肝膿瘍的超音波診斷及追踪

SONOGRAPHIC DIAGNOSIS AND FOLLOW-UP OF LIVER ABSCESS

陳信實(Sin-Sue Chen) ； 周宜宏(Yi-Hong Chou) ； 潘慧本(Huay-Ben Pan) ； 刁翠美(Chui-Mei Tiu) ； 姜仁惠(Jen-Huey Chiang) ； 劉正義(Cheng-Yi Liu) ； 許重權(Chung-Chuan Hsu) ； 吳峻吉(Chun-Chi Wu) ； 張遵(Tsuen Chang)

《中華放射線醫學雜誌》 12卷2期 (1987/06) Pp. 123-128

摘要

覆閱133例肝膿瘍住院病人，75例接受超音波檢查，其中證實為阿米巴性膿瘍的有23例，細菌性膿瘍有36例，雖然肝膿瘍超音波突變異極大，大致可歸納出4種型態:第1型：病灶無可確認之邊緣，呈局部肝實質彌漫性回音異常，常是高回音兼雜多處細小無回音。第2型：寬而模糊之病灶邊緣，其內部回音多為不均勻。第3型：病灶有界限分明而不規則之周壁，其內部回音不均勻。第4型：病灶有規則而明確之周壁，其內呈均勻之低或無回音，偶而有液體沈渣界面。說追蹤檢查此4種型態與膿瘍的進行有極密切的關係。膿瘍病灶有2種常存的特徵，即後方回音增強和四周邊緣的回音型態一致。阿米巴性與細菌性膿瘍在超音波圖像極難分辨，然而多發性及含氧型的膿瘍大多發生於細菌性..41病人接受超音波追踪檢查，其腫瘍富的演變及穿刺抽吸及引流所產生的影響亦一併討論。

並列摘要

Sonographic examination of seventy-five patients with liver abscess were reviewed. Although wide variety of the initial sonographic pictures exist, they can be grouped into four types: 1. Focal echogenic change without distinct margin, 2. Wide and ill-defined margin with low echogenic center, 3. Irregular but well-defined margin with variable internal echoes, 4. Regular and well-defined margin with homogeneous hypo- or anechoic internal structure. Each type represents a phase of the disease being observed during evolution of the inflammatory process. Forty-one patients had been studied with follow-up sonograms. Successive change according to the order of these four phases were observed in twelve patients with medical treatment only. Of the twenty-nine patients who had received percutaneous aspiration or drainage, only three cases did not follow, the order. Two constant sonographic findings can be recognized in all phases of the disease. 1. Presence of distal acoustic enhancement either due to necrotic material of edematous change. 2. Presence of the same echo pattern at every part of the surrounding margin due to synchronous inflammatory change. These could provide clues to differentiate its inflammatory nature from solid neoplasm. Some difficulties were encountered in this arbitary division of the continuous evolution of the disease. However, it provides brief explanation for the wide variety of the initial pictures and good correlation of the progressive inflammatory process.