高的肝脏结节病患者。
