目的

探讨超声造影（CEUS）检查在西藏地区肝破裂诊断中的临床应用价值。

方法

患者女，47 岁，藏族，因“被牛角顶伤后右上腹痛1 h”于2022 年11 月22 日就诊。查体：生命体征平稳，右上腹可见一5 cm 横行伤口，皮下组织外翻，渗血。右上腹腹肌紧张，轻压痛阳性。肝区叩痛阳性。采用彩色多普勒超声诊断仪对患者进行超声及CEUS 诊断，明确是否存在肝破裂及活动性出血，为临床进一步诊疗提供依据。

结果

腹部超声检查提示，肝脏大小形态正常，表面光滑，肝实质回声均匀，右肝S5 被膜下可见一片状混合回声区，范围约30 mm×22 mm。考虑肝破裂可能性大，腹腔积血可能性大。进一步行CEUS 检查，造影剂1.5 ml 经肘静脉注入，第一次观察肝S5 异常回声区，动脉期、门静脉期、延迟期均呈无增强；第二次观察肝被膜及腹腔积液，未见明确微泡溢出。结合CEUS 判断患者肝破裂，未见明确活动性出血征象。遂行超声引导下腹腔积液置管引流术，引流出暗红色血性液体，予以静卧、抗感染、对症支持治疗，患者生命体征平稳，好转出院。出院后3 周门诊复查彩超提示肝实质回声均匀，肝被膜下回声区较前明显缩小，内未见明显液性暗区。患者无任何不适，恢复正常生活。

结论

在西藏地区CEUS 对肝破裂的诊断有较高的时效性，是一种可靠、便捷的诊断方式，值得在基层推广。

Objective

To evaluate the clinical value of contrast-enhanced ultrasound (CEUS)in the diagnosis of liver rupture in Xizang, China.

Methods

On November 22, 2022, a 47-year-old female patient from Xizang was admitted to the hospital due to ＂the right upper abdominal pain for 1 h after being injured by the cattle horn＂.Physical examination revealed stable vital signs, a 5-cm transverse wound in the right upper abdomen, subcutaneous tissue exposure and blood oozing.The muscles of the right upper abdomen were tense, positive for tenderness.The patient had percussion tenderness of the liver area.Ultrasound and CEUS diagnosis by color Doppler ultrasound to confirm the incidence of liver rupture and active bleeding, providing evidence for subsequent clinical diagnosis and treatment.

Results

Abdominal ultrasound showed that the liver size and morphology were normal, with smooth surface and even echo in liver parenchyma.A patchy mixed echo area, approximately 30 mm×22 mm in size, could be seen beneath the S5 capsule in the right lobe.The possibility of liver rupture and hematocele in the abdominal cavity was considered.CEUS was performed by injection of 1.5 ml contrast agent through the elbow vein.The abnormal echo area of S5 liver segment was observed for the first time, and there was no enhancement in the arterial,portal venous and delayed phases, respectively.Secondary CEUS was conducted to observe hepatic capsule and peritoneal effusion and detect no evident microbubble overflow.Combined with CEUS, the diagnosis of liver rupture was made.No evident signs of active bleeding were found.Ultrasound-guided catheter drainage of peritoneal effusion was performed, and dark-red bloody fluid was drained.Subsequently, the patient lay down for resting, anti-infection and symptomatic treatment.The patient showed stable vital signs and was discharged.At 3 weeks after discharge, color Doppler ultrasound showed that the echo of liver parenchyma was uniform, the echo area beneath liver capsule was significantly decreased, and no evident dark fluid area was found.The patient restored normal life without any discomfort.

Conclusions

CEUS is a timely, reliable and convenient diagnostic tool for liver rupture in Xizang, which is worthy of widespread application at grassroot-level hospitals.