Biliobronchial Fistula Secondary to Treatment of Hepatocellular Carcinoma and Diagnosed With Tc-99m Mebrofenin Cholescintigraphy: A Case Report and Literature Review

Biliobronchial fistula (BBF) is a rare acquired or congenital condition defined as an abnormal communication between biliary tract and bronchial tree. Due to BBF's high mortality rate, prompt diagnosis is crucial. Unfortunately, the diagnosis can be extremely difficult since most symptoms are non-specific and may be misdiagnosed as a respiratory infection. The non-invasive cholescintigraphy, or hepatobiliary iminodiacetic acid (HIDA) scan, with dynamic imaging can accurately diagnose BBF, leading to swift management and treatment In our case, an 83-year-old man presented with mild fever, progressive productive cough, dyspnea on exertion, and abdominal fullness for one month. In addition, he had a history of hepatocellular carcinoma (HCC) and lung metastasis with resection, immunotherapy, and several courses of radiofrequency ablation and transarterial embolization. Abdominal and chest computer tomography revealed a hypodense lesion extending from liver dome toward right lower lung, suggesting metastasis or abscess formation. During hospitalization, the patient developed bilioptysis; therefore, BBF was suspected and HIDA scan using Tc-99m mebrofenin was arranged. By using the HIDA scan's dynamic imaging, the radiotracer could clearly be seen moving from the hepatic dome, through the fistula, and into the right lower lung, confirming the diagnosis of an active BBF. In the end, surgical intervention was performed, patient's symptoms improved, and he was discharged. This case demonstrates the convenience and precision of the HIDA scan for BBF diagnosis, producing a clear visualization of the active fistula between hepatobiliary and respiratory system.

關鍵字

biliobronchial fistula (BBF) ； cholescintigraphy ； hepatocellular carcinoma (HCC) ； hepatobiliary iminodiacetic acid (HIDA) scan

並列摘要

支氣管膽道瘻管是一種罕見的先天或後天性疾病，為膽道和支氣管樹之間存在異常通道。其伴隨的高死亡率，讓快速診斷顯得格外重要。然而支氣管膽道瘻管的症狀多不具特異性，不僅不易診斷，更可能被誤診為呼吸道感染。藉由非侵入性膽道閃爍造影的動態檢查，可以正確地診斷支氣管膽道瘻管，讓患者得到立即的治療。我們的案例是一位83歲男性，過去病史為肝細胞癌合併肺部轉移，並從7年前開始接受切除手術、免疫治療，及多次射頻燒灼術和肝動脈栓塞治療術。病人因為近1個月有輕度發燒、咳痰、呼吸困難、腹脹等症狀，前來求診。其腹部和胸部電腦斷層顯示有一個從肝穹窿向右下肺延伸的低密度病灶，初步懷疑是腫瘤轉移或是膿瘍。住院期間，病患有膽汁樣痰。因懷疑支氣管膽道瘻管，安排Tc-99m mebrofenin的膽道閃爍造影。透過膽道閃爍造影的動態影像，可看到放射性示蹤劑從病患的肝穹窿透過廔管流入右下肺葉，確診為支氣管膽道瘻管。經過手術治療，患者症狀獲得改善且順利出院。有賴於膽道閃爍造影中，膽道和呼吸系統間有示蹤劑的流動，讓支氣管膽道瘻管的診斷得以確立。此一案例顯示膽道閃爍造影在診斷支氣管膽道瘻管的便利性與準確性。

並列關鍵字

支氣管膽道廔管；肝細胞癌；肝膽亞氨基二乙酸閃爍造影；膽道閃爍造影

國際替代計量

Biliobronchial Fistula Secondary to Treatment of Hepatocellular Carcinoma and Diagnosed With Tc-99m Mebrofenin Cholescintigraphy: A Case Report and Literature Review

全文下載

主題瀏覽