tuberculousperitonitis結(jié)核性腹膜炎tuberculousperitonitis結(jié)核性腹膜炎tuberculousperitonitis結(jié)核性腹膜炎AbdominalTuberculosis

腹部結(jié)核病ZhouLiuCancerHospitalChineseAcademyofMedicalSciences,ShenzhencenterGeneralconsiderationCanaffectanyorganintheabdomenImportanceofclinicalcontextindiagnosisHigh-riskpopulation：immunocompromisedpatients,especiallyAIDS（免疫抑制的病人）Typicalsymptoms:suchasdiarrhea,feveretc（腹瀉、發(fā)熱等）Laboratoryfindings（實驗室檢查）：serumandculture（血清和培養(yǎng)）Histologicanalysis（組織學(xué)檢查）RadiologicalfindingsmightmimicmanydifferentdiseaseInflammatorydisease：Crohn'sdiseaseNeoplasticdisease:Lymphomatosis,Peritonealcarcinomatosistuberculousperitonitis結(jié)核性腹膜炎tutuberculousperitonitis結(jié)核性腹膜炎共29張課件2tuberculousperitonitis結(jié)核性腹膜炎共29張課件3tuberculousperitonitis結(jié)核性腹膜炎共29張課件4tuberculousperitonitis結(jié)核性腹膜炎共29張課件5PathophysiologyofGastrointestinalTB

（胃腸道TB的病理生理學(xué)）BacteriaMucosa粘膜Submucosa粘膜下層Epithelioidtubercles表皮樣結(jié)節(jié)Ulceration潰瘍Granulomaformation肉芽腫形成Caseousnecrosis干酪性壞死Cicatrization瘢痕形成Sloughing脫落Surroundingmucosathickening鄰近粘膜增厚Lymphnodes淋巴結(jié)Peritoneum腹膜Circulationliver肝pancreas胰spleen脾SpreadingPathophysiologyofGastrointes6ComplicationsofintestinaltuberculosisBowelobstruction（腸梗阻）Perforation（穿孔）Abscessformation（膿腫形成）Fistula（瘺道形成）Intussusception（腸套疊）Bowelwallischemia（腸壁缺血）1ileocecaljunction(90%)23456Complicationsofintestinaltu7Fixedandnarrowedileum（回腸固定及變窄）;

Conicalandshrunkencecum（錐形和萎縮的盲腸）mimicCrohn'sdiseaseUniformandconcentricthickeningofterminalileumwall（回腸末端腸壁向心性均勻增厚）Fixedandnarrowedileum（回腸固定及8ileocecaltuberculosis回盲部結(jié)核

Mildwallthickeningofthececum（盲腸壁輕度增厚）

Pericecallymphnodes（盲腸周圍淋巴結(jié)）ileocecaltuberculosis回盲部結(jié)核

Circumferentialthickeningofthececumandterminalileum（盲腸和末端回腸壁環(huán)形增厚）

Adjacentlymphnodes（鄰近淋巴結(jié)）Progressingileocecaltuberculosis回盲部結(jié)核

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

(A)Twostricturesindescendingandtransversecolon

(B)MarkedinfiltrationandasymmetricalthickeningoftheascendingcolonandmesentericenlargedlymphnodeTuberculosisoftheileum

Symmetricmuralthickningileum(arrows)andadjacentenlargedlymphnodeColonictuberculosis

(A)Twos11TuberculouslymphadenopathyMultipleenlargedlymphnodesHypodensecentersandperipheralenhancement低密度中心伴有周圍強化Conglomeratelymphnodes淋巴結(jié)融合Caseationandliquefactionsubstancesatthecenter（中心干酪樣和液化壞死）Peripheralinflammatorylymphatictissue（周圍炎性組織）TuberculouslymphadenopathyMul12Multipleenlargedlymphnodes

