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中华医学超声杂志(电子版) ›› 2026, Vol. 23 ›› Issue (07) : 634 -638. doi: 10.3877/cma.j.issn.1672-6448.2026.07.013

病例报告

超声误诊为自身免疫性胰腺炎的胰腺神经内分泌肿瘤伴胰源性门脉高压一例并文献复习
郑维亚, 郭稳, 陈涛†()   
  1. 100035 首都医科大学附属北京积水潭医院超声科
  • 收稿日期:2025-12-08 出版日期:2026-07-01
  • 通信作者: 陈涛
  • 基金资助:
    国家自然科学基金项目(82572229)

Pancreatic neuroendocrine tumor with pancreatogenic portal hypertension misdiagnosed as autoimmune pancreatitis on ultrasound: a case report and literature review

Weiya Zheng, Wen Guo, Tao Chen†()   

  • Received:2025-12-08 Published:2026-07-01
  • Corresponding author: Tao Chen
引用本文:

郑维亚, 郭稳, 陈涛. 超声误诊为自身免疫性胰腺炎的胰腺神经内分泌肿瘤伴胰源性门脉高压一例并文献复习[J/OL]. 中华医学超声杂志(电子版), 2026, 23(07): 634-638.

Weiya Zheng, Wen Guo, Tao Chen. Pancreatic neuroendocrine tumor with pancreatogenic portal hypertension misdiagnosed as autoimmune pancreatitis on ultrasound: a case report and literature review[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2026, 23(07): 634-638.

图1 肿大的胰腺超声图像。图a、b、c为经腹部二维超声图像,可以观察到胰腺弥漫性肿大,回声减低、不均匀,并伴散在囊性变,胰尾部呈结节样改变,图a主要显示胰腺头体部,图b显示胰腺体尾部,图c显示明显肿大的胰腺尾部。图d在放大模式下,可以观察到胰腺实质内的小囊性结构(白箭头所示)。图e、f为彩色多普勒成像,胰腺实质内可探及较丰富血流信号,图e主要显示胰腺尾部,图f主要显示胰腺体部
图2 胰源性门脉高压患者超声图像。图a显示脾明显肿大,脾门处脾静脉可探及(白箭头所示),胰尾后方则无法观察到明确脾静脉主干结构。图b、c分别展示了在二维超声及彩色多普勒血流成像模式下,脾门至胃底部可以观察到迂曲扩张的脾静脉属支,胃底区显著,提示胃底静脉曲张。图d显示增宽的门静脉(三角符号所示),同时可以观察到肝回声正常,无肝病表现
图3 胰腺神经内分泌肿瘤(PNET)患者腹部增强CT图像。图a、b显示动脉期及延迟期轴位PNET图像(白箭头所示),可见肿瘤动脉期不均匀强化,延迟期均匀强化,图b还可见增强后的门静脉与肿瘤组织边界不清(虚线方框)。图c显示冠状位肿瘤图像(白箭头所示),以及曲张的胃底静脉(三角符号所示),图d显示残存的正常胰头组织(虚线圆形)
图4 术中切除的胰腺肿瘤大体标本,断端切面灰白细腻,丧失胰腺正常结构
图5 神经内分泌肿瘤病理图像。图a(HE×200)、图b(HE×400)示神经内分泌细胞分布排列以及脉管内瘤栓(白色虚线)
图6 胰腺神经内分泌肿瘤患者术后4个月腹部增强CT图(均为门脉期)。图a为术前腹部增强CT图像,图b、c均为术后4个月的腹部增强CT图,分别为轴位以及冠状位,提示胃底曲张静脉较术前明显减少(白色虚线)。图c可见原脾门区大量迂曲血管影已基本消失(与图3c对比)
表1 不同胰腺病变的超声特点
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