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ID:19523743
大小:479.50 KB
页数:17页
时间:2018-10-03
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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
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