RimenhancementandNecrossinside（環(huán)形強化和內(nèi)部壞死）

Calcification（鈣化）

Largepsoasabscess（腰大肌膿腫）Multipleenlargedlymphnodes

13Tuberculousperitonitis結(jié)核性腹膜炎Wettype90%Fibrotic-fixedtype7%HighdensityLargevolumeofascitesProteinandcellularcontentSmallvolumeofascitesFixedbowelloopsOmentalmassesDrytype3%DenseperitonealadhesionsFibrousperitonealreactionCaseousnodulesTuberculousperitonitis結(jié)核性腹膜炎14Thickening,enhancement,andnodularityofperitoneum腹膜增厚、強化、結(jié)節(jié)狀

ileocolicadenopathy回盲部淋巴結(jié)Thickening,enhancement,andn15Mesenteryinvolvement:mostcommonOmentalinvolvement:nodular,smudgedPeritonealinvolvement:smooth,tinynodulesAscites:30-100%ofcases&multiplestandsoffibrinanddebris（纖維素或碎片）&septa（分隔）Mesenteryinvolvement:mostco16Wettype濕型

Ascites:septa（分隔）

Peritoneum:smooththickening&enhancement（光滑增厚&強化）Fibroustype纖維型

Omentum&peritoneum:

thickening（增厚）

Bowelloops:conglomerate（聚攏）Wettype濕型

Ascites:septa（分隔17Drytype干型Sclerosingencapsulatingperitonitis(abdominalcocoon)“繭”Clusteringofsmallbowelloopsinthecenterofabdomen腹部中央腸袢聚攏Drytype干型Sclerosingencapsul18SignsassistinginguidingdiagnosisoftuberculousperitonitisPresenceofmesentericmacronodulesEnhancementandregularthickeningoftheparietalperitoneumSplenomegalyandcalcificationofthespleenInvolvementoftheileocecalwallRetroperitonealandperi-pancreaticlymphadenopathywithahypodensecenterandring-enhancementSignsassistinginguidingdia19Ascites

lymphnodes:mesenteric&retroperitoneal

Necrosisinsideandring-likeenhancement

Omentum:Thickening

Peritoneum:Enhancement&RegularthickeningAscites

lymphnodes:mesenteri20Hepatic,SplenicandpancreaticTB肝、脾、胰腺結(jié)核Usuallyinafinemiliarypattern（粟粒樣）,belowtheresolvingcapacityofCTMostcommonpresentation:non-specifichepatosplenomegaly（肝脾腫大）Occasionally,tinyscatteringlow-densityfoci（微小低密度灶）Rarely,macronodularform（大結(jié)節(jié)）：pseudotumorortuberculoma（假瘤或結(jié)核球）1-3cmorasingletumor-likemassHepatic,Splenicandpancreati21MiliaryhepaticTB粟粒型Enlargedliver肝大Heterogeneousparenchyma密度不均Multiplehypoenhancingnodulesinthespleen伴有脾臟多發(fā)小結(jié)節(jié)，低強化MiliaryhepaticTB粟粒型Enlarged22Tinyhypovascularnodulesscatteringintheliverandspleen低血供結(jié)節(jié)

Enlargedliverandspleen肝脾大

slightlyrimenhancement輕度環(huán)形強化Micronodulartuberculosis微小結(jié)節(jié)型Tinyhypovascularnodulesscat23Macronodular大結(jié)節(jié)

Hypovascular低血供Macronodularhepatic&splenictuberculosis大結(jié)節(jié)型Macronodular大結(jié)節(jié)

Hypovascular24Pancreatictuberculosis胰腺結(jié)核Slightincreaseinthedimensionofpancreas體積稍增大Lossoflobulatedcontour邊緣變光滑

