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1、Abdominal Tuberculosis腹部结核病,Zhou LiuCancer Hospital Chinese Academy of Medical Sciences, Shenzhen center,1,uberculousperitonitis结核性腹膜炎,Abdominal Tuberculosis腹部结核病Zh,General consideration,Can affect any organ in the abdomenImportance of clinical context in diagnosisHigh-risk population：immunocompromi
2、sed patients, especially AIDS（免疫抑制的病人）Typical symptoms: such 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 diseaseInflammatory disease：Crohns diseaseNeoplastic disease: Lymphomatosis, Perito
3、neal carcinomatosis,2,uberculousperitonitis结核性腹膜炎,General considerationCan affec,Classification,Gastrointestinal tuberculosis（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,3,uberculousperitonitis结核性腹膜炎,Cl
4、assificationGastrointestinal,Different pathways,4,uberculousperitonitis结核性腹膜炎,Different pathwaysModes of inv,Pathophysiology of Gastrointestinal TB（胃肠道TB的病理生理学）,Bacteria,Mucosa粘膜Submucosa粘膜下层,Epithelioid tubercles表皮样结节,Ulceration溃疡,Granuloma formation肉芽肿形成,Caseous necrosis干酪性坏死,Cicatrization瘢痕形成,Slo
5、ughing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,5,uberculousperitonitis结核性腹膜炎,Pathophysiology of Gastrointes,Complications of intestinal tuberculosisBowel obstruction（肠梗阻）Perforation（穿孔）Abscess formation（脓肿形成）Fistula（瘘道形成）Intussus
6、ception（肠套叠）Bowel wall ischemia（肠壁缺血）,1 ileocecal junction(90%),2,3,4,5,6,6,uberculousperitonitis结核性腹膜炎,Complications of intestinal tu,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）,
7、7,uberculousperitonitis结核性腹膜炎,Fixed and narrowed ileum（回肠固定及,ileocecal tuberculosis 回盲部结核Mild wall thickening of 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）,Progressin
8、g,8,uberculousperitonitis结核性腹膜炎,ileocecal tuberculosis 回盲部结核M,Differentiating imaging features,9,uberculousperitonitis结核性腹膜炎,Differentiating imaging featur,Colonic tuberculosis(A) Two strictures in descending and transverse colon(B) Marked infiltration and asymmetrical thickening of the ascending co
9、lon and mesenteric enlarged lymph node,Tuberculosis of the ileumSymmetric mural thickning ileum (arrows) and adjacent enlarged lymph node,10,uberculousperitonitis结核性腹膜炎,Colonic tuberculosis(A) Two s,Tuberculous lymphadenopathy,Multiple enlarged lymph nodes Hypodense centers and peripheral enhancemen
10、t 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）,11,uberculousperitonitis结核性腹膜炎,Tuberculous lymphadenopathyMul,Multiple enlarged lymph nodesRim enhancement and Necross inside （环形强化和内部坏死）Calcif
11、ication（钙化）Large psoas abscess（腰大肌脓肿）,12,uberculousperitonitis结核性腹膜炎,Multiple enlarged lymph nodes,Tuberculous peritonitis 结核性腹膜炎,Wet type90%,Fibrotic-fixed type 7%,High density,Large volume of ascites,Protein and cellular content,Small volume of ascites,Fixed bowel loops,Omental masses,Dry type 3%,
12、Dense peritoneal adhesions,Fibrous peritoneal reaction,Caseous nodules,13,uberculousperitonitis结核性腹膜炎,Tuberculous peritonitis 结核性腹膜炎,Thickening, enhancement, and nodularity of peritoneum 腹膜增厚、强化、结节状ileocolic adenopathy 回盲部淋巴结,14,uberculousperitonitis结核性腹膜炎,Thickening, enhancement, and n,Mesentery in
13、volvement: most commonOmental involvement: nodular, smudgedPeritoneal involvement: smooth, tiny nodulesAscites: 30-100% of cases &multiple stands of fibrin and debris（纤维素或碎片）& septa（分隔）,15,uberculousperitonitis结核性腹膜炎,Mesentery involvement: most co,Wet type 湿型Ascites: septa （分隔）Peritoneum: smooth thi
14、ckening & enhancement（光滑增厚&强化）,Fibrous type 纤维型Omentum&peritoneum: thickening （增厚）Bowel loops: conglomerate（聚拢）,16,uberculousperitonitis结核性腹膜炎,Wet type 湿型Ascites: septa （分隔,Dry type 干型,Sclerosing encapsulating peritonitis (abdominal cocoon) “茧”Clustering of small bowel loops in the center of abdomen
15、 腹部中央肠袢聚拢,17,uberculousperitonitis结核性腹膜炎,Dry type 干型Sclerosing encapsul,18,uberculousperitonitis结核性腹膜炎,Signs assisting in guiding dia,Asciteslymph nodes: mesenteric& retroperitonealNecrosis inside and ring-like enhancement Omentum: Thickening Peritoneum: Enhancement & Regular thickening,19,uberculou
16、speritonitis结核性腹膜炎,Asciteslymph nodes: mesenteri,Hepatic, Splenic and pancreatic TB 肝、脾、胰腺结核,Usually in a fine miliary pattern（粟粒样）, below the resolving capacity of CTMost common presentation: non-specific hepatosplenomegaly（肝脾肿大）Occasionally, tiny scattering low-density foci（微小低密度灶）Rarely, macronod
17、ular form（大结节）：pseudotumor or tuberculoma（假瘤或结核球）1-3cm or a single tumor-like mass,20,uberculousperitonitis结核性腹膜炎,Hepatic, Splenic and pancreati,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,21,uberculousperitonitis结核性
18、腹膜炎,Miliary hepatic TB 粟粒型Enlarged,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,22,uberculousperitonitis结核性腹膜炎,Tiny hypovascular nodules scat,Macronodular 大结节Hypovascular 低血供,Macronodula
19、r hepatic & splenic tuberculosis 大结节型,23,uberculousperitonitis结核性腹膜炎,Macronodular 大结节Hypovascular,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,24,uberculousperitonitis结核性腹膜炎,Pancreatic tuberculosis 胰腺结核Sl,Associated Findings,Thoracic
20、findings: 15% 合并胸部结核Genitourinary tuberculosis 泌尿生殖道结核Musculoskeletal tuberculosis 骨骼肌肉结核Central nervous system tuberculousis CNS TB 中枢神经系统结核,25,uberculousperitonitis结核性腹膜炎,Associated FindingsThoracic fi,A painting is more than the sum of its parts.A cow by itself is just a cow.A meadow by itself is
21、 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.,26,uberculousperitonitis结核性腹膜炎,A painting is more than the su,Thank you,27,uberculousperitonitis结核性腹膜炎,Thank you27uberculousperitonit,
