tuberculousperitonitis结核性腹膜炎共29张课件

tuberculousperitonitis结核性腹膜炎tuberculousperitonitis结核性腹膜炎tuberculousperitonitis结核性腹膜炎AbdominalTuberculosis

腹部结核病ZhouLiuCancerHospitalChineseAcademyofMedicalSciences,ShenzhencenterGeneralconsiderationCanaffectanyorganintheabdomenImportanceofclinicalcontextindiagnosisHigh-riskpopulation：immunocompromisedpatients,especiallyAIDS（免疫抑制的病人）Typicalsymptoms:suchasdiarrhea,feveretc（腹泻、发热等）Laboratoryfindings（实验室检查）：serumandculture（血清和培养）Histologicanalysis（组织学检查）RadiologicalfindingsmightmimicmanydifferentdiseaseInflammatorydisease：Crohn'sdiseaseNeoplasticdisease:Lymphomatosis,Peritonealcarcinomatosistuberculousperitonitis结核性腹膜炎tutuberculousperitonitis结核性腹膜炎共29张课件2tuberculousperitonitis结核性腹膜炎共29张课件3tuberculousperitonitis结核性腹膜炎共29张课件4tuberculousperitonitis结核性腹膜炎共29张课件5PathophysiologyofGastrointestinalTB

（胃肠道TB的病理生理学）BacteriaMucosa粘膜Submucosa粘膜下层Epithelioidtubercles表皮样结节Ulceration溃疡Granulomaformation肉芽肿形成Caseousnecrosis干酪性坏死Cicatrization瘢痕形成Sloughing脱落Surroundingmucosathickening邻近粘膜增厚Lymphnodes淋巴结Peritoneum腹膜Circulationliver肝pancreas胰spleen脾SpreadingPathophysiologyofGastrointes6ComplicationsofintestinaltuberculosisBowelobstruction（肠梗阻）Perforation（穿孔）Abscessformation（脓肿形成）Fistula（瘘道形成）Intussusception（肠套叠）Bowelwallischemia（肠壁缺血）1ileocecaljunction(90%)23456Complicationsofintestinaltu7Fixedandnarrowedileum（回肠固定及变窄）;

Conicalandshrunkencecum（锥形和萎缩的盲肠）mimicCrohn'sdiseaseUniformandconcentricthickeningofterminalileumwall（回肠末端肠壁向心性均匀增厚）Fixedandnarrowedileum（回肠固定及8ileocecaltuberculosis回盲部结核

Mildwallthickeningofthececum（盲肠壁轻度增厚）

Pericecallymphnodes（盲肠周围淋巴结）ileocecaltuberculosis回盲部结核

Circumferentialthickeningofthececumandterminalileum（盲肠和末端回肠壁环形增厚）

Adjacentlymphnodes（邻近淋巴结）Progressingileocecaltuberculosis回盲部结核

M9DifferentiatingimagingfeaturesTuberculosisCrohn'sdiseaseAsymmetric,irregularwallthickeningCircumferentialbowelwallthickeningFleischnersignonbariumstudiesCobblestoneappearanceonbariumNocreepingfatCreepingfat(abnormalquantityofmesentericfatPositivechestfilm(50%)NegativechestfilmOmentalandperitonealthickeningNormalomentumandperitoneumEnlargedlymphnodeswithlow-denstitycentersEnlargedsoft-tissuedensitylymphnodesDifferentiatingimagingfeatur10Colonictuberculosis

(A)Twostricturesindescendingandtransversecolon

(B)MarkedinfiltrationandasymmetricalthickeningoftheascendingcolonandmesentericenlargedlymphnodeTuberculosisoftheileum

Symmetricmuralthickningileum(arrows)andadjacentenlargedlymphnodeColonictuberculosis

(A)Twos11TuberculouslymphadenopathyMultipleenlargedlymphnodesHypodensecentersandperipheralenhancement低密度中心伴有周围强化Conglomeratelymphnodes淋巴结融合Caseationandliquefactionsubstancesatthecenter（中心干酪样和液化坏死）Peripheralinflammatorylymphatictissue（周围炎性组织）TuberculouslymphadenopathyMul12Multipleenlargedlymphnodes