Pancreatictuberculosis胰腺結(jié)核Sl25AssociatedFindingsThoracicfindings:15%合并胸部結(jié)核Genitourinarytuberculosis泌尿生殖道結(jié)核Musculoskeletaltuberculosis骨骼肌肉結(jié)核CentralnervoussystemtuberculousisCNSTB中樞神經(jīng)系統(tǒng)結(jié)核AssociatedFindingsThoracicfi26Apaintingismorethanthesumofitsparts.Acowbyitselfisjustacow.Ameadowbyitselfismerelygrassandflowers.Thesunshinepeekingthroughthetreesismerelyabeamoflight.Butyouputthemalltogether,itcanbemagic.Youhavetoseethewholelandscape.Apaintingismorethanthesu27ThankyouThankyou28謝謝騎封篙尊慈榷灶琴村店矣墾桂乖新壓胚奠倘擅寞僥蝕麗鑒晰溶廷籮侶郎蟲林森-消化系統(tǒng)疾病的癥狀體征與檢查林森-消化系統(tǒng)疾病的癥狀體征與檢查11、越是沒有本領(lǐng)的就越加自命不凡。——鄧拓

12、越是無能的人，越喜歡挑剔別人的錯兒?！獝蹱柼m

13、知人者智，自知者明。勝人者有力，自勝者強?！献?/p>

14、意志堅強的人能把世界放在手中像泥塊一樣任意揉捏。——歌德

15、最具挑戰(zhàn)性的挑戰(zhàn)莫過于提升自我?！~克爾·F·斯特利謝謝騎封篙尊慈榷灶琴村店矣墾桂乖新壓胚奠倘擅寞僥蝕麗鑒晰溶廷tuberculousperitonitis結(jié)核性腹膜炎tuberculousperitonitis結(jié)核性腹膜炎tuberculousperitonitis結(jié)核性腹膜炎AbdominalTuberculosis

腹部結(jié)核病ZhouLiuCancerHospitalChineseAcademyofMedicalSciences,ShenzhencenterGeneralconsiderationCanaffectanyorganintheabdomenImportanceofclinicalcontextindiagnosisHigh-riskpopulation：immunocompromisedpatients,especiallyAIDS（免疫抑制的病人）Typicalsymptoms:suchasdiarrhea,feveretc（腹瀉、發(fā)熱等）Laboratoryfindings（實驗室檢查）：serumandculture（血清和培養(yǎng)）Histologicanalysis（組織學(xué)檢查）RadiologicalfindingsmightmimicmanydifferentdiseaseInflammatorydisease：Crohn'sdiseaseNeoplasticdisease:Lymphomatosis,Peritonealcarcinomatosistuberculousperitonitis結(jié)核性腹膜炎tutuberculousperitonitis結(jié)核性腹膜炎共29張課件31tuberculousperitonitis結(jié)核性腹膜炎共29張課件32tuberculousperitonitis結(jié)核性腹膜炎共29張課件33tuberculousperitonitis結(jié)核性腹膜炎共29張課件34PathophysiologyofGastrointestinalTB

（胃腸道TB的病理生理學(xué)）BacteriaMucosa粘膜Submucosa粘膜下層Epithelioidtubercles表皮樣結(jié)節(jié)Ulceration潰瘍Granulomaformation肉芽腫形成Caseousnecrosis干酪性壞死Cicatrization瘢痕形成Sloughing脫落Surroundingmucosathickening鄰近粘膜增厚Lymphnodes淋巴結(jié)Peritoneum腹膜Circulationliver肝pancreas胰spleen脾SpreadingPathophysiologyofGastrointes35ComplicationsofintestinaltuberculosisBowelobstruction（腸梗阻）Perforation（穿孔）Abscessformation（膿腫形成）Fistula（瘺道形成）Intussusception（腸套疊）Bowelwallischemia（腸壁缺血）1ileocecaljunction(90%)23456Complicationsofintestinaltu36Fixedandnarrowedileum（回腸固定及變窄）;

Conicalandshrunkencecum（錐形和萎縮的盲腸）mimicCrohn'sdiseaseUniformandconcentricthickeningofterminalileumwall（回腸末端腸壁向心性均勻增厚）Fixedandnarrowedileum（回腸固定及37ileocecaltuberculosis回盲部結(jié)核

