侵袭性肺炎克雷伯菌肝脓肿综合征临床及影像学特点

目的 观察侵袭性肺炎克雷伯菌肝脓肿综合征（IKLAS）的临床及影像学特点。方法 回顾性分析18例IKLAS的临床及影像学表现。结果 临床表现为发热（18例）、寒战（11例），部分伴呼吸、消化、神经系统症状及视觉障碍；13例合并糖尿病；实验室感染指标增高，肝功能异常。肝脓肿位于肝右叶15例，肝左叶2例，同时累及肝左右叶1例；脓肿大小2.45~10.27 cm，平均（5.70±2.35）cm；3例为含气脓肿。双肺病灶分布以外周胸膜下为主，CT表现包括无空洞结节（18/18，100%）、空洞性结节（15/18，83.33%）、蜂窝脓肿（13/18，72.22%）、晕征（4/18，22.22%）、反晕征（3/18，16.67%）、实变影（3/18，16.67%）、外周楔形影（2/18，11.11%）、滋养血管征（2/18，11.11%）、磨玻璃影（1/18，5.56%）及双侧胸腔积液（15/18，83.33%）。2例合并颅内及眼部感染。结论 IKLAS影像学表现具有一定特征性，结合临床有助于诊断。

Clinical and imaging characteristics of invasive Klebsiella pneumoniae liver abscess syndrome

Objective To observe the clinical and imaging characteristics of invasive Klebsiella pneumoniae liver abscess syndrome (IKLAS). Methods Clinical and imaging findings of 18 patients with IKLAS were retrospectively analyzed. Results Clinical manifestations included fever (n=18), chills (n=11), some accompanied by respiratory, digestive, nervous system symptoms and visual impairment. Among 18 patients, 13 were found with diabetes. Laboratory examinations showed rise of infection indicators and hepatic function abnormality. Liver abscess located at right lobe in 15 cases, at left lobe in 2 cases, simultaneously involved at both right and left lobe in 1 case, sized 2.45-10.27 cm, mean (5.70±2.35)cm, and gas in abscess was observed in 3 cases. Lung lesions mainly located at the peripheral subpleural areas, CT showed nodules without cavity (18/18, 100%), with cavity (15/18, 83.33%) or honeycomb-like (13/18, 72.22%) abscess, with halo sign (4/18, 22.22%), reverse halo sign (3/18, 16.67%), consolidation shadows (3/18, 16.67%), peripheral wedge shadow (2/18, 11.11%), nourishing blood vessels (2/18, 11.11%), ground glass opacity (1/18, 5.56%) and bilateral pleural effusion (15/18, 83.33%). Two patients were found with intracranial and eye infection. Conclusion IKLAS has certain characteristic imaging manifestations, which are helpful to diagnosis combining with clinical characteristics.