肝脏囊性病变-5PPT推荐.ppt

1、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.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical Unive

2、rsity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.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityN

3、o.1 hospital of Shanxi medical University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.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1

4、hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University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.1 hospital of Shanx

5、i medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University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

6、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.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi me

7、dical UniversityNo.1 hospital of Shanxi medical University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.1 h

8、ospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University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

9、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.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo

10、.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University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T2WIDWIADC mapT1WI动脉期动脉期门脉期门脉期平衡期平衡期No.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medi

11、cal UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University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.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical Univer

12、sityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University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.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1

13、 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University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.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospita

14、l of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University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.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Sha

15、nxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University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.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of S

16、hanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University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.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityN