最新急腹症AcuteAbdomen影像学表现ppt课件.ppt

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1、急腹症AcuteAbdomen影像学表现一急腹症检查方法及应用范围：1、腹部平片：主要应于胃肠道穿孔性或梗阻性急腹症。2、钡灌肠造影：应用于肠套叠、扭转等梗阻性急腹症的诊治。3、CT检查：可应用于所有急腹症检查，价值较高。4、超声检查：主要应用于实质性脏器外伤、腹腔积液、局限性脓肿、结石与梗阻、肠套叠及急性炎症的检查。PossiblecausesofintestinalobstuctionCongenitalInflammatoryLesion(extrinsicandintrinsicbowel)TraumaClassificationJejunala

2、ndilealobstruction:Candycane:>3loops+>3cmgas-fluidlevels+>3~5hoursonsetDisparityinsizebetweenobstructedandnormalloopsLittle/nogas+stoolincolonwithcompletemechanicalobstructionafter12-24hoursStepladderappearance;string-of-bead;Cave:fluid-distendedloopsmayleadonetooverlookobstructi

3、on!!!Uprightabdominalradiographshowsmultipleair–fluidlevels.Pneumobilia(arrow)ispresent,asisstring-ofpearlssign(arrowheads).ClassificationColonicobstructionDilatedcolononlyDilatedsmallbowel(incompetentileo-cecalvalve)Gas-fluidlevelsdistaltohepaticflexure(fluidisnormalincecumandas

4、cendingcolon)Cecummostdilatedportion(>10cmwillbecritical)肠扭转大肠扭转ClassificationClosed-loopobstructionFixationofbowelloop:Coffeebeansign:gasfilledlooppseudotumor:fluid-filledloopU-shapeddilatedbowelloopIncreasingintraluminalfluidBeaksign:pointofobstructionWhirlsign:twistingofbowel肠

5、梗阻机械性肠梗阻单纯性肠梗阻：肠管通畅性障碍绞窄性肠梗阻：肠管通畅性障碍伴有血运障碍动力性肠梗阻麻痹性肠梗阻：痉挛性肠梗阻：血运性肠梗阻：肠系膜动脉血栓或栓塞所致钡剂造影须慎重使用，钡剂吸收水分会加重梗阻单纯性肠梗阻阶梯状气液平大跨度肠袢鱼肋征绞窄性肠梗阻假肿瘤征：两端闭锁的绞锁肠段内充满大量液体，仰卧位呈肿块影，而站立位或侧卧位水平位片上则在该肿瘤块影上部见一短小的液面咖啡豆征：闭襻小跨度蜷曲肠襻：肠系膜增厚缩短长液面征：张力低、血性液体空回肠换位征：小肠扭转绞窄性肠梗阻StrangulatedobstructionTriad:closed-loop

6、obstructionoftheinvolvedsegment(majorityofcases)MechanicalobstructionproximaltotheinvolvedsegmentVenouscongestionoftheinvolvedloopAbdominalplainfilm:signsforvolvulus（肠扭转）orclosed-loopobstruction+bowelthickeningCThas63%~100%detectionrate!!!Poor/noenhancementofbowelwallMesentericha

7、zinessduetoedema肠扭转小肠扭转：空回肠换位、花瓣样或香蕉样排列麻痹性肠梗阻IleusCauses:postoperativeIntra-abdominalinflammationischemicboweldiseaseLarge+smallbowel±gastricdistensionDecreasedsmallboweldistensioninserialfilmsDelayedbutfreepassageofcontrastmaterialLocalizedileusCauses:oftenassociatedwithadjacen

8、tacuteinflammatoryprocess(acutepancreati