uberculousperitonitis結(jié)核性腹膜炎課件

1、Abdominal Tuberculosis腹部結(jié)核病Zhou LiuCancer Hospital Chinese Academy of Medical Sciences, Shenzhen center1uberculousperitonitis結(jié)核性腹膜炎Abdominal Tuberculosis腹部結(jié)核病ZhGeneral considerationCan affect any organ in the abdomenImportance of clinical context in diagnosisHigh-risk population：immunocompromised pa

2、tients, especially AIDS（免疫抑制的病人）Typical symptoms: such as diarrhea, fever etc（腹瀉、發(fā)熱等）Laboratory findings（實驗室檢查）：serum and culture（血清和培養(yǎng)）Histologic analysis（組織學(xué)檢查）Radiological findings might mimic many different diseaseInflammatory disease：Crohns diseaseNeoplastic disease: Lymphomatosis, Peritoneal c

3、arcinomatosis2uberculousperitonitis結(jié)核性腹膜炎General considerationCan affecClassificationGastrointestinal tuberculosis（胃腸道結(jié)核）Tuberculous lymphadenopathy（結(jié)核性淋巴結(jié)炎）Tuberculous peritonitis （結(jié)核性腹膜炎）Solid organ involvement （實性器官累及）Hepatic and splenic TBPancreatic TB3uberculousperitonitis結(jié)核性腹膜炎ClassificationGa

4、strointestinalDifferent pathwaysModes of involvement in abdominal tuberculosisBy ingestion（吞咽） Infected food or milk- Primary intestinal tuberculosis（原發(fā)性腸結(jié)核） Infected sputum（痰）-Secondary intestinal tuberculosis（繼發(fā)性腸結(jié)核）Hematogenous spread from distant tubercular focus（血性播散）Contagious spread from infe

5、cted adjacent foci（鄰近累及）Through lymphatic channel（淋巴擴散）4uberculousperitonitis結(jié)核性腹膜炎Different pathwaysModes of invPathophysiology of Gastrointestinal TB（胃腸道TB的病理生理學(xué)）BacteriaMucosa粘膜Submucosa粘膜下層Epithelioid tubercles表皮樣結(jié)節(jié)Ulceration潰瘍Granuloma formation肉芽腫形成Caseous necrosis干酪性壞死Cicatrization瘢痕形成Sloughi

6、ng脫落Surrounding mucosa thickening鄰近粘膜增厚Lymph nodes淋巴結(jié)Peritoneum腹膜Circulationliver肝 pancreas胰spleen脾Spreading5uberculousperitonitis結(jié)核性腹膜炎Pathophysiology of GastrointesComplications of intestinal tuberculosisBowel obstruction（腸梗阻）Perforation（穿孔）Abscess formation（膿腫形成）Fistula（瘺道形成）Intussusception（腸套疊）B

7、owel wall ischemia（腸壁缺血）1 ileocecal junction(90%)234566uberculousperitonitis結(jié)核性腹膜炎Complications of intestinal tuFixed and narrowed ileum（回腸固定及變窄）; Conical and shrunken cecum（錐形和萎縮的盲腸）mimic Crohns diseaseUniform and concentric thickening of terminal ileum wall（回腸末端腸壁向心性均勻增厚）7uberculousperitonitis結(jié)核性腹

8、膜炎Fixed and narrowed ileum（回腸固定及ileocecal tuberculosis 回盲部結(jié)核Mild wall thickening of the cecum（盲腸壁輕度增厚）Pericecal lymph nodes（盲腸周圍淋巴結(jié)）ileocecal tuberculosis 回盲部結(jié)核Circumferential thickening of the cecum and terminal ileum（盲腸和末端回腸壁環(huán)形增厚）Adjacent lymph nodes（鄰近淋巴結(jié)）Progressing8uberculousperitonitis結(jié)核性腹膜炎il

9、eocecal tuberculosis 回盲部結(jié)核MDifferentiating imaging featuresTuberculosisCrohns diseaseAsymmetric, irregular wall thickeningCircumferential bowel wall thickeningFleischner sign on barium studiesCobblestone appearance on bariumNo creeping fat Creeping fat (abnormal quantity of mesenteric fatPositive ch

10、est film (50%)Negative chest filmOmental and peritoneal thickeningNormal omentum and peritoneumEnlarged lymph nodes with low-denstity centersEnlarged soft-tissue density lymph nodes9uberculousperitonitis結(jié)核性腹膜炎Differentiating imaging featurColonic tuberculosis(A) Two strictures in descending and tran

11、sverse 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 node10uberculousperitonitis結(jié)核性腹膜炎Colonic tuberculosis(A) Two sTuberculous lymphadenop

