结核性腹膜炎 .pptx

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1、Abdominal Tuberculosis腹部结核病Zhou LiuCancer Hospital Chinese Academy of Medical Sciences,Shenzhen centerGeneral considerationCan affect any organ in the abdomenImportance of clinical context in diagnosisHigh-risk population：immunocompromised patients,especially AIDS（免疫抑制的病人）Typical symptoms:such as di

2、arrhea,fever etc（腹泻、发热等）Laboratory findings（实验室检查）：serum and culture（血清和培养）Histologic analysis（组织学检查）Radiological findings might mimic many different diseaseInflammatory disease：Crohns diseaseNeoplastic disease:Lymphomatosis,Peritoneal carcinomatosisClassificationGastrointestinal tuberculosis（胃肠道结核）

3、Tuberculous lymphadenopathy（结核性淋巴结炎）Tuberculous peritonitis（结核性腹膜炎）Solid organ involvement（实性器官累及）Hepatic and splenic TBPancreatic TBDifferent pathwaysModes of involvement in abdominal tuberculosisBy ingestion（吞咽）Infected food or milk-Primary intestinal tuberculosis（原发性肠结核）Infected sputum（痰）-Seconda

4、ry intestinal tuberculosis（继发性肠结核）Hematogenous spread from distant tubercular focus（血性播散）Contagious spread from infected adjacent foci（邻近累及）Through lymphatic channel（淋巴扩散）Pathophysiology of Gastrointestinal TB（胃肠道TB的病理生理学）BacteriaMucosa粘膜Submucosa粘膜下层Epithelioid tubercles表皮样结节Ulceration溃疡Granuloma f

5、ormation肉芽肿形成Caseous necrosis干酪性坏死Cicatrization瘢痕形成Sloughing脱落Surrounding mucosa thickening邻近粘膜增厚Lymph nodes淋巴结Peritoneum腹膜Circulationliver肝 pancreas胰spleen脾SpreadingComplications of intestinal tuberculosisBowel obstruction（肠梗阻）Perforation（穿孔）Abscess formation（脓肿形成）Fistula（瘘道形成）Intussusception（肠套叠）B

6、owel wall ischemia（肠壁缺血）1 ileocecal junction(90%)23456Fixed and narrowed ileum（回肠固定及变窄）;Conical and shrunken cecum（锥形和萎缩的盲肠）mimic Crohns diseaseUniform and concentric thickening of terminal ileum wall（回肠末端肠壁向心性均匀增厚）ileocecal tuberculosis 回盲部结核Mild wall thickening of the cecum（盲肠壁轻度增厚）Pericecal lymph

7、 nodes（盲肠周围淋巴结）ileocecal tuberculosis 回盲部结核Circumferential thickening of the cecum and terminal ileum（盲肠和末端回肠壁环形增厚）Adjacent lymph nodes（邻近淋巴结）ProgressingDifferentiating imaging featuresTuberculosisCrohns diseaseAsymmetric,irregular wall thickeningCircumferential bowel wall thickeningFleischner sign

8、on barium studiesCobblestone appearance on bariumNo creeping fat Creeping fat(abnormal quantity of mesenteric fatPositive chest film(50%)Negative chest filmOmental and peritoneal thickeningNormal omentum and peritoneumEnlarged lymph nodes with low-denstity centersEnlarged soft-tissue density lymph n

9、odesColonic tuberculosis(A)Two strictures in descending and transverse colon(B)Marked infiltration and asymmetrical thickening of the ascending colon and mesenteric enlarged lymph nodeTuberculosis of the ileumSymmetric mural thickning ileum(arrows)and adjacent enlarged lymph nodeTuberculous lymphade

10、nopathyMultiple enlarged lymph nodes Hypodense centers and peripheral enhancement 低密度中心伴有周围强化Conglomerate lymph nodes 淋巴结融合Caseation and liquefaction substances at the center（中心干酪样和液化坏死）Peripheral inflammatory lymphatic tissue（周围炎性组织）Multiple enlarged lymph nodesRim enhancement and Necross inside（环形

11、强化和内部坏死）Calcification（钙化）Large psoas abscess（腰大肌脓肿）Tuberculous peritonitis 结核性腹膜炎Wet type90%Fibrotic-fixed type 7%High density Large volume of ascites Protein and cellular content Small volume of ascites Fixed bowel loops Omental masses Dry type 3%Dense peritoneal adhesions Fibrous peritoneal reacti

12、on Caseous nodulesThickening,enhancement,and nodularity of peritoneum 腹膜增厚、强化、结节状ileocolic adenopathy 回盲部淋巴结Mesentery involvement:most commonOmental involvement:nodular,smudgedPeritoneal involvement:smooth,tiny nodulesAscites:30-100%of cases&multiple stands of fibrin and debris（纤维素或碎片）&septa（分隔）Wet

13、type 湿型Ascites:septa（分隔）Peritoneum:smooth thickening&enhancement（光滑增厚&强化）Fibrous type 纤维型Omentum&peritoneum:thickening（增厚）Bowel loops:conglomerate（聚拢）Dry type 干型Sclerosing encapsulating peritonitis(abdominal cocoon)“茧”Clustering of small bowel loops in the center of abdomen 腹部中央肠袢聚拢Signs assisting i

14、n guiding diagnosis of tuberculous peritonitisPresence of mesenteric macronodulesEnhancement and regular thickening of the parietal peritoneumSplenomegaly and calcification of the spleenInvolvement of the ileocecal wallRetroperitoneal and peri-pancreatic lymphadenopathy with a hypodense center and r

15、ing-enhancementAsciteslymph nodes:mesenteric&retroperitonealNecrosis inside and ring-like enhancement Omentum:Thickening Peritoneum:Enhancement&Regular thickening Hepatic,Splenic and pancreatic TB 肝、脾、胰腺结核Usually in a fine miliary pattern（粟粒样）,below the resolving capacity of CTMost common presentati

16、on:non-specific hepatosplenomegaly（肝脾肿大）Occasionally,tiny scattering low-density foci（微小低密度灶）Rarely,macronodular form（大结节）：pseudotumor or tuberculoma（假瘤或结核球）1-3cm or a single tumor-like massMiliary hepatic TB 粟粒型Enlarged liver 肝大Heterogeneous parenchyma 密度不均Multiple hypoenhancing nodules in the sple

17、en 伴有脾脏多发小结节，低强化Tiny hypovascular nodules scattering in the liver and spleen 低血供结节Enlarged liver and spleen 肝脾大slightly rim enhancement 轻度环形强化Micronodular tuberculosis 微小结节型Macronodular 大结节Hypovascular 低血供Macronodular hepatic&splenic tuberculosis 大结节型Pancreatic tuberculosis 胰腺结核Slight increase in th

18、e dimension of pancreas 体积稍增大Loss of lobulated contour 边缘变光滑 Associated FindingsThoracic findings:15%合并胸部结核Genitourinary tuberculosis 泌尿生殖道结核Musculoskeletal tuberculosis 骨骼肌肉结核Central nervous system tuberculousis CNS TB 中枢神经系统结核A painting is more than the sum of its parts.A cow by itself is just a cow.A meadow by itself is merely grass and flowers.The sunshine peeking through the trees is merely a beam of light.But you put them all together,it can be magic.You have to see the whole landscape.Thank you