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首页> 外文期刊>BMJ Open Gastroenterology >Pitfalls in diagnosis and treatment of alveolar echinococcosis: a sentinel case series
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Pitfalls in diagnosis and treatment of alveolar echinococcosis: a sentinel case series

机译：肺泡棘球虫病诊治中的陷阱：前哨病例系列

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BackgroundAlveolar echinococcosis (AE) is a neglected zoonosis presenting with focal liver lesions (FLL) with a wide range of imaging patterns resembling benign as well as malignant FLLs. Complementary serology and histopathology may be misleading.ObjectiveThe objective of our study is to highlight pitfalls leading to wrong diagnoses and harmful interventions in patients with AE.DesignThis retrospective sentinel case series analyses diagnostic and treatment data of patients with confirmed AE.Results80 patients treated between 1999 and 2014 were included in the study. In 26/80 patients treatment decisions were based on a wrong diagnosis. AE was mistaken for cystic echinococcosis (CE) in 12/26 patients followed by cholangiocellular carcinoma (CCA) in 5/26 patients; 61/80 patients had predominantly infiltrative liver lesions and 19/80 patients had a predominantly pseudocystic radiological presentation. Serology correctly differentiated between Echinococcus multilocularis and Echinococcus granulosus in 53/80 patients. Histopathology reports attributed the right Echinococcus species in 25/58 patients but failed to differentiate E. multilocularis from E. granulosus in 25/58 patients. Although contraindicated in AE 8/25 patients treated surgically had instillation of a protoscolicidal agent intraoperatively. One of the eight patients developed toxic cholangitis and liver failure and died 1?year after liver transplantation.ConclusionsMisclassification of AE leads to a critical delay in growth inhibiting benzimidazole treatment, surgical overtreatment and bares the risk of liver failure if protoscolicidal agents are instilled in AE pseudocysts.
机译：背景肺泡棘球co病（AE）是一种被忽视的人畜共患病，表现为局灶性肝病灶（FLL），其影像学范围广泛，类似于良性和恶性FLL。补充血清学和组织病理学可能会产生误导作用。目的本研究的目的是强调导致AE患者错误诊断和有害干预措施的陷阱。本回顾性前哨病例系列分析了AE确诊患者的诊断和治疗数据。结果80例患者于1999年之间接受治疗和2014年被纳入研究。在26/80例患者中，治疗决定是基于错误的诊断。在12/26例患者中，AE被误认为是囊性棘球co虫病（CE），在5/26例患者中，AE被误认为是胆管细胞癌（CCA）。 61/80例患者主要为浸润性肝病灶，19/80例患者主要为假性囊性影像学表现。在53/80例患者中，血清学正确区分了多叶棘球oc球菌和颗粒棘球E球菌。组织病理学报告归因于25/58患者中正确的棘球oc种，但未能区分25/58患者中的多眼大肠杆菌和颗粒状大肠杆菌。尽管在AE 8/25中是禁忌的，但接受手术治疗的患者在术中滴入了原生杀虫剂。八名患者中的一名发展为中毒性胆管炎和肝功能衰竭，并在肝移植后1年内死亡。假性囊肿。

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