肝细粒棘球蚴病合并结核性脓胸误诊为肝 肺细粒棘球蚴病1例

肝细粒棘球蚴病是由细粒棘球绦虫幼虫感染人或动物肝脏组织而引起的一种慢性寄生虫病。结核性脓胸是一种慢性活动性感染性疾病,主要侵犯胸膜间隙引起内脏、壁胸膜增厚。同时感染上述两种疾病的患者较为罕见。本文报道1例肝细粒棘球蚴病合并结核性脓胸误诊为肝、肺细粒棘球蚴病的病例,并结合相关文献进行分析讨论,旨在提高临床医师对该病的鉴别能力。     

肝泡状棘球蚴病

肝泡状棘球蚴病 (Ａｌｖｅｏｌａｒｅｃｈｉｎｏｃｏｃｃｏｓｉｓ ,Ａ ｅ .)是一种对人体危害极大的人畜共患的寄生虫病 ,由多房棘球绦虫的幼虫寄生于肝脏并不断增殖芽生 ,似癌样浸润扩散 ,造成肝组织不可逆的进行性损害。临床上具有慢性隐袭进行性的特点 ,常伴有肺及脑等重要器官转移。由于Ａ ｅ .具有一定的地区分布性 ,易于引起误诊 ,因此复习有关文献 ,提高Ａ ｅ .的全面认识 ,对临床诊治工作必将有所裨益。1　流行病学[1- 5]泡球蚴病主要流行于北半球高纬度地带。我国主要在西北地区流行。　　多房棘球绦虫的主要终宿主是狐及狼等野生…     

肝巨大囊状棘球蚴病1例

患者，女，15岁，新疆伊宁市人，满族，2001年3月起自感腹胀、右上腹肋缘下有一包块。2002年6月5日，因头痛、呕吐，去南京市第一医院就诊。B超检查示右肝占位，诊断为“肝巨大囊肿”。同年6月24日来我院就诊，门诊以“肝巨大囊肿”收入院，住院号：268787。入院后体检：皮肤、巩膜无黄染，无蜘蛛痣及肝掌，浅表淋巴结无肿大，心肺功能正常，全腹软，右上腹肋缘下可扪及一巨大包块，质软，边缘不清，     

肝泡型棘球蚴病—我们的认识：附113例临床分析

肝泡型棘球蚴病(简称泡肝)是泡状棘球绦虫的蚴虫寄生于人体肝脏,在肝内不断增殖芽生,引起炎症、变性、坏死、液化导致肝功能损害,而引起一系列症状甚至死亡的寄生虫病,其主要呈外殖性芽生,似癌样浸润扩散造成肝组织不可逆的进行性损害,所以被称为恶性寄生虫病。我院自1965年至今经病理证实为泡肝者共113例,现将本组临床资料报告如下,并对流行病学、病理变化、治疗和诊断进行一些讨论。     

肝泡状棘球蚴病1例报告

正1病例资料患者男性,62岁。因入本院前半月余发现全身皮肤黏膜黄染就诊于临夏州中心医院行上腹部增强CT示:符合肝左叶巨块型肝癌并门静脉癌栓形成。未行特殊处理,建议转院治疗,于2016年5月4日来本院就诊。患者既往体健,无肝炎病史,少量饮酒。生于甘肃省积石山县,为牧区,家中饲养牛羊及犬类。入院查体:全身皮肤黏膜重度黄染,腹平坦,未见胃型及蠕动波,未见腹壁静脉曲张;腹肌柔软,右上腹压痛,无反跳痛,     

肝泡球蚴病（泡型包虫病）

人体肝包虫病(棘球蚴病)有囊型和泡型,囊型包虫病(CE)由细粒棘球绦虫的幼虫致病,通称包虫囊肿。泡型包虫病(AE)简称泡球蚴病,由多房棘球绦虫的幼虫所致。这二型包虫病无论是生物学、流行病学、病理学、临床学、治疗和预后等方面,均有差异。目前对 AE 的认识仍然不足,误诊者屡见不鲜。为此,特作扼要介绍。     

肾棘球蚴病8例

棘球蚴病是牧区常见的地方病。人是中间宿主 ,如果误食犬细粒棘球绦虫卵 ,即在十二指肠孵化成六钩蚴 ,穿过肠黏膜潜入门静脉 ,寄生于肝脏。六钩蚴也可穿过门静脉 ,寄生于肺脏。人的棘球蚴病多发于肝、肺 ,仅有极少量的六钩蚴随动脉血流进入全身其他脏器 。新疆伊犁州新华医院1987～2002年 ,共治疗棘球蚴病524例 ,其中肾棘球蚴病8例 ,报告如下。     