12、athyMultiple enlarged lymph nodes Hypodense centers and peripheral enhancement 低密度中心伴有周圍強化Conglomerate lymph nodes 淋巴結(jié)融合Caseation and liquefaction substances at the center （中心干酪樣和液化壞死）Peripheral inflammatory lymphatic tissue（周圍炎性組織）11uberculousperitonitis結(jié)核性腹膜炎Tuberculous lymphadenopathyMulMultiple

13、enlarged lymph nodesRim enhancement and Necross inside （環(huán)形強化和內(nèi)部壞死）Calcification（鈣化）Large psoas abscess（腰大肌膿腫）12uberculousperitonitis結(jié)核性腹膜炎Multiple enlarged lymph nodesTuberculous peritonitis 結(jié)核性腹膜炎Wet type90%Fibrotic-fixed type 7%High density Large volume of ascites Protein and cellular content Smal

14、l volume of ascites Fixed bowel loops Omental masses Dry type 3%Dense peritoneal adhesions Fibrous peritoneal reaction Caseous nodules13uberculousperitonitis結(jié)核性腹膜炎Tuberculous peritonitis 結(jié)核性腹膜炎Thickening, enhancement, and nodularity of peritoneum 腹膜增厚、強化、結(jié)節(jié)狀ileocolic adenopathy 回盲部淋巴結(jié)14uberculousper

15、itonitis結(jié)核性腹膜炎Thickening, enhancement, and nMesentery involvement: most commonOmental involvement: nodular, smudgedPeritoneal involvement: smooth, tiny nodulesAscites: 30-100% of cases &multiple stands of fibrin and debris（纖維素或碎片）& septa（分隔）15uberculousperitonitis結(jié)核性腹膜炎Mesentery involvement: most co

16、Wet type 濕型Ascites: septa （分隔）Peritoneum: smooth thickening & enhancement（光滑增厚&強化）Fibrous type 纖維型Omentum&peritoneum: thickening （增厚）Bowel loops: conglomerate（聚攏）16uberculousperitonitis結(jié)核性腹膜炎Wet type 濕型Ascites: septa （分隔Dry type 干型Sclerosing encapsulating peritonitis (abdominal cocoon) “繭”Clustering

17、 of small bowel loops in the center of abdomen 腹部中央腸袢聚攏17uberculousperitonitis結(jié)核性腹膜炎Dry type 干型Sclerosing encapsulSigns assisting in guiding diagnosis of tuberculous peritonitisPresence of mesenteric macronodulesEnhancement and regular thickening of the parietal peritoneumSplenomegaly and calcificat

18、ion of the spleenInvolvement of the ileocecal wallRetroperitoneal and peri-pancreatic lymphadenopathy with a hypodense center and ring-enhancement18uberculousperitonitis結(jié)核性腹膜炎Signs assisting in guiding diaAsciteslymph nodes: mesenteric& retroperitonealNecrosis inside and ring-like enhancement Omentu

19、m: Thickening Peritoneum: Enhancement & Regular thickening 19uberculousperitonitis結(jié)核性腹膜炎Asciteslymph nodes: mesenteriHepatic, Splenic and pancreatic TB 肝、脾、胰腺結(jié)核Usually in a fine miliary pattern（粟粒樣）, below the resolving capacity of CTMost common presentation: non-specific hepatosplenomegaly（肝脾腫大）Occ

20、asionally, tiny scattering low-density foci（微小低密度灶）Rarely, macronodular form（大結(jié)節(jié)）：pseudotumor or tuberculoma（假瘤或結(jié)核球）1-3cm or a single tumor-like mass20uberculousperitonitis結(jié)核性腹膜炎Hepatic, Splenic and pancreatiMiliary hepatic TB 粟粒型Enlarged liver 肝大Heterogeneous parenchyma 密度不均Multiple hypoenhancing n

21、odules in the spleen 伴有脾臟多發(fā)小結(jié)節(jié)，低強化21uberculousperitonitis結(jié)核性腹膜炎Miliary hepatic TB 粟粒型EnlargedTiny hypovascular nodules scattering in the liver and spleen 低血供結(jié)節(jié)Enlarged liver and spleen 肝脾大slightly rim enhancement 輕度環(huán)形強化Micronodular tuberculosis 微小結(jié)節(jié)型22uberculousperitonitis結(jié)核性腹膜炎Tiny hypovascular nodules scatMacronodular 大結(jié)節(jié)Hypovascular 低血供Macronodular hepatic & splenic tuberculosis 大結(jié)節(jié)型23uberculousperitonitis結(jié)核性腹膜炎Macronodular 大結(jié)節(jié)Hypovascular Pancreatic tuberculosis 胰腺結(jié)核Slight increase in the dimension of pancre