肝脏囊性病变-5PPT推荐.ppt

肝脏囊性病变-5PPT推荐.ppt

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山西医科大学第一医院山西医科大学第一医院山西医科大学第一医院山西医科大学第一医院李健丁李健丁李健丁李健丁No.1hospitalofShanximedicalUniversityNo.1hospitalofShanximedicalUniversityNo.1hospitalofShanximedicalUniversityNo.1hospitalofShanximedicalUniversityNo.1hospitalofShanximedicalUniversityNo.1hospitalofShanximedicalUniversity肝肝肝肝脏脏脏脏的的的的囊囊囊囊性性性性病病病病变变变变肝脏感染性疾病肝脏感染性疾病肝脏的非肿瘤性囊性病变肝脏的非肿瘤性囊性病变肝脏的肿瘤性囊性病变肝脏的肿瘤性囊性病变No.1hospitalofShanximedicalUniversityNo.1hospitalofShanximedicalUniversityNo.1hospitalofShanximedicalUniversityNo.1hospitalofShanximedicalUniversityNo.1hospitalofShanximedicalUniversityNo.1hospitalofShanximedicalUniversity肝肝肝肝脏脏脏脏的的的的囊囊囊囊性性性性病病病病变变变变肝脏感染性疾病肝脏感染性疾病肝脏病原菌感染肝脏病原菌感染细菌性肝脓肿细菌性肝脓肿真菌性肝脓肿真菌性肝脓肿肝脏结核肝脏结核肝脏寄生虫感染肝脏寄生虫感染肝包虫病肝包虫病阿米巴肝脓肿阿米巴肝脓肿No.1hospitalofShanximedicalUniversityNo.1hospitalofShanximedicalUniversityNo.1hospitalofShanximedicalUniversityNo.1hospitalofShanximedicalUniversityNo.1hospitalofShanximedicalUniversityNo.1hospitalofShanximedicalUniversity肝肝肝肝脏脏脏脏的的的的囊囊囊囊性性性性病病病病变变变变细菌性肝脓肿细菌性肝脓肿定义定义细菌性肝脓肿是由细菌感染致肝实细菌性肝脓肿是由细菌感染致肝实质的坏死液化并聚集形成脓腔，多起病质的坏死液化并聚集形成脓腔，多起病急、发展快，临床主要表现是发热、腹急、发展快，临床主要表现是发热、腹痛及肝内叩击痛痛及肝内叩击痛No.1hospitalofShanximedicalUniversityNo.1hospitalofShanximedicalUniversityNo.1hospitalofShanximedicalUniversityNo.1hospitalofShanximedicalUniversityNo.1hospitalofShanximedicalUniversityNo.1hospitalofShanximedicalUniversity肝肝肝肝脏脏脏脏的的的的囊囊囊囊性性性性病病病病变变变变发病机理及病理学特点发病机理及病理学特点病理炎症病理炎症坏死、液化坏死、液化脓腔脓腔各种病因的肝脓肿基本病理变化相近各种病因的肝脓肿基本病理变化相近中央坏死脓液中央坏死脓液壁三层：

@#@肉芽组织、增生纤维组织层、壁三层：

@#@肉芽组织、增生纤维组织层、炎性充血层炎性充血层细菌性肝脓肿细菌性肝脓肿No.1hospitalofShanximedicalUniversityNo.1hospitalofShanximedicalUniversityNo.1hospitalofShanximedicalUniversityNo.1hospitalofShanximedicalUniversityNo.1hospitalofShanximedicalUniversityNo.1hospitalofShanximedicalUniversity肝肝肝肝脏脏脏脏的的的的囊囊囊囊性性性性病病病病变变变变CTCT表现表现平扫：

@#@平扫：

@#@早早期期局部低密度，边界不清，胆管积气局部低密度，边界不清，胆管积气形成期形成期低密度区内多发更低密度，低密度区内多发更低密度，“花瓣状花瓣状”成熟期成熟期融合成大的脓腔，密度略高于水融合成大的脓腔，密度略高于水1/101/51/101/5内有气体，脓肿壁形成内有气体，脓肿壁形成合并包膜下脓肿、肝外脓肿、胸腔积液合并包膜下脓肿、肝外脓肿、胸腔积液细菌性肝脓肿细菌性肝脓肿No.1hospitalofShanximedicalUniversityNo.1hospitalofShanximedicalUniversityNo.1hospitalofShanximedicalUniversityNo.1hospitalofShanximedicalUniversityNo.1hospitalofShanximedicalUniversityNo.1hospitalofShanximedicalUniversity肝肝肝肝脏脏脏脏的的的的囊囊囊囊性性性性病病病病变变变变增强：