腰臀部细粒棘球蚴病1例

本文报道1例原发于腰臀部的细粒棘球蚴病病例。该病例初诊时被误诊为“皮下脓肿”,后经影像学检查及抗棘球蚴抗体试验得以确诊。本病例报道旨在提高临床医师对细粒棘球蚴病的认识,避免和减少误诊、漏诊。     

肝泡型棘球蚴病非手术治疗的疗效评价

目的探讨非手术治疗的晚期肝泡型棘球蚴病患者的治疗方法。方法对中国人民解放军第四医院2006-2009年收治的25例无法根治性切除的肝泡型棘球蚴病患者进行回顾性调查分析,了解其治疗方法和疗效。结果 25例肝泡型棘球蚴病患者中,男性18例,女性7例,平均年龄为41岁。其中单纯药物治疗[持续服用阿苯达唑15～20 mg/(kg.d)]12例,药物结合穿刺治疗11例,药物结合介入治疗2例。阿苯达唑治疗2周为一疗程,一般持续3个疗程。治疗后1～4年共有18人获随访。其中单纯药物治疗组有效2例,改善7例;药物结合穿刺治疗组有效2例,改善5例;药物结合介入治疗组2例均无效。结论持续服用阿苯达唑可作为非手术治疗肝泡型棘球蚴病患者的主要治疗方法。     

广西柳州市棘球蚴病一例报告

患者男性,57岁,工人,广西柳州市人.于1999年底开始咳嗽,干咳为主,偶有少许白粘痰,右胸隐痛不适,午后时有潮热及盗汗.外院诊断为"右侧胸腔积液",经抽胸水及抗炎治疗后病情好转.2001年4月上述症状复发,胸片示右肺阴影,诊断为右胸膜、肺多发性结核瘤,门诊按常规抗结核治疗半年,症状好转.     

Non-traumatic diaphragmatic hernia of the liver in an adult:a case report

BACKGROUND: Diaphragmatic hernia of the liver is a rare clinical entity, usually found after trauma in adults. This study was undertaken to elucidate a misdiagnosis of non-traumatic diaphragmatic hernia of the liver in an adult. METHOD: The clinical data of one patient with non-traumatic diaphragmatic hernia of the liver was analyzed. RESULTS: A tumor in the right lower thorax was revealed by chest X-ray and computed tomography. Non-traumatic diaphragmatic hernia of the liver was not identified until the operation. Pathological analysis confirmed the finding. The patient recovered well. CONCLUSIONS: Non-traumatic diaphragmatic hernia of the liver in an adult is a rare right-sided diaphragmatic hernia, which can move up into the chest cavity. It should be distinguished from lung cancer. The diagnosis and evaluation of non-traumatic diaphragmatic hernia of the liver can help optimize surgical management.     

腹膜假性黏液瘤误诊为肝硬化1例

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Tension gastrothorax in late-onset congenital diaphragmatic hernia,a rare but life-threatening condition: A case report

Rationale:Tension gastrothorax is a serious condition that can cause acute respiratory failure, which is mostly related to congenital diaphragmatic hernia (CDH) in pediatric cases. It is uncommon in late-onset CDH patients, and is difficult to diagnose due to atypical presentation. It is often misdiagnosed as tension pneumothorax or pleural effusion, leading to delayed treatment and potentially fatal outcome. In this study, we are reporting our experience of diagnosis and treatment of tension gastrothorax in a late-onset CDH patient.Patient concerns:A 2-year old boy presented to this hospital with severe dyspnea and abdominal pain that suddenly occurred while taking a bath.Diagnosis:Based on radiological findings we diagnosed tension gastrothorax.Interventions:Hernia reduction and diaphragmatic defect repair were performed under thoracotomy.Outcomes:After the operation, the patient''s clinical symptoms and imaging findings improved. At 1-year postoperative follow up, the patient was well with normal chest x-ray findings.Lessons:Tension gastrothorax in late-onset CDH is a life-threatening condition that requires rapid diagnosis and treatment. When the diagnosis is unclear by chest x-ray, chest computed tomography should be performed to confirm the diagnosis. A nasogastric tube should be inserted whenever possible for diagnosis and gastric decompression. Although laparotomy is the most preferred approach, we recommend that surgeons consider taking a thoracotomy approach in unstable patients that cannot undergo gastric decompression before operation.     

