肝脓肿与血肿课件

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1、BENIGNFOCALLIVERLESIONSAbscessesandHaematomaClinicalfeaturesofanabscess(脓肿)Patientspresentwithfever,oftenaccompaniedbyrightupperquadrant(RUQ)painandvomiting（呕吐）.Abnormalliverfunctiontests(LFTs)andanaemia（贫血）canalsobepresent.Theclinicalhistoryhelpstheson

2、ographer（超声医生）toestablishthenatureofthefocallesionandaetiologyoftheabscess.Abscessesofanytypemaybesolitaryormultiple.Becausetheultrasoundappearancesofabscessescanbesimilartothoseofnecrotic（坏死的）tumoursorhaematoma（血肿）,theclinicalpictureisofparticularimpor

3、tancetothesonographer.UltrasoundappearancesHepaticabscessesmaydisplayavarietyofacousticfeatures.Theirinternalappearancesvaryconsiderably.Intheveryearlystagesthereisazoneofinfected,oedematous（水肿的）livertissuewhichappearsonultrasoundasahypoechoic,solidfoca

4、llesion.Astheinfectiondevelops,thelivertissuebecomesnecrotic（坏死的）andliquefactiontakesplace.Theabscessmaystillappearfullofhomogeneousechoesfrompusandcanbemistakenforasolidlesion,butasitprogresses,thefluidcontentmaybecomeapparent,usuallywithconsiderablede

5、bris（碎片）withinit.Becausetheyarefluid-filled,abscessesdemonstrateposteriorenhancement(Fig.4.7A).(A)Earlystagesofapyogenicabscessinatransplantedliver.Thelesionlooksquitesolid,butnotetheposteriorenhancement.Themarginsofanabscessareirregularandoftenill-defi

6、nedandfrequentlythickened.Theinflammatorycapsuleoftheabscessmaydemonstratevascularity（多血管）oncolourorpowerDopplerbutthisisnotinvariableanddependsonequipmentsensitivityandsizeofthelesion.Infectionwithgas-formingorganismsmayaccountforthepresenceofgaswithin

7、someliverabscesses(Fig.4.7B).Thegascontainedwithinthislargeabscessintherightlobeoftheliverobscuresthefullextentofthelesion.(Largeabscesseslikethis,whichcontaingas,maymimictheacousticappearancesofnormalbowel.)TherearethreemaintypesofabscessPyogenicabsces

8、s（化脓性脓肿）Amoebicabscess（阿米巴脓肿）Candidiasisabscess（念珠菌脓肿）PyogenicabscessTheseformasaresultofinfectionenteringtheliverthroughtheportalvenoussystem(门静脉系统).Mostcommonly,appendiceal（阑尾的）ordiverticular（憩室的）abscessesareresponsible,butintr