1腹壁、腹膜腔及腹膜后间隙常用的检查方法1.X线2.CT3.超声4.MRI2正常解剖及变异-平片3CT4嗜酸性肠炎嗜酸性肠炎5腹部腹膜腔的划分1.腹腔间隙:肝上下间隙、肝胃、肝脾、网膜囊上下间隙2.下腹腔间隙:结肠旁沟、结肠下间隙3.盆腔间隙:膀胱直肠凹、膀胱子宫凹、子宫直肠凹6后腹膜腔的划分•肾前间隙:位于腹膜壁层和肾前筋膜之间,内含胰腺、十二指肠、升结肠、降结肠及肠系膜血管。•肾周间隙:位于肾前、后筋膜之间,除有肾脏、肾上腺、肾动脉及肾静脉,还有丰富的脂肪组织,前后筋膜在外侧融合成侧锥筋膜,肾周间隙像一个倒立的圆锥。•肾后间隙:位于肾后筋膜和腹横筋膜之间,内含脂肪、血管、神经和淋巴管。7基本病变的影像诊断腹部平片腹腔积气游离气腹:freepneumoperitoneum局限性气腹:腹腔积液腹腔内高密度影:结石、钙斑腹壁异常89间位结肠10111213gallbladderstone14Nephrolithiasis:AP:highdensitieswithvarioussizeintheupperabdomen;L:thehighdensitiesoverlappedbythespine15腹部异物16输尿管结石Calculusinleftureter1718膀胱巨大结石19腹部CT的异常表现•平扫气体及液体潴留高密度肿块•增强肠系膜腹膜结构异常20膀胱输尿管入口处多发结石2122急性胰腺炎所致腹膜炎症23消化系统常见疾病acuteabdomencommondiseasesofesophagus---stomach,intestine---liver---biliarysystem---pancreas---spleen24Thecommonreasonsofacuteabdomen•Digestivesystem:perforation,obstruction,inflammation•Urinarytract:stone•Gynecology(妇科):ectopicpregnancy(宫外孕)•Artery血管:aneurism(动脉瘤)aorticdissection(夹层)embolism(栓塞)25肠梗阻intestineobstruction26肠梗阻ileus机械性肠梗阻mechanical动力性肠梗阻dynamic血运性肠梗阻Aterialembolism单纯性肠梗阻SimpleIO绞窄性肠梗阻StrangulatedIO麻痹性肠梗阻paralyticIO痉挛性肠梗阻SpasticIO分类27肠梗阻(intestineobstruction)病因:粘连、炎症、肿瘤、手术等临床症状:腹痛、腹胀、呕吐、停止排便排气腹部包块和腹膜刺激征:绞窄性腹部膨隆,肠鸣音消失:麻痹性28单纯性小肠梗阻(simplesmallintestineobstruction)立位平片•阶梯状气液平(透视可见液面上下变化活跃)•大跨度肠袢•鱼肋征•驼峰征碘剂造影2930肠梗阻的CT表现:回肠远端胆源性结石致肠梗阻3132绞窄性肠梗阻(strangulatedintestineobstruction)•常见病因:扭转、内疝、粘连等•扭转肠段70cm时可出现下列征象:–“假肿瘤”征–“咖啡豆”征–小跨度卷曲:“8”字征、“花瓣”、“香蕉征”等–小肠内长液面征–肠袢空回肠扭转征33343536麻痹性梗阻(paralyticintestineobstruction)•常见病因:急性腹膜炎、腹部术后、低钾症等•X线平片及CT平扫可见:腹部肠腔普遍性中等度积气。立位平片见阶梯状气液面(透视下静止液面)37立位卧位38结肠梗阻(colonobstruction)•病因:肿瘤、炎症、扭转•梗阻近端结肠或小肠胀气扩大并积液•钡剂灌肠可明确原因39胃肠道穿孔(perforationofgastrointestinaltract)•病因:溃疡、肿瘤及炎症•腹部透视或腹部平片:腹腔内积气,游离气腹。4041间位结肠42肠穿孔43肠套叠(intussusception)•为一种特殊类型的肠梗阻,儿童多见于2岁以下小儿(急性),成人多为肿瘤所致肠套叠,多为慢性过程•分类:小肠、回结肠、结肠型•症状:阵发性腹痛、呕吐、腹部肿块、便血•影像学表现:–平片:全肠梗阻征象–空气灌肠:用于发病24小时以内,可作诊断,亦可作治疗。梗阻端见软组织块影–钡灌肠:•梗阻端见杯口状充盈缺损•套叠鞘之肠壁可呈弹簧弓样征象4445成人肠套叠小儿肠套叠46肠扭转(vovulus)•小肠扭转•乙状结肠扭转(volvulusofthesigmoidcolon)–立位平片见“天平征”(即闭袢扩大伸长气液面)–卧位平片见“川字征”(充气之闭袢)。–钡灌肠:鸟嘴征肠系膜扭转474849食管异物(foreignbodyofesophagus)儿童因误咽含在口内的硬币、别针等,成人常为食物中的鱼刺、碎骨片及脱落假牙等主要症状有呕吐、梗阻感、疼痛、吞咽困难等50•X线检查–不透线异物:异物易停留在食管狭窄处,X线透视、摄片均能见到。圆形物在正位呈片状,侧位呈扁平条状影;长形物其长轴与食管长轴相一致–透线异物:经造影检查可明确,钡棉•CT检查51硬币骨头鱼刺52食管静脉曲张esophagealvarices•Esophagealvaricesresultfromdilatationofsubmucosalveinsintheesophagusactingascollateralvenousdrainageinthepresenceofobstructionelsewhere.•Usuallythisiscausedbycirrhosisoftheliversothatportalbloodflowisreroutedviatheesophagustothesuperiorvenacava.53•pathomechanism病理机制portalhypertensiontheexcessbloodfromtheleftgastricveinandtheshortgastricveinflowintothesubmucosalveinsinthedistalregionofesophagusandtheperioesophagealvenousplexus,thenintotheazygosveinandSVC,whichresultintheesophagealvarices.门V系统高压,大量静脉血液自胃冠状V和胃短V食管远段粘膜下V和食管周围V丛奇静脉上腔V,致胃底V和食管下段V曲张(上行性V曲张)。esophagealvarices食管静脉曲张54门脉高压侧支循环示意图55clinicalsymptoms临床症状Themainsymptomsishaematemesis.Thepatientalwayssufferedfromcirrhosis.主要为呕血(有肝硬化病史)56•Esophagealvaricesareacommon-anddangerouscomplicationofcirrhosis,andthebleedingfromthevaricesisamedicalemergency.EsophagealVaricesEndoscopeview57•食管静脉曲张食管吞钡表现:–轻度:病变局限于下段,粘膜皱襞稍增宽、迂曲,管壁锯齿状,蠕动正常–中度:范围可延至中段,粘膜呈蚯蚓状、串珠状、管腔收缩欠佳,排空延迟–重度:范围更广,甚至全食管,食管明显扩张,不易收缩,腔内可见环状、囊状充盈缺损,但管壁柔软胃底静脉曲张胃钡餐表现:空泡状葡萄样充盈缺损58Esophagealvarices.Bariumswallow.Revealinglongitudinalserpiginousfillingdefectsinmiddleanddistalportionoftheesophagus.5960gastricfundusvarices胃底静脉曲张Fillingdefectlikevacuolusandgrapes空泡状葡萄样充盈缺损61●MR表现门脉造影加MIP重建可显示曲张的食管静脉网,效果近似于血管造影。食管周围可见管状或圆点状流空低信号影●血管造影采用经肠系膜上动