腹壁细粒棘球蚴病1例

腹壁细粒棘球蚴病较为罕见,本文报道了1例腹壁细粒棘球蚴病患者。该患者因发现腹部包块1年、伴包块皮肤破溃5 d,以“腹壁细粒棘球蚴病”收住入院,行腹壁下细粒棘球蚴病内囊摘除术,术后病理为细粒棘球蚴病（单房多子囊型）。本文旨在为腹壁细粒棘球蚴病临床诊断和治疗提供经验。     

Recurrence of a congenital diaphragmatic hernia 57 years postoperatively: A case report and review of the literature

Rationale:Postoperative recurrence of congenital diaphragmatic hernia (CDH) in adults is very rare. There is currently no precedent and no established treatment. We encountered a case of CDH which recurred 57 years, postoperatively.Patient concerns:A 57-year-old man with dyspnea on exertion was referred to our hospital. He had undergone surgery at the same hospital for CDH when he was 46 days old.Diagnosis and interventions:Laboratory studies, except diagnostic imaging and spirometry, were otherwise within normal limits. He was diagnosed with recurrent CDH based on computed tomography and underwent laparoscopic surgery.Outcomes:His postoperative course was uneventful, and there was no recurrence on follow-up.Lessons:We reported our encounter with a case of recurrent CDH, more than 50 years after the initial surgery. When managing diaphragmatic hernias, prompt surgical treatment, with consideration to prior surgical history for CDH, leads to satisfactory results.     

以肝脾多发占位为首发表现的肺结核伴全身多脏器播散1例报告

1病例资料患者女性,27岁,因＂反复发热3个月＂于2015年8月26日入住吉林大学第一医院。3个月前患者无明显诱因出现发热,体温最高41℃,发热多见于下午或夜间,平均每日发作1~2次,伴畏寒、寒战,期间反复发热,体温在38.5℃左右,曾就诊于北京协和医院,考虑为＂发热待查＂,具体诊疗不详,发热未见明显改善。病程中,咳少量白色黏液样痰、量少、无盗汗、食欲减退。入院查体：全身浅表淋巴结未扪及肿大,     

酒精性肝硬化合并局限性肝脂肪浸润病变误诊为肝癌1例报告并文献复习

<正>1病例资料患者男性,51岁,因反复纳差、乏力5年入院。患者于5年前无明显诱因出现纳差、乏力,外院诊断为肝硬化、腹水,经保肝、对症处理后缓解。2年前于外院检查肝脏CT发现肝脏占位性病变(图1a,b),考虑诊断为"肝癌",患者及家属拒绝手术、放化疗及介入等治疗,出院后未行特殊处理,近期自感上述症状加重,食欲差,睡眠欠佳,近1个月体质量下降5 kg,大便稀,尿黄,来本科室住院治疗。即往饮酒史:7岁患甲型肝炎,已     

辅助性T淋巴细胞17在肝囊型包虫病患者外周血中的变化

目的 探讨肝囊型包虫病患者外周血中辅助性T淋巴细胞(Th)17的变化.方法 将56例受试者分为:健康志愿者(HD)组20例,肝囊型包虫病(CE)组18例,肝囊型包虫病合并胆瘘(BF)组18例.流式细胞仪胞内染色分析法检测各组受试者外周血中Th17细胞占CD4+T淋巴细胞比例,ELlSA检测血清Th17细胞相关细胞因子IL-17、IL-23水平.数据行t检验和Pearson相关分析.结果 CE组患者外周血Th17/CD4+T淋巴细胞比例为(0.23±0.11)%,明显低于BF组的(0.76±0.43)%和HD组的(0.52±0.50)%(t=2.225,t=4.077,均P＜0.05),而BF组和HD组间差异无统计学意义(t=1.931,P＞0.05).血清IL-17和IL-23在CE组分别为(12.1±3.7)ng/L和(84.4±46.0)ng/L,明显低于BF组的(15.5±4.1)ng/L和(138.6±37.9)ng/L(t=2.515,t=3.649,均P＜0.05),也低于HD组的(14.8±4.4)ng/L和(138.1±48.7)ng/L(t=2.401,t=3.706,均P＜0.05),而BF组和HD组间差异无统计学意义(t=0.534,P＞0.05).各组血清IL-17水平与IL-23水平呈正相关(r=0.657,P＜0.05).结论 肝囊型包虫病患者外周血中Th17细胞比例明显减少,血清IL-17、IL-23水平显著降低.     

POEMS综合征误诊为肝硬化伴顽固性腹水1例

1．临床资料：患者,男性,60岁。因肢体无力11个月,腹胀1个月就诊。患者于2005年10月起,逐渐出现手足麻木、乏力,外院诊断为周围神经炎,未予治疗。2005年12月在我院神经内科亦诊断为周围神经病变,予强的松15 mg/d治疗1个月,10mg/d治疗2个月,5mg/d治疗至2006年6月。2006年7月开始出现腹胀,B超示大量腹水,停用强的松,予白蛋白、速尿治疗,效果不佳。[第一段]