uberculousperitonitis结核性腹膜炎

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1、Abdominal Tuberculosis腹部结核病Zhou LiuCancer Hospital Chinese Academy of Medical Sciences, Shenzhen center General consideration Can affect any organ in the abdomen Importance of clinical context in diagnosisHigh-risk population：immunocompromised patients, especially AIDS（免疫抑制的病人）Typical symptoms: such

2、 as diarrhea, fever etc（腹泻、发热等）Laboratory findings（实验室检查）：serum and culture（血清和培养）Histologic analysis（组织学检查） Radiological findings might mimic many different disease Inflammatory disease：Crohns diseaseNeoplastic disease: Lymphomatosis, Peritoneal carcinomatosis Classification Gastrointestinal tuberc

3、ulosis（胃肠道结核） Tuberculous lymphadenopathy（结核性淋巴结炎） Tuberculous peritonitis （结核性腹膜炎） Solid organ involvement （实性器官累及）Hepatic and splenic TBPancreatic TB Different pathwaysModes of involvement in abdominal tuberculosisBy ingestion（吞咽） Infected food or milk- Primary intestinal tuberculosis（原发性肠结核） Infe

4、cted sputum（痰）-Secondary intestinal tuberculosis（继发性肠结核）Hematogenous spread from distant tubercular focus（血性播散）Contagious spread from infected adjacent foci（邻近累及） Through lymphatic channel（淋巴扩散） Pathophysiology of Gastrointestinal TB（胃肠道TB的病理生理学）BacteriaMucosa粘膜Submucosa粘膜下层 Epithelioid tubercles表皮样

5、结节Ulceration溃疡Granuloma formation肉芽肿形成Caseous necrosis干酪性坏死Cicatrization瘢痕形成Sloughing脱落Surrounding mucosa thickening邻近粘膜增厚Lymph nodes淋巴结Peritoneum腹膜Circulationliver肝 pancreas胰spleen脾Spreading Complications of intestinal tuberculosisBowel obstruction（肠梗阻）Perforation（穿孔）Abscess formation（脓肿形成）Fistula（

6、瘘道形成）Intussusception（肠套叠）Bowel wall ischemia（肠壁缺血）1 ileocecal junction(9 0 %)234 56 Fixed and narrowed ileum（回肠固定及变窄）; Conical and shrunken cecum（锥形和萎缩的盲肠）mimic Crohns disease Uniform and concentric thickening of terminal ileum wall（回肠末端肠壁向心性均匀增厚） ileocecal tuberculosis 回盲部结核Mild wall thickening of

7、the cecum（盲肠壁轻度增厚）Pericecal lymph nodes（盲肠周围淋巴结）ileocecal tuberculosis 回盲部结核Circumferential thickening of the cecum and terminal ileum（盲肠和末端回肠壁环形增厚）Adjacent lymph nodes（邻近淋巴结）Progressing Differentiating imaging featuresTuberculosis Crohns diseaseAsymmetric, irregular wall thickening Circumferential

8、bowel wall thickeningFleischner sign on barium studies Cobblestone appearance on bariumNo creeping fat Creeping fat (abnormal quantity of mesenteric fatPositive chest film (5 0 %) Negative chest filmOmental and peritoneal thickening Normal omentum and peritoneum Enlarged lymph nodes with low-denstit

9、y centers Enlarged soft-tissue density lymph nodes Colonic tuberculosis(A) Two strictures in descending and transverse colon(B) Marked infiltration and asymmetrical thickening of the ascending colon and mesenteric enlarged lymph node Tuberculosis of the ileumSymmetric mural thickning ileum (arrows)

10、and adjacent enlarged lymph node Tuberculous lymphadenopathyMultiple enlarged lymph nodes Hypodense centers and peripheral enhancement 低密度中心伴有周围强化Conglomerate lymph nodes 淋巴结融合 Caseation and liquefaction substances at the center （中心干酪样和液化坏死） Peripheral inflammatory lymphatic tissue（周围炎性组织） Multiple

11、enlarged lymph nodesRim enhancement and Necross inside （环形强化和内部坏死）Calcification（钙化）Large psoas abscess（腰大肌脓肿） Tuberculous peritonitis 结核性腹膜炎Wet type9 0 % Fibrotic-fixed type 7 %High density Large volume of ascites Protein and cellular content Small volume of ascites Fixed bowel loops Omental masses

12、Dry type 3 %Dense peritoneal adhesions Fibrous peritoneal reaction Caseous nodules Thickening, enhancement, and nodularity of peritoneum 腹膜增厚、强化、结节状ileocolic adenopathy 回盲部淋巴结 Mesentery involvement: most common Omental involvement: nodular, smudged Peritoneal involvement: smooth, tiny nodules Ascite

13、s: 3 0 -1 0 0 % of cases &multiple stands of fibrin and debris（纤维素或碎片）& septa（分隔） Wet type 湿型Ascites: septa （分隔）Peritoneum: smooth thickening & enhancement（光滑增厚&强化）Fibrous type 纤维型Omentum&peritoneum: thickening （增厚）Bowel loops: conglomerate（聚拢） Dry type 干型Sclerosing encapsulating peritonitis (abdomi

14、nal cocoon) “茧”Clustering of small bowel loops in the center of abdomen 腹部中央肠袢聚拢 Signs assisting in guiding diagnosis of tuberculous peritonitisPresence of mesenteric macronodulesEnhancement and regular thickening of the parietal peritoneumSplenomegaly and calcification of the spleenInvolvement of t

15、he ileocecal wallRetroperitoneal and peri-pancreatic lymphadenopathy with a hypodense center and ring-enhancement Asciteslymph nodes: mesenteric& retroperitonealNecrosis inside and ring-like enhancement Omentum: Thickening Peritoneum: Enhancement & Regular thickening Hepatic, Splenic and pancreatic

16、TB 肝、脾、胰腺结核 Usually in a fine miliary pattern（粟粒样）, below the resolving capacity of CT Most common presentation: non-specific hepatosplenomegaly（肝脾肿大） Occasionally, tiny scattering low-density foci（微小低密度灶） Rarely, macronodular form（大结节）：pseudotumor or tuberculoma（假瘤或结核球）1 -3 cm or a single tumor-lik

17、e mass Miliary hepatic TB 粟粒型Enlarged liver 肝大Heterogeneous parenchyma 密度不均Multiple hypoenhancing nodules in the spleen 伴有脾脏多发小结节，低强化 Tiny hypovascular nodules scattering in the liver and spleen 低血供结节Enlarged liver and spleen 肝脾大slightly rim enhancement 轻度环形强化Micronodular tuberculosis 微小结节型 Macronod

18、ular 大结节Hypovascular 低血供Macronodular hepatic & splenic tuberculosis 大结节型 Pancreatic tuberculosis 胰腺结核Slight increase in the dimension of pancreas 体积稍增大Loss of lobulated contour 边缘变光滑 Associated Findings Thoracic findings: 1 5 % 合并胸部结核 Genitourinary tuberculosis 泌尿生殖道结核 Musculoskeletal tuberculosis 骨

19、骼肌肉结核 Central nervous system tuberculousis CNS TB 中枢神经系统结核 A painting is more than the sum of its parts. A cow by itself is just a cow. A meadow by itself is merely grass and flowers. The sunshine peeking through the trees is merely a beam of light. But you put them all together, it can be magic. You have to see the whole landscape. Thank you