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題名 | 肝膿瘍合併門靜脈侵犯:一病例報告=Pyogenic Liver Abscess with Portal Vein Encasement That Mimics a Hepatic Malignant Tumor |
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作者 | 徐偉倫; 張文熊; 王蒼恩; 范揚凱; 張文瀚; 陳碧芳; Hsu, Wei-lun; Chang, Wen-hsiung; Wang, Tsang-en; Fan, Yang-kai; Chang, Wen-han; Chen, Be-fong; |
期刊 | 中華民國急救加護醫學會雜誌 |
出版日期 | 20060300 |
卷期 | 17:1 民95.03 |
頁次 | 頁24-30 |
分類號 | 415.537 |
語文 | chi |
關鍵詞 | 肝腫瘤; 化膿性肝膿瘍; 肝門靜脈包埋; 甲型胎兒蛋白; Hepatoma; Pyogenic liver abscess; Portal vein encasement; Alphafetoprotein; |
中文摘要 | 肝臟的佔位性病灶合併血管侵犯常被認為是肝細胞癌的徵象,化膿性肝膿瘍對於肝內血管的侵犯則較少見。我們要報告一個病例,一名斜歲女性除了B型肝炎家族史以外沒有任何的系統性疾病,血液檢查發現肝轉臉嗨上升,電腦斷層發現肝門脈遭該病灶包埋,以及下腔靜脈遭壓迫導致雙側腎臟的代償性擴大。病人經過三次超音波導引抽吸,病理報告並沒有發現惡性細胞,培養也沒有結果。經過抗生素的治療,病人的休克很快地改善,病灶也逐漸變小,在六個月後的門診追蹤,病灶和血管侵犯也消失了。確定這是一例發炎性肝膿瘍的病人。結論:化膿性肝膿瘍可能以侵犯肝內血管的形式出現,嚴重時可能直接威脅生命,因此必須即時作出區別,鑑別診斷的方法包括:( 1)查詢是否有病毒性肝炎或是肝硬化的危險因子;( 2)檢查病人是否有系統性發炎反應症狀(systemic inflammatory response syndrome) ; ( 3)安排肝臟三相動態電腦斷層攝影;( 4)詢問是否有肝膿瘍的危險因子(如糖尿病、HIV 感染或其它免疫不全等); ( 5 ) 執行肝臟切片以為組織和微生物的檢查;( 6)檢驗血清甲型胎兒蛋白。 |
英文摘要 | A space-occupying lesion with portal vein encasement is normally thought to suggest hepatocellular carcinoma when identified by computed tomography (CT). We report a 44 year-old female who had suffered from fever and general malaise for10 days prior to the admission and was transferred to our ER from a local hospital because of a liver space-occupying lesion and shock. She had a family history of chronic hepatitis B and hepatoma. Abnormal liver function (AST: 342 IU/L, ALT: 313 IU/L) was found.Enhanced CT at our ER showed one hypervascular space-occupying lesion on the right lobe of the liver with portal vein encasement. Hepatocellular carcinoma was highly suspected. However, echo-guided biopsy was negative for malignancy and for bacterial culture three times. After empirical antibiotic treatment,her hemodynamic status improved and the size of the lesion decreased. A liver abscess was diagnosed. The abdominal CT six months later showed no space-occupying lesion of the liver. Conclusion: A pyogenic liver abscess can invade the intrahepatic vessels. To differentiate liver abscess and hepatoma, we should (1) check the risk factors for viral hepatitis infection and liver cirrhosis; (2) find if the patient has systemic inflammatory response syndrome; (3) check the contrast media difference using a tri-phased liver dynamic CT scan; (4) determine if there is a history of high risk of liver abscess due to, for example, diabetes or HIV infection; (5) perform a liver biopsy with both histological and microbiological examinations and (6) check the patient’s serum alpha-fetoprotein level. |
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