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.Theclinicalhistoryhelpsthesonographer（超声医生）toe

2、stablishthenatureofthefocallesionandaetiologyoftheabscess.Abscessesofanytypemaybesolitaryormultiple.Becausetheultrasoundappearancesofabscessescanbesimilartothoseofnecrotic（坏死的）tumoursorhaematoma（血肿）,theclinicalpictureisofparticularimportancetothesonographer.Ultrasoundap

3、pearancesHepaticabscessesmaydisplayavarietyofacousticfeatures.Theirinternalappearancesvaryconsiderably.Intheveryearlystagesthereisazoneofinfected,oedematous（水肿的）livertissuewhichappearsonultrasoundasahypoechoic,solidfocallesion.Astheinfectiondevelops,thelivertissuebecome

4、snecrotic（坏死的）andliquefactiontakesplace.Theabscessmaystillappearfullofhomogeneousechoesfrompusandcanbemistakenforasolidlesion,butasitprogresses,thefluidcontentmaybecomeapparent,usuallywithconsiderabledebris（碎片）withinit.Becausetheyarefluid-filled,abscessesdemonstratepost

5、eriorenhancement(Fig.4.7A).(A)Earlystagesofapyogenicabscessinatransplantedliver.Thelesionlooksquitesolid,butnotetheposteriorenhancement.Themarginsofanabscessareirregularandoftenill-definedandfrequentlythickened.Theinflammatorycapsuleoftheabscessmaydemonstratevascularity

6、（多血管）oncolourorpowerDopplerbutthisisnotinvariableanddependsonequipmentsensitivityandsizeofthelesion.Infectionwithgas-formingorganismsmayaccountforthepresenceofgaswithinsomeliverabscesses(Fig.4.7B).Thegascontainedwithinthislargeabscessintherightlobeoftheliverobscuresthef

7、ullextentofthelesion.(Largeabscesseslikethis,whichcontaingas,maymimictheacousticappearancesofnormalbowel.)TherearethreemaintypesofabscessPyogenicabscess（化脓性脓肿）Amoebicabscess（阿米巴脓肿）Candidiasisabscess（念珠菌脓肿）PyogenicabscessTheseformasaresultofinfectionenteringtheliverthrou

8、ghtheportalvenoussystem(门静脉系统).Mostcommonly,appendiceal（阑尾的）ordiverticular（憩室的）abscessesareresponsible,butintr