Mildwallthickeningofthececum（盲腸壁輕度增厚）

Pericecallymphnodes（盲腸周圍淋巴結(jié)）ileocecaltuberculosis回盲部結(jié)核

Circumferentialthickeningofthececumandterminalileum（盲腸和末端回腸壁環(huán)形增厚）

Adjacentlymphnodes（鄰近淋巴結(jié)）Progressingileocecaltuberculosis回盲部結(jié)核

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

(A)Twostricturesindescendingandtransversecolon

(B)MarkedinfiltrationandasymmetricalthickeningoftheascendingcolonandmesentericenlargedlymphnodeTuberculosisoftheileum

Symmetricmuralthickningileum(arrows)andadjacentenlargedlymphnodeColonictuberculosis

(A)Twos40TuberculouslymphadenopathyMultipleenlargedlymphnodesHypodensecentersandperipheralenhancement低密度中心伴有周圍強化Conglomeratelymphnodes淋巴結(jié)融合Caseationandliquefactionsubstancesatthecenter（中心干酪樣和液化壞死）Peripheralinflammatorylymphatictissue（周圍炎性組織）TuberculouslymphadenopathyMul41Multipleenlargedlymphnodes

RimenhancementandNecrossinside（環(huán)形強化和內(nèi)部壞死）

Calcification（鈣化）

Largepsoasabscess（腰大肌膿腫）Multipleenlargedlymphnodes

42Tuberculousperitonitis結(jié)核性腹膜炎Wettype90%Fibrotic-fixedtype7%HighdensityLargevolumeofascitesProteinandcellularcontentSmallvolumeofascitesFixedbowelloopsOmentalmassesDrytype3%DenseperitonealadhesionsFibrousperitonealreactionCaseousnodulesTuberculousperitonitis結(jié)核性腹膜炎43Thickening,enhancement,andnodularityofperitoneum腹膜增厚、強化、結(jié)節(jié)狀

ileocolicadenopathy回盲部淋巴結(jié)Thickening,enhancement,andn44Mesenteryinvolvement:mostcommonOmentalinvolvement:nodular,smudgedPeritonealinvolvement:smooth,tinynodulesAscites:30-100%ofcases&multiplestandsoffibrinanddebris（纖維素或碎片）&septa（分隔）Mesenteryinvolvement:mostco45Wettype濕型

Ascites:septa（分隔）

Peritoneum:smooththickening&enhancement（光滑增厚&強化）Fibroustype纖維型

Omentum&peritoneum:

thickening（增厚）

Bowelloops:conglomerate（聚攏）Wettype濕型

Ascites:septa（分隔46Drytype干型Sclerosingencapsulatingperitonitis(abdominalcocoon)“繭”Clusteringofsmallbowelloopsinthecenterofabdomen腹部中央腸袢聚攏Drytype干型Sclerosingencapsul47SignsassistinginguidingdiagnosisoftuberculousperitonitisPresenceofmesentericmacronodulesEnhancementandregularthickeningoftheparietalperitoneumSplenomegalyandcalcificationofthespleenInvolvementoftheileocecalwallRetroperitonealandperi-pancreaticlymphadenopathywithahypodensecenterandring-enhancementSignsassistinginguidingdia48Ascites

lymphnodes:mesenteric&retroperitoneal

Necrosisinsideandring-likeenhancement

Omentum:Thickening

Peritoneum:Enhancement&RegularthickeningAscites

lymphnodes:mesenteri49Hepatic,SplenicandpancreaticTB肝、脾、胰腺結(jié)核Usuallyinafinemiliarypattern（粟粒樣）,belowtheresolvingcapacityofCTMostcommonpresentation:non-specifichepatosplenomegaly（肝脾腫大）Occasionally,tinyscatteringlow-densityfoci（微小低密度灶）Rarely,macronodularform（大結(jié)節(jié)）：pseudotumorortuberculoma（假瘤或結(jié)核球）1-3cmorasingletumor-likemassHepatic,Splenicandpancreati50MiliaryhepaticTB粟粒型Enlargedliver肝大Heterogeneousparenchyma密度不均Multiplehypoenhancingnodulesinthespleen伴有脾