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1 病例报告 男,21岁,因腹胀,活动后气短4个月入院。患者4个月前无诱因出现腹胀、活动后气短,伴纳差乏力,无发冷发热。半月后在当地医院按结核性胸腹水抗痨治疗2个月,抗痨开始时曾见巩膜黄染,为进一步诊治,来我院就诊。查体:神志清晰,营养中等。颈静脉轻度怒张,气管左移。右胸饱满,右胸叩浊,呼吸音消失,心脏未见异常。腹膨隆,肝右肋下4cm,剑突下6cm,质中等,触痛,睥肋下2cm,叩诊肝上界在右锁骨中线第5肋间,腹水征阳性。实验室检查:血常规、肝功正常,结核菌素试验阴性,腹水淡黄色,介于渗漏液之间,未找到抗酸杆菌。胸膜活检病理未见特异性改变。胸透示右侧大量胸腔积液。腹部B超示肝大、睥大、腹水。胸腹部CT示肝大、腹水、右胸腔积液。以结核性胸腹水抗痨治疗,治疗期间胸水时多时少,胸透有时为右胸腔大量积液,有时仅为右肺底积液。多次腹部B超无新的阳性发现。2月后专家会诊再次B超发现中左肝静脉近下腔静脉入口处管腔消失,右肝静脉明显狭窄,中右及左肝静脉间可见拱状交通支,脐静脉见重建现象。下腔静脉造影示下腔静脉节段性狭窄(胸_(10)～胸_(12)),压力正常,肝中左静脉未显示,肝右静脉部分显示,确诊为柏-查氏综合征。
1 case report Male, 21 years old, due to abdominal distension, shortness of breath after admission for 4 months. Patients 4 months ago, no incentive to cause abdominal distension, shortness of breath after activity, with anorexia fatigue, no fever. Half a month later at the local hospital according to tuberculous pleural effusion anti-tuberculosis treatment for 2 months, the beginning of anti-tuberculosis had seen scleral yellow dye, to further treatment, to our hospital. Examination: Consciousness, nutrition is medium. Jugular vein mild rage, left tracheal. Right chest full, right chest tap turbid, breath sounds disappear, no abnormal heart. Abdominal bulge, the right rib under the liver 4cm, 6cm below the xiphoid, medium quality, tenderness, ribs 2cm, percussion liver in the middle of the right subclavian midline in the 5th intercostal, ascites sign positive. Laboratory tests: blood, normal liver function, negative tuberculin test, ascites pale yellow, between the leakage between the acid-fast bacilli not found. Pleural biopsy pathology no specific changes. Thoracic show a large number of pleural effusion on the right. Abdominal B-ultrasound shows large liver, large, ascites. Chest and abdomen CT showed liver, ascites, right pleural effusion. To tuberculous pleural effusion anti-tuberculosis treatment, pleural effusion during treatment for more than a few, sometimes a right chest thoracic pleural effusion, and sometimes only the right lung effusion. Multiple abdomen B-no new positive findings. After expert consultation in February, B-mode ultrasound again found that the lumen disappeared near the entrance of the IVC and showed obvious narrowing of the right hepatic vein. The arch-shaped traffic branch was visible between the right and left hepatic veins. The reconstruction of the umbilical vein was seen. Inferior vena cava showed segmental inferior vena cava stenosis (thoracic (10) thoracic (12)), normal pressure, the left middle hepatic vein was not shown, and the right hepatic vein was partially diagnosed as Parker-Chashe syndrome .