Nakamura Naohiro, Matsuno Yoshiki, Aoi Kazunori, Kosaka Hisashi, Kobayashi Sanshiro, Takahashi Yu, Tahara Tomomitsu, Noda Yuri, Tsuta Koji, Naganuma Makoto
Third Department of Internal Medicine, Kansai Medical University, Japan.
Department of Surgery, Kansai Medical University, Japan.
Intern Med. 2025 Aug 15;64(16):2439-2445. doi: 10.2169/internalmedicine.4528-24. Epub 2025 Feb 18.
Although the liver is often involved in sarcoidosis, the majority of patients are asymptomatic and have a normal liver function; therefore, hepatic sarcoidosis may sometimes not be recognized in clinical practice. Radiologically, most hepatic nodules show hypoenhancement on contrast-enhanced computed tomography or magnetic resonance imaging (MRI) and they are hypointense across all sequences of MRI. In this case, hepatic nodules were slightly hyperintense on T2-weighted images and contrasted from the early phases on gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid. We faced difficulties in distinguishing hepatic sarcoidosis from metastatic liver tumors with concurrent duodenal adenocarcinomas. Consequently, this case was diagnosed based on the pathological findings from a laparoscopic lateral segment hepatectomy.
尽管肝脏常受累于结节病,但大多数患者无症状且肝功能正常;因此,肝结节病在临床实践中有时可能未被识别。在放射学上,大多数肝结节在对比增强计算机断层扫描或磁共振成像(MRI)上表现为强化减弱,且在MRI的所有序列上均为低信号。在本病例中,肝结节在T2加权图像上呈轻度高信号,与钆乙氧基苄基二乙三胺五乙酸早期相不同。我们在鉴别肝结节病与并发十二指肠腺癌的肝转移瘤时遇到困难。因此,该病例是根据腹腔镜左外叶肝切除术的病理结果确诊的。