右肝上间隙结核性肿块伴肝脏受累1例并文献回顾

Tuberculous Mass in the Right Suprahepatic Space with Hepatic Involvement: A Case Report and Literature Review

摘要: 目的：探讨并分析右肝上间隙结核性肿块伴肝脏受累这一罕见病例的临床特点、影像学表现、诊断思路及治疗方法。方法：收集并整理1例因“右上腹疼痛1月余”就诊的患者的基本信息、病史、实验室检查(包括结核菌素皮肤试验、炎症指标等)、影像学资料(腹部增强MRI、胸部CT)以及超声引导下经皮肝包块穿刺活检的病理结果，进行综合分析。结果：患者无结核病史及全身中毒症状，实验室检查仅见炎症指标轻度升高及结核菌素试验阳性。胸部CT未见结核感染征象，腹部增强MRI显示右肝上间隙占位，伴边缘及间隔强化，邻近肝实质受压。肝穿刺活检病理提示肉芽肿性炎伴坏死，镜检下找到抗酸杆菌，随后进行结核杆菌DNA检测为阳性，最终确诊为肝结核。经HRZE抗结核治疗后，患者症状较前显著缓解。结论：右肝上间隙结核感染临床罕见且缺乏特异性，易与肿瘤及其他感染性疾病混淆。其确诊需依靠组织病理学检查，同时辅以分子技术与增强影像学进行综合评估。早期抗结核治疗以及对大脓肿及时行手术引流，是预防严重并发症的关键。

Abstract: Objective: To explore and analyze the clinical characteristics, imaging manifestations, diagnostic ideas, and treatment methods of a rare disease of tuberculous mass with liver involvement in the right suprahepatic space. Method: Collect and organize the basic information, medical history, laboratory tests (including tuberculin skin test, inflammatory indicators, etc.), imaging data (abdominal enhanced MRI, chest CT), and pathological results of ultrasound-guided percutaneous liver mass biopsy of a patient who visited due to “upper right abdominal pain for more than one month” for comprehensive analysis. Results: The patient had no history of tuberculosis and systemic toxic symptoms, and only slight increase of inflammatory indicators and positive tuberculin test were found in laboratory examination. Chest CT showed no signs of tuberculosis infection, while abdominal enhanced MRI showed a mass in the right hepatic space, accompanied by marginal and septal enhancement, and the adjacent liver parenchyma was compressed. The liver biopsy pathology indicated granulomatous inflammation with necrosis. Acid-fast bacilli were found under microscopy, and subsequent DNA testing for Mycobacterium tuberculosis was positive. The final diagnosis was liver tuberculosis. After anti-tuberculosis treatment, the patient’s symptoms significantly improved. Conclusion: Tuberculosis infection in the right suprahepatic space is rare and lack of specificity, which is easily confused with tumor and other infectious diseases. Its diagnosis relies on histopathological examination, supplemented by molecular technology and enhanced imaging for comprehensive evaluation. Early anti-tuberculosis treatment and timely surgical drainage of large abscesses are key to preventing serious complications.