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目的 分析细菌性肝脓肿超声图像特点及其误诊原因。方法 回顾分析2022年1月至2024年1月收治2例被误诊的细菌性肝脓肿患者的超声图像资料和临床资料。结果 1例劳累后右上腹隐痛，伴恶心、呕吐，且次日疼痛转移至右下腹，伴寒战、发热。诊断为急性阑尾炎，予以退热、抗感染治疗无好转。查体示右下腹肌紧张、压痛明显，B超提示右下腹阑尾增粗伴管壁水肿。剖腹探查见阑尾尖端轻度充血，行阑尾切除术。术后症状如故，术后第5天，患者如厕时突感右上腹剧痛，大汗，疼痛迅速波及全腹。遂行肝穿刺引流术，抽出脓性液体，脓液培养出大肠埃希菌。确诊为细菌性肝脓肿，误诊时间为7 d。经抗感染、引流等治疗后痊愈出院，随访预后良好。1例因右上腹隐痛不适伴发热1个月，加重2 d入院。有胆管炎、胆囊结石病史。初步诊断为急性化脓性胆管炎伴感染性休克，经抗休克和抗感染治疗后病情好转。次日B超提示肝右叶占位病性变，增强CT检查考虑原发性肝癌。后经肝穿刺及剖腹探查术，最终诊断为细菌性肝脓肿，误诊时间6 d。术后随访6个月，预后良好。结论 细菌性肝脓肿超声图像有一定特征，易误诊为急性阑尾炎、肝癌等。为减少误诊，医师需详细询问病史，仔细分析超声图像，提高对细菌性肝脓肿的认识和诊断能力，避免漏误诊的发生。
Abstract：Objective To analyze the ultrasound imaging characteristics and causes of misdiagnosis of bacterial liver abscess(BLA). Methods The ultrasound image data and clinical data of 2 patients withBLA misdiagnosed in our hospital from January 2022 to January 2024 were retrospectively analyzed. Results One patient had dull pain in the right upper abdomen after fatigue, accompanied by nausea and vomiting, and the pain was transferred to the right lower abdomen the next day, accompanied by chills and fever. The patient was diagnosed with acute appendicitis and was not improved after antipyretic and anti-infective treatment. Physical examination showed obvious tension and tenderness in the right lower abdominal muscles. B-ultrasound showed enlargement of the right lower abdominal appendix with wall edema. Exploratory laparotomy revealed mild congestion at the tip of the appendix, and an appendectomy was performed. The symptoms remained after operation. On the fifth day after the operation, the patient suddenly felt severe pain in the right upper abdomen and sweating when going to the toilet, and the pain quickly spread to the whole abdomen. Liver puncture and drainage were performed, purulent fluid was extracted, and Escherichia coli was cultured from the pus. The diagnosis was BLA, and the misdiagnosis lasted 7 d. After anti-infection and drainage treatment, the patient was cured and discharged. The prognosis was good during follow-up. One patient was admitted due to right upper quadrant pain and fever for 1 month, which worsened for 2 d. He had a past history of cholangitis and gallstones. The initial diagnosis of acute suppurative cholangitis with septic shock was made, and the condition improved after anti-shock and anti-infection treatment. The next day, B-ultrasound showed a space-occupying lesion in the right lobe of the liver, and primary liver cancer was considered after enhanced CT examination. After liver puncture and exploratory laparotomy, the final diagnosis was BLA, and the misdiagnosis lasted 6 d. After 6 months of follow-up, the prognosis was good. Conclusion The ultrasound images of BLA have certain characteristics, which are more likely to be misdiagnosed as acute appendicitis and liver cancer. In order to reduce misdiagnosis, doctors need to inquire about the medical history in detail, analyze the ultrasound images carefully, improve the understanding and diagnostic ability of BLA, and avoid the occurrence of missed diagnosis and misdiagnosis.
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基本信息:
DOI：
中图分类号:R445.1;R575.4
引用信息:
[1]张猛,王阿娇.细菌性肝脓肿超声误诊原因分析[J].临床误诊误治,2025,38(16):1-6.
基金信息:
廊坊市科学技术研究与发展计划自筹经费项目(2024013054)