关键词: 免疫功能, 肝脏, 结核病, 影像特征, 计算机断层扫描

Abstract: Objective To understand the clinical and imaging characteristics with immunonormal hepatic tuberculosis, and provide a basis for early diagnosis and treatment of liver tuberculosis. Method Retrospective analysis of clinical data and CT images of 33 patients with liver tuberculosis admitted to Inner Mongolia Fourth People's Hospital, Guangzhou Chest Hospital, and Shenzhen Third People's Hospital from December 2017 to November 2023, summarizing and analyzing the clinical imaging characteristics of liver tuberculosis. Result Among the 33 patients with liver tuberculosis, males were the majority(20/33), and the main symptoms were abdominal pain, bloating, chest pain, chest tightness, cough, and sputum production. 29 of whom had concurrent pulmonary tuberculosis (87.88%), and 2 of whom had a previous history of tuberculosis（6.06%）; In this group of cases, there were 23 cases of Mycobacterium tuberculosis involving multiple organs(≥ 3), accounting for 69.70%.There were 13 cases (39.4%) of liver tuberculosis patients with single lesions and 20 cases (60.6%) with multiple lesions;Among the HTB patients in this group, serosal HTB was the most common type (14 cases, accounting for 42.42%), followed by tuberculous tumor (8 cases, accounting for 24.24%) or mixed HTB with tuberculous tumor and serosal type (9 cases, accounting for 27.27%). Tuberculous liver abscess (2 cases, accounting for 6.06%) was relatively rare, and there was no miliary HTB. Serous type liver tuberculosis is mainly characterized by cystic and solid nodules under the hepatic capsule, with enhanced CT circular enhancement or persistent enhancement of solid components, and abnormal perfusion in some adjacent hepatic parenchymal arteries. Hepatic tuberculosis tumors are mainly characterized by single or multiple round, oval, or petal shaped slightly low-density nodules or masses, with blurred edges and various forms of enhancement on contrast-enhanced scans. And transient halo enhancement of liver tissue around the lesion in the arterial phase, continuous enhancement in the portal phase, lesion shrinkage in the delayed phase, and circular enhancement around the lesion periphery. Tuberculous liver abscess is mainly characterized by unclear and blurred boundaries of lesions on plain scan, presenting as multilocular cystic lesions. After enhancement, there is continuous enhancement around the lesion and the separation of the cyst wall and interior. 17 patients with serosal liver tuberculosis or tuberculous tumors complicated with serosal liver tuberculosis accompanied by tuberculous pleurisy and/or tuberculous peritonitis. Conclusion In young patients with active tuberculosis disease in other organs outside the liver, when abdominal CT shows inflammatory disease of the liver, liver tuberculosis should be considered. In non HIV infected/AIDS patients, serous hepatic tuberculosis has a high incidence rate, usually accompanied by tuberculous pleurisy and/or peritonitis.

Key words: Immunologic function, Hepar, Tuberculosis, Clinical features, Computed tomography