RimenhancementandNecrossinside（环形强化和内部坏死）

Calcification（钙化）

Largepsoasabscess（腰大肌脓肿）Multipleenlargedlymphnodes

13Tuberculousperitonitis结核性腹膜炎Wettype90%Fibrotic-fixedtype7%HighdensityLargevolumeofascitesProteinandcellularcontentSmallvolumeofascitesFixedbowelloopsOmentalmassesDrytype3%DenseperitonealadhesionsFibrousperitonealreactionCaseousnodulesTuberculousperitonitis结核性腹膜炎14Thickening,enhancement,andnodularityofperitoneum腹膜增厚、强化、结节状

ileocolicadenopathy回盲部淋巴结Thickening,enhancement,andn15Mesenteryinvolvement:mostcommonOmentalinvolvement:nodular,smudgedPeritonealinvolvement:smooth,tinynodulesAscites:30-100%ofcases&multiplestandsoffibrinanddebris（纤维素或碎片）&septa（分隔）Mesenteryinvolvement:mostco16Wettype湿型

Ascites:septa（分隔）

Peritoneum:smooththickening&enhancement（光滑增厚&强化）Fibroustype纤维型

Omentum&peritoneum:

thickening（增厚）

Bowelloops:conglomerate（聚拢）Wettype湿型

Ascites:septa（分隔17Drytype干型Sclerosingencapsulatingperitonitis(abdominalcocoon)“茧”Clusteringofsmallbowelloopsinthecenterofabdomen腹部中央肠袢聚拢Drytype干型Sclerosingencapsul18SignsassistinginguidingdiagnosisoftuberculousperitonitisPresenceofmesentericmacronodulesEnhancementandregularthickeningoftheparietalperitoneumSplenomegalyandcalcificationofthespleenInvolvementoftheileocecalwallRetroperitonealandperi-pancreaticlymphadenopathywithahypodensecenterandring-enhancementSignsassistinginguidingdia19Ascites

lymphnodes:mesenteric&retroperitoneal

Necrosisinsideandring-likeenhancement

Omentum:Thickening

Peritoneum:Enhancement&RegularthickeningAscites

lymphnodes:mesenteri20Hepatic,SplenicandpancreaticTB肝、脾、胰腺结核Usuallyinafinemiliarypattern（粟粒样）,belowtheresolvingcapacityofCTMostcommonpresentation:non-specifichepatosplenomegaly（肝脾肿大）Occasionally,tinyscatteringlow-densityfoci（微小低密度灶）Rarely,macronodularform（大结节）：pseudotumorortuberculoma（假瘤或结核球）1-3cmorasingletumor-likemassHepatic,Splenicandpancreati21MiliaryhepaticTB粟粒型Enlargedliver肝大Heterogeneousparenchyma密度不均Multiplehypoenhancingnodulesinthespleen伴有脾脏多发小结节，低强化MiliaryhepaticTB粟粒型Enlarged22Tinyhypovascularnodulesscatteringintheliverandspleen低血供结节

Enlargedliverandspleen肝脾大

slightlyrimenhancement轻度环形强化Micronodulartuberculosis微小结节型Tinyhypovascularnodulesscat23Macronodular大结节

Hypovascular低血供Macronodularhepatic&splenictuberculosis大结节型Macronodular大结节

Hypovascular24Pancreatictuberculosis胰腺结核Slightincreaseinthedimensionofpancreas体积稍增大Lossoflobulatedcontour边缘变光滑

