肝吸虫性胆管炎的CT表现与误诊分析

目的：探讨肝吸虫性胆管炎的CT表现特点及误诊原因。方法：本组48例临床表现急性胆管炎的肝吸虫病例行螺旋CT检查,并对照逆行性胰胆管造影加内镜下奥狄括约肌切开术和胆总管探查术结果进行回顾性分析。结果：肝内胆管扩张48例,末梢胆管囊状扩张38例;肝外胆管扩张32例和胆总管壁增厚12例,胆总管内高密度影6例;胆囊增大20例,胆囊内団状软组织影2例。本组15例术前CT误诊,其中误诊为胆管结石8例,因胆总管壁增厚并有强化而误诊胆总管下端癌4例和壶腹癌1例,误诊为肝内周围型胆管癌2例。结论：在肝吸虫疫区,当CT表现为胆管炎征象并伴有肝包膜下小胆管囊状扩张时,需要考虑吸虫所致。

CT diagnosis and misdiagnosis of cholangitis caused by clonorchis sinensis

Objective：To explore the imaging features of CT and causes of misdiagnosis of cholangitis caused by clonorchis sinensis.Methods：48 cases with cholangitis caused by clonorchis sinensis were examined by helical CT.The results of CT were compared with those of ERCP＋EST and CBD （common bile duct） operation.Results：Dilation of the intrahepatic biliary duct （n=48） and small cystiform dilation of peripheral biliary duct （n=38）,extrahepatic biliary dilation （n=32） and wall thickening （n=12） and high density tissue in the common bile duct （n=6） were found.Among the 15 cases misdiagnosed by CT before operation,8 cases were misdiagnosed as choledocholithiasis,4 cases as cholangiocarcinoma,1 as carcinoma of Vater′s ampulla and 2 cases as intrahepatic cholangiocarcinoma.Conclusion：In the endemic area of clonorchiasis,CT features of cholangitis with cystic dilatation of subcapsular peripheral duct should be considered as caused by clonorchiasis.