tuberculousperitonitis结核性腹膜炎课件

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,PeritonealcarcinomatosisClassificationGastrointestinaltuberculosis〔胃肠道结核〕Tuberculouslymphadenopathy〔结核性淋巴结炎〕Tuberculousperitonitis〔结核性腹膜炎〕Solidorganinvolvement〔实性器官累及〕HepaticandsplenicTBPancreaticTBDifferentpathwaysModesofinvolvementinabdominaltuberculosisByingestion（吞咽）Infectedfoodormilk-Primaryintestinaltuberculosis（原发性肠结核）Infectedsputum（痰）-Secondaryintestinaltuberculosis（继发性肠结核）Hematogenousspreadfromdistanttubercularfocus（血性播散）Contagiousspreadfrominfectedadjacentfoci（邻近累及）Throughlymphaticchannel（淋巴扩散）PathophysiologyofGastrointestinalTB

〔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SpreadingComplicationsofintestinaltuberculosisBowelobstruction〔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%)23456Fixedandnarrowedileum〔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〕ileocecaltuberculosis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〕ProgressingDifferentiatingimagingfeaturesTuberculosisCrohn'sdiseaseAsymmetric,irregularwallthickeningCircumferentialbowelwallthickeningFleischnersignonbariumstudiesCobblestoneappearanceonbariumNocreepingfatCreepingfat(abnormalquantityofmesentericfatPositivechestfilm(50%)NegativechestfilmOmentalandperitonealthickeningNormalomentumandperitoneumEnlargedlymphnodeswithlow-denstitycentersEnlargedsoft-tissuedensitylymphnodesColonictuberculosis

(A)Twostricturesindescendingandtransversecolon

(B)MarkedinfiltrationandasymmetricalthickeningoftheascendingcolonandmesentericenlargedlymphnodeTuberculosisoftheileum

Symmetricmuralthickningileum(arrows)andadjacentenlargedlymphnodeTuberculouslymphadenopathyMultipleenlargedlymphnodesHypodensecentersandperipheralenhancement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〕Multipleenlargedlymphnodes

RimenhancementandNecrossinside〔环形强化和内部坏死〕

Calcification〔钙化〕

Largepsoasabscess〔腰大肌脓肿〕Tuberculousperitonitis结核性腹膜炎Wettype90%Fibrotic-fixedtype7%HighdensityLargevolumeofascitesProteinandcellularcontentSmallvolumeofascitesFixedbowelloopsOmentalmassesDrytype3%DenseperitonealadhesionsFibrousperitonealreactionCaseousnodulesThickening,enhancement,andnodularityofperitoneum腹膜增厚、强化、结节状

ileocolicadenopathy回盲部淋巴结Mesenteryinvolvement:mostcommonOmentalinvolvement:nodular,smudgedPeritonealinvolvement:smooth,tinynodulesAscites:30-100%ofcases&multiplestandsoffibrinanddebris〔纤维素或碎片〕&septa〔分隔〕Wettype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〕Drytype干型Sclerosingencapsulatingperitonitis(abdominalcocoon)“茧〞Clusteringofsmallbowelloopsinthecenterofabdomen腹部中央肠袢聚拢SignsassistinginguidingdiagnosisoftuberculousperitonitisPresenceofmesentericmacronodulesEnhancementandregularthickeningoftheparietalperitoneumSplenomegalyandcalcificationofthespleenInvolvementoftheileocecalwallRetroperitonealandperi-pancreaticlymphadenopathywithahypodensecenterandring-enhancementAscites

lymphnodes:mesenteric&retroperitoneal

Necrosisinsideandring-likeenhancement

Omentum:Thickening

Peritoneum:Enhancement&RegularthickeningHepatic,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-likemassMiliaryhepaticTB粟粒型Enlargedliver肝大Heterogeneousparenchyma密度不均Multiplehypoenhancingnodulesinthespleen伴有脾脏多发小结节，低强化Tinyhypovascularnodulesscatteringintheliverandspleen低血供结节

Enlargedliverandspleen肝脾大

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

Hypovascular低血供Macronodularhepatic&splenictuberculosis大结节型Pancreatictuberculosis胰腺结核Slightincreaseinthedimensionofpancreas体积稍增大Lossoflobulatedcontour边缘变光滑

AssociatedFindingsThoracicfindings:15%合并胸部结核Genitourinarytuberculosis泌尿生殖道结核Musculoskeletaltuberculosis骨骼肌肉结核CentralnervoussystemtuberculousisCNSTB中