HistoryandCTimages
病史和CT成像
History:A56-year-oldwomanpresentswithvaguerightupperquadrantabdominalpainforthepastseveralmonths.Thepatientdeniedanyrecenttravelhistory.
病史：患者，女性，56岁。右上腹部隐痛数月。患者表示近期无外游记录。
Imagesfromcontrast-enhancedCToftheabdomenareshownbelow.
如下是患者腹部CT增强图像。点击图片放大，结合图像，回答下列问题。
（T=True;F=False)
1.Thereisawell-circumscribedlesion.
1.病变边界清楚。（T/F）
2.Thereisprominentperipheralenhancement.
2.明显周边增强。（T/F)
3.Thereareenhancingmuralnodules.
3.附壁结节增强。（T/F)
4.Whichofthefollowingisthemostlikelyetiologyoftheabovelesion?
A.Vascular
B.Infectious
C.Neoplastic
D.Congenital
4.下列哪一项最有可能是上述病变病因？
A.血管
B.感染
C.肿瘤
D.先天
5.Whichofthefollowingisthemostlikelydiagnosis?
A.Biliarycystadenocarcinoma
B.Biloma
C.Hepaticabscess
D.Simplehepaticcyst
E.Hydatidcyst
5.该病最有可能诊断为？
A.肝胆管囊腺癌
B.胆汁瘤
C.肝脓肿
D.单纯性肝囊肿
E.包虫囊肿
6.Theabovediagnosishasamalegenderpredilection.
6.上述诊断疾病易发生于男性（T/F)
7.Whichofthefollowingistheoptimaltreatmentforthispatient?
A.Intravenousantibiotics
B.Percutaneousaspiration
C.Percutaneousaspirationandsclerosis
D.Percutaneousmicrowaveablation
E.Magneticresonanceimagingforfurthercharacterization
7.下列哪一项是该病最佳治疗方案？
A.静脉注射抗生素
B.经皮穿刺
C.经皮穿刺硬化治疗
D.经皮微波消融
E.行MRI进行进一步表征检查
8.Thereisamalegenderpredilectionwithsimplehepaticcysts.
8.单纯性肝囊肿易发生于男性。（T/F）
Percutaneousaspirationandsclerosis
经皮穿刺硬化治疗
Giventhesymptomsfromthelesion,percutaneousaspirationandsclerosisofthehepaticcystusingamixtureofabsoluteethylalcoholandethiodizedoilwasperformed.Clickimagestoenlarge.
考虑到病变症状，采用了无水乙醇和乙碘油的混合物进行肝囊肿经皮穿刺硬化治疗。点击图片放大，结合图像，回答下列问题。
1.Whichofthefollowingisacontraindicationtopercutaneoussclerosis?
A.Presenceofintralesionalhemorrhage
B.Cystdiametergreaterthan10cm
C.Abdominalpainduetomasseffectfromthecyst
D.Communicationbetweenthecystandthecentralbiliarytree
1.下列哪一项是禁忌经皮硬化治疗？
A.出现病灶内出血
B.囊肿直径大于10厘米
C.囊肿肿块引起腹部疼痛
D.囊肿与中央胆管的传递
2.Approximatelywhatvolumeofabsolutealcoholshouldbeinfusedrelativetothevolumeoffluidaspiratedfromthecysttoensureadequatesclerosis?
2.为保足够硬化，相对于囊肿抽液量，大约应该注入多少无水乙醇？
A.5%
B.25%
C.50%
D.75%
Answer:T、F、F、D、D、F、C、F、D、B
Findingsanddiagnosis
发现和诊断
Findings:
发现：
CToftheabdomen:Axialandcoronalcontrast-enhancedCTimagesdemonstrateawell-circumscribed,round,thin-walledlesionwithfluidattenuationintherighthepaticlobe.Thelesionmeasures14cminthelongestdiameter.Therearenointernalseptations,enhancingmuralnodules,orinternalfluid-fluidlevels.
腹部CT：轴位和冠状位增强CT图像显示边界清楚的圆形薄壁病灶，并伴有右肝叶流体衰减。病灶最长直径为14厘米。内部无分隔、附壁结节增强和流体-流体水平。
Percutaneousaspirationandsclerosis:Usingreal-timeultrasoundandfluoroscopic-guidance,a12-Frenchlockingloopdrainwasplacedintotherighthepaticlobelesionand1.4Lofserousfluidwasaspirated.Asclerosantmixture(absolutealcoholandethiodizedoil)wastheninfused.After30minutes,thesclerosantwasaspiratedandthedrainagecatheterwasremoved.Cytologyoftheinitiallyaspiratedfluiddemonstratednoevidenceofmalignancy.