@#@增强：

@#@早期病变区楔形或斑片状强化早期病变区楔形或斑片状强化形成期和成熟期增强三层脓肿壁结构形成期和成熟期增强三层脓肿壁结构肉芽组织层强化明显肉芽组织层强化明显纤维组织层强化不明显纤维组织层强化不明显周围炎性水肿充血带动脉期一过周围炎性水肿充血带动脉期一过性明显性明显强化（双靶征）强化（双靶征）No.1hospitalofShanximedicalUniversityNo.1hospitalofShanximedicalUniversityNo.1hospitalofShanximedicalUniversityNo.1hospitalofShanximedicalUniversityNo.1hospitalofShanximedicalUniversityNo.1hospitalofShanximedicalUniversity肝肝肝肝脏脏脏脏的的的的囊囊囊囊性性性性病病病病变变变变男性，男性，51岁。

@#@高热，右上腹痛。

@#@早期肝脓肿岁。

@#@高热，右上腹痛。

@#@早期肝脓肿T2WIDWIADCmapT1WI动脉期动脉期门脉期门脉期平衡期平衡期No.1hospitalofShanximedicalUniversityNo.1hospitalofShanximedicalUniversityNo.1hospitalofShanximedicalUniversityNo.1hospitalofShanximedicalUniversityNo.1hospitalofShanximedicalUniversityNo.1hospitalofShanximedicalUniversity肝肝肝肝脏脏脏脏的的的的囊囊囊囊性性性性病病病病变变变变细菌性肝脓肿早期细菌性肝脓肿早期动脉期动脉期动脉期动脉期动脉期动脉期门脉期门脉期门脉期门脉期门脉期门脉期No.1hospitalofShanximedicalUniversityNo.1hospitalofShanximedicalUniversityNo.1hospitalofShanximedicalUniversityNo.1hospitalofShanximedicalUniversityNo.1hospitalofShanximedicalUniversityNo.1hospitalofShanximedicalUniversity肝肝肝肝脏脏脏脏的的的的囊囊囊囊性性性性病病病病变变变变细菌性肝脓肿细菌性肝脓肿No.1hospitalofShanximedicalUniversityNo.1hospitalofShanximedicalUniversityNo.1hospitalofShanximedicalUniversityNo.1hospitalofShanximedicalUniversityNo.1hospitalofShanximedicalUniversityNo.1hospitalofShanximedicalUniversity肝肝肝肝脏脏脏脏的的的的囊囊囊囊性性性性病病病病变变变变细菌性肝脓肿细菌性肝脓肿No.1hospitalofShanximedicalUniversityNo.1hospitalofShanximedicalUniversityNo.1hospitalofShanximedicalUniversityNo.1hospitalofShanximedicalUniversityNo.1hospitalofShanximedicalUniversityNo.1hospitalofShanximedicalUniversity肝肝肝肝脏脏脏脏的的的的囊囊囊囊性性性性病病病病变变变变细菌性肝脓肿细菌性肝脓肿No.1hospitalofShanximedicalUniversityNo.1hospitalofShanximedicalUniversityNo.1hospitalofShanximedicalUniversityNo.1hospitalofShanximedicalUniversityNo.1hospitalofShanximedicalUniversityNo.1hospitalofShanximedicalUniversity肝肝肝肝脏脏脏脏的的的的囊囊囊囊性性性性病病病病变变变变细菌性肝脓肿：

@#@双靶征细菌性肝脓肿：

@#@双靶征No.1hospitalofShanximedicalUniversityNo.1hospitalofShanximedicalUniversityNo.1hospitalofShanximedicalUniversityNo.1hospitalofShanximedicalUniversityNo.1hospitalofShanximedicalUniversityNo.1hospitalofShanximedicalUniversity肝肝肝肝脏脏脏脏的的的的囊囊囊囊性性性性病病病病变变变变真菌性肝脓肿真菌性肝脓肿大部分都有大剂量抗肿瘤药物应用史，大部分都有大剂量抗肿瘤药物应用史，以假丝酵母菌和曲霉菌为代表的真菌性以假丝酵母菌和曲霉菌为代表的真菌性感染的发生率较高。

@#@多同时发生于多个感染的发生率较高。

@#@多同时发生于多个脏器，表现为坏死性、化脓性甚至慢性脏器，表现为坏死性、化脓性甚至慢性肉芽肿性组织反应肉芽肿性组织反应No.1hospitalofShanximedicalUniversityNo.1hospitalofShanximedicalUniversityNo.1hospitalofShanximedicalUniversityNo.1hospitalofShanximedicalUniversityN