Peripancreatic and Biliary Tuberculosis Mimicking Pancreatic Neoplasia on F-18 FDG PET/CT: A Case Report and a Literature Review of Its Diagnostic Approach

胰臟旁與膽道結核在氟化去氧葡萄糖正子電腦斷層造影中仿似胰臟腫瘤：病例報告和診斷方法之文獻回顧

郭嬿姝(Yen-Shu Kuo) ； 連恆煇(Heng-Hui Lein) ； 黃世鴻(Shih-Hung Huang) ； 孫辰明(Chen-Ming Sun) ； 謝秉儒(Ping-Ju Hsieh)

《核子醫學暨分子影像雜誌》 29卷1期 (2016/03) Pp. 23-29

https://doi.org/10.6332/ANMMI.2901.003

摘要

胰臟旁和膽道結核在台灣是一罕見病症。因其低發生率、非特異性的臨床表徵及與胰臟腫瘤高度相似的影像學表現，使得其臨床和影像診斷頗具挑戰。我們提出一個病例報告，並針對常見的診斷方式進行文獻回顧。我們觀察到：胰臟或胰臟旁病灶合併有阻塞性黃疸時，若在磁振造影中未見胰管擴張，但發現有總膽管管壁異常顯影現象，以及在氟化去氧葡萄糖正子電腦斷層造影的延遲影像中病灶有持續高攝取情形，應考慮將胰臟旁和膽道結核之可能性提高，並將之列入鑑別診斷。運用內視鏡超音波導引細針抽吸診斷此類病症，應可避免不必要的手術。

關鍵字

內視鏡超音波 ； 氟化去氧葡萄糖正子電腦斷層造影 ； 核磁共振造影 ； 阻塞性黃疸 ； 胰臟旁/膽道結核

並列摘要

Peripancreatic and biliary tuberculosis (TB) is a rare condition in Taiwan. Its low incidence, together with its non-characteristic clinical manifestations and radiologic findings, which highly mimic those of pancreatic neoplasia, pose a diagnostic challenge for both clinicians and imagers. We presented a case with such typical scenario and a literature review which focused on the commonly used diagnostic approaches. We reported our observations that in the presence of a pancreatic/peripancreatic mass with obstructive jaundice, the absence of the pancreatic duct dilatation, the abnormal enhancement of the common bile duct on the magnetic resonance imaging, and a persistently high SUV_(max) on the delayed phase F-18 fluorodeoxyglucose positron emission tomography may aid in raising the suspicion for peripancreatic/biliary TB, and enlisting it in the differential diagnosis. The utilization of endoscopic ultrasound-guided fine needle aspiration may avoid unnecessary surgery in the diagnosis of such disorder.

並列關鍵字

Endoscopic ultrasonography ； F-18 FDG PET/CT ； magnetic resonance imaging ； obstructive jaundice ； peripancreatic/biliary tuberculosis