经皮穿刺硬化治疗：采用实时超声和透视，将12F（1F=0.mm）的锁环式引流管放置到右肝叶病变中，并且抽吸1.4L浆液。再灌入硬化剂混合物（无水乙醇和乙碘油）。30分钟后，抽吸硬化剂，移出引流管。最初的抽吸液细胞学表明无恶性肿瘤。
Differentialdiagnosis
鉴别诊断:
Simplehepaticcyst
单纯性肝囊肿
Adultpolycysticliverdisease
成人多囊性肝病
Biliarycystadenoma/cystadenocarcinoma
胆管囊腺瘤/囊腺癌
Biloma
胆汁瘤
Hepaticabscess
肝脓肿
Hydatidcyst
包虫囊肿
Hepaticcavernoushemangioma
肝海绵状血管瘤
Diagnosis:Simplehepaticcysttreatedwithpercutaneousaspirationandsclerosis
诊断：经皮穿刺硬化治疗的单纯性肝囊肿
Keypoints
要点
Simplehepaticcyst
单纯性肝囊肿
Pathophysiology
病理生理学
Simplehepaticcystisacongenitalcystlinedbycuboidalepithelium.
单纯性肝囊肿是一种内衬立方上皮的先天性囊肿。
Originatesfromaberrantbiliaryendotheliumthatoccursseparatefromthebiliarytree.
起源于与胆道系统分离的异常胆管内皮细胞。
Maydevelopinanyportionoftheliver.
在肝脏任意部位均可发展。
Variableinsize,rangingfromafewmillimetersto10-20cminsize.
大小从几毫米到10-20厘米不等。
Naturalhistory:
自然病史：
Theygenerallyremainstableinsize,butmayslowlyenlargeandcausesymptomsrelatedtomasseffect.
一般大小保持稳定，但可能会慢慢扩大，引起与肿块病变的相关症状。
Complicationsarerelativelyrarebutincludethefollowing:
并发症较罕见，如下：
Cystrupture
囊肿破裂；
Intralesionalhemorrhage
病灶内出血；
Secondaryinfection
继发性感染；
Epidemiology
流行病学
Thereisafemalegenderpredilection,approximately5:1versusmales.
该病女性发生较常见，男vs女为1:5。
Prevalenceisapproximately5%to15%inthegeneralpopulation.
在普通人群中的患病率大约在5%-15%之间。
Clinicalpresentation
临床表现
Approximately15%ofcystsareestimatedtobesymptomatic.
约15%的囊肿存在症状。
Largercystsmayexertmasseffectonadjacentbiliarystructures,vessels,orenteralstructures,includingthestomach,leadingtosymptoms(i.e.,obstructivejaundiceandabdominalpain).
较大的囊肿可对邻近的胆结构，血管或肠结构（包括胃）产生占位效应，引起症状（即：阻塞性黄疸和腹痛）。
Imagingfeatures
影像学特点
CT:
Roundorovalshape
Well-circumscribed
Thinwalls
Homogeneouswaterattenuation(-10to+10HU)content
Nomuralnodularity:Notably,hemorrhagemaymimicmuralnodularity.
Nomuralcalcification
Noseptations
Noenhancement
CT：
圆形或椭圆形
边界清楚
薄壁
均匀水样衰减(-10to+10HU)
无壁结节：需注意，出血可能与壁结节相似。
无壁钙化
无分隔
无增强
Differentialdiagnoses
鉴别诊断
Adultpolycysticliverdisease
成人多囊性肝病
Biliarycystadenoma/cystadenocarcinoma
胆管囊腺瘤/囊腺癌
Biloma
胆汁瘤
Hepaticabscess
肝脓肿
Hydatidcyst
包虫囊肿
Hepaticcavernoushemangioma
肝海绵状血管瘤
Treatment
治疗
1.Symptomatic,large,orinfectedcystsmaybetreatedwithpercutaneousaspirationandsclerotherapy(aspirationalonedoesnotprovidedurableresultsastheepithelialcellsalongthecystwallwillcontinuetosecretefluid).
1.可用经皮穿刺硬化疗法（仅仅进行抽吸不能够产生持久性结果，因为沿着囊肿壁的上皮细胞会继续分泌液体）治疗症状性大的或感染的囊肿。
vVarietyofsclerosantshavebeenused,includingabsoluteethylalcohol,tetracycline,anddoxycycline.Withabsolutealcohol,avolumeofapproximately25%oftheaspiratedcystfluidshouldbeinstilledtoensureadequatecontactwiththeepithelialcellsliningthecystwall.
v采用了不同的硬化剂，包括无水乙醇，四环素和多西环素。使用无水乙醇，应灌注大约25％的抽吸囊液以确保与囊壁上的上皮细胞能充分接触。
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