超声诊断双侧颌下腺木村病1例

木村病是一种罕见的良性、慢性浸润性疾病,病因尚不明确,可能与免疫紊乱、过敏反应、非特异性感染等有关1],临床表现以长期存在并易反复的无痛性头颈部皮下软组织肿物为主,多见于唾液腺,该病可发生于任何年龄,男性发病率远高于女性。木村病呈良性病程,根据既往研究,复发率较高。实验室检查提示,患者外周血嗜酸粒细胞计数增高,血清IgE水平增高2]。本例特异性超声表现为：双侧颌下腺内低回声病灶,其内见多发小片状低回声区间夹杂“网格状”高回声,内部见丰富血流信号,腺体内及周围淋巴结皮髓质分界不清,可见“门型”血流信号。主要和软组织内血管瘤鉴别,血管瘤超声表现为软组织内梭形、圆形或卵圆形肿物,边界清晰或不清晰,内部回声不均匀,多为低回声,可见典型的蜂窝状结构,内可探及丰富血流信号,探头加压松开后血流信号增多,周围未见淋巴结增大。而木村病探头加压后肿块形变不明显,血流信号变化不大,可与血管瘤鉴别。木村病术前明确诊断较困难,超声是诊断木村和术后随访观察疗效的首选影像学检查方法。

Ultrasonic diagnosis of bilateral submandibular gland Kimura disease: a case report

Kimura disease is a rare benign and chronic infiltrative disease. The etiology is not clear. It may be related to immune disorders, allergic reactions, non-specific infections and other related 1]. The clinical manifestations are mainly chronic pain prone subcutaneous soft tissue tumors, which are common in salivary glands. The disease can occur at any age and the incidence rate of male is far higher than that of women. Kimura disease has a benign course. According to previous studies, the recurrence rate is high. Laboratory examination showed that the peripheral blood eosinophil count increased and the serum IgE level increased 2]. The specific ultrasonic manifestations of this case are: hypoechoic lesions in bilateral submandibular glands, with multiple small flake hypoechoic intervals mixed with "grid" hyperechoic, rich blood flow signals, unclear boundary between skin and medulla of lymph nodes in and around the glands, and "portal" blood flow signals. It is mainly differentiated from hemangioma in soft tissue. The ultrasonic manifestations of hemangioma are spindle, round or ovoid tumors in soft tissue, with clear or unclear boundary, uneven internal echo, mostly low echo, typical honeycomb structure can be seen, rich blood flow signals can be detected, the blood flow signals increase after the pressure of the probe is loosened, and there is no enlargement of surrounding lymph nodes. However, after the Kimura disease probe was pressurized, the mass deformation was not obvious, and the blood flow signal changed little, which can be distinguished from hemangioma. It is difficult to make a definite diagnosis of Kimura disease before operation. Ultrasound is the first choice for the diagnosis of Kimura disease and postoperative follow-up observation.