Pancreatictuberculosis胰腺结核Sl25AssociatedFindingsThoracicfindings:15%合并胸部结核Genitourinarytuberculosis泌尿生殖道结核Musculoskeletaltuberculosis骨骼肌肉结核CentralnervoussystemtuberculousisCNSTB中枢神经系统结核AssociatedFindingsThoracicfi26Apaintingismorethanthesumofitsparts.Acowbyitselfisjustacow.Ameadowbyitselfismerelygrassandflowers.Thesunshinepeekingthroughthetreesismerelyabeamoflight.Butyouputthemalltogether,itcanbemagic.Youhavetoseethewholelandscape.Apaintingismorethanthesu27ThankyouThankyou28谢谢骑封篙尊慈榷灶琴村店矣垦桂乖新压胚奠倘擅寞侥蚀丽鉴晰溶廷箩侣郎虫林森-消化系统疾病的症状体征与检查林森-消化系统疾病的症状体征与检查11、越是没有本领的就越加自命不凡。——邓拓

12、越是无能的人，越喜欢挑剔别人的错儿。——爱尔兰

13、知人者智，自知者明。胜人者有力，自胜者强。——老子

14、意志坚强的人能把世界放在手中像泥块一样任意揉捏。——歌德

15、最具挑战性的挑战莫过于提升自我。——迈克尔·F·斯特利谢谢骑封篙尊慈榷灶琴村店矣垦桂乖新压胚奠倘擅寞侥蚀丽鉴晰溶廷tuberculousperitonitis结核性腹膜炎tuberculousperitonitis结核性腹膜炎tuberculousperitonitis结核性腹膜炎AbdominalTuberculosis

腹部结核病ZhouLiuCancerHospitalChineseAcademyofMedicalSciences,ShenzhencenterGeneralconsiderationCanaffectanyorganintheabdomenImportanceofclinicalcontextindiagnosisHigh-riskpopulation：immunocompromisedpatients,especiallyAIDS（免疫抑制的病人）Typicalsymptoms:suchasdiarrhea,feveretc（腹泻、发热等）Laboratoryfindings（实验室检查）：serumandculture（血清和培养）Histologicanalysis（组织学检查）RadiologicalfindingsmightmimicmanydifferentdiseaseInflammatorydisease：Crohn'sdiseaseNeoplasticdisease:Lymphomatosis,Peritonealcarcinomatosistuberculousperitonitis结核性腹膜炎tutuberculousperitonitis结核性腹膜炎共29张课件31tuberculousperitonitis结核性腹膜炎共29张课件32tuberculousperitonitis结核性腹膜炎共29张课件33tuberculousperitonitis结核性腹膜炎共29张课件34PathophysiologyofGastrointestinalTB

（胃肠道TB的病理生理学）BacteriaMucosa粘膜Submucosa粘膜下层Epithelioidtubercles表皮样结节Ulceration溃疡Granulomaformation肉芽肿形成Caseousnecrosis干酪性坏死Cicatrization瘢痕形成Sloughing脱落Surroundingmucosathickening邻近粘膜增厚Lymphnodes淋巴结Peritoneum腹膜Circulationliver肝pancreas胰spleen脾SpreadingPathophysiologyofGastrointes35ComplicationsofintestinaltuberculosisBowelobstruction（肠梗阻）Perforation（穿孔）Abscessformation（脓肿形成）Fistula（瘘道形成）Intussusception（肠套叠）Bowelwallischemia（肠壁缺血）1ileocecaljunction(90%)23456Complicationsofintestinaltu36Fixedandnarrowedileum（回肠固定及变窄）;

Conicalandshrunkencecum（锥形和萎缩的盲肠）mimicCrohn'sdiseaseUniformandconcentricthickeningofterminalileumwall（回肠末端肠壁向心性均匀增厚）Fixedandnarrowedileum（回肠固定及37ileocecaltuberculosis回盲部结核

Mildwallthickeningofthececum（盲肠壁轻度增厚）

Pericecallymphnodes（盲肠周围淋巴结）ileocecaltuberculosis回盲部结核

Circumferentialthickeningofthececumandterminalileum（盲肠和末端回肠壁环形增厚）

Adjacentlymphnodes（邻近淋巴结）Progressingileocecaltuberculosis回盲部结核

M38DifferentiatingimagingfeaturesTuberculosisCrohn'sdiseaseAsymmetric,irregularwallthickeningCircumferentialbowelwallthickeningFleischnersignonbariumstudiesCobblestoneappearanceonbariumNocreepingfatCreepingfat(abnormalquantityofmesentericfatPositivechestfilm(50%)NegativechestfilmOmentalandperitonealthickeningNormalomentumandperitoneumEnlargedlymphnodeswithlow-denstitycentersEnlargedsoft-tissuedensitylymphnodesDifferentiatingimagingfeatur39Colonictuberculosis

(A)Twostricturesindescendingandtransversecolon

(B)MarkedinfiltrationandasymmetricalthickeningoftheascendingcolonandmesentericenlargedlymphnodeTuberculosisoftheileum

Symmetricmuralthickningileum(arrows)andadjacentenlargedlymphnodeColonictuberculosis

(A)Twos40TuberculouslymphadenopathyMultipleenlargedlymphnodesHypodensecentersandperipheralenhancement低密度中心伴有周围强化Conglomeratelymphnodes淋巴结融合Caseationandliquefactionsubstancesatthecenter（中心干酪样和液化坏死）Peripheralinflammatorylymphatictissue（周围炎性组织）TuberculouslymphadenopathyMul41Multipleenlargedlymphnodes

RimenhancementandNecrossinside（环形强化和内部坏死）

Calcification（钙化）

Largepsoasabscess（腰大肌脓肿）Multipleenlargedlymphnodes

42Tuberculousperitonitis结核性腹膜炎Wettype90%Fibrotic-fixedtype7%HighdensityLargevolumeofascitesProteinandcellularcontentSmallvolumeofascitesFixedbowelloopsOmentalmassesDrytype3%DenseperitonealadhesionsFibrousperitonealreactionCaseousnodulesTuberculousperitonitis结核性腹膜炎43Thickening,enhancement,andnodularityofperitoneum腹膜增厚、强化、结节状

ileocolicadenopathy回盲部淋巴结Thickening,enhancement,andn44Mesenteryinvolvement:mostcommonOmentalinvolvement:nodular,smudgedPeritonealinvolvement:smooth,tinynodulesAscites:30-100%ofcases&multiplestandsoffibrinanddebris（纤维素或碎片）&septa（分隔）Mesenteryinvolvement:mostco45Wettype湿型

Ascites:septa（分隔）

Peritoneum:smooththickening&enhancement（光滑增厚&强化）Fibroustype纤维型

Omentum&peritoneum:

thickening（增厚）

Bowelloops:conglomerate（聚拢）Wettype湿型

Ascites:septa（分隔46Drytype干型Sclerosingencapsulatingperitonitis(abdominalcocoon)“茧”Clusteringofsmallbowelloopsinthecenterofabdomen腹部中央肠袢聚拢Drytype干型Sclerosingencapsul47SignsassistinginguidingdiagnosisoftuberculousperitonitisPresenceofmesentericmacronodulesEnhancementandregularthickeningoftheparietalperitoneumSplenomegalyandcalcificationofthespleenInvolvementoftheileocecalwallRetroperitonealandperi-pancreaticlymphadenopathywithahypodensecenterandring-enhancementSignsassistinginguidingdia48Ascites

lymphnodes:mesenteric&retroperitoneal

Necrosisinsideandring-likeenhancement

Omentum:Thickening

Peritoneum:Enhancement&RegularthickeningAscites

lymphnodes:mesenteri49Hepatic,SplenicandpancreaticTB肝、脾、胰腺结核Usuallyinafinemiliarypattern（粟粒样）,belowtheresolvingcapacityofCTMostcommonpresentation:non-specifichepatosplenomegaly（肝脾肿大）Occasionally,tinyscatteringlow-densityfoci（微小低密度灶）Rarely,macronodularform（大结节）：pseudotumorortuberculoma（假瘤或结核球）1-3cmorasingletumor-likemassHepatic,Splenicandpancreati50MiliaryhepaticTB粟粒型Enlargedliver肝大Heterogeneousparenchyma密度不均Multiplehypoenhancingnodulesinthespleen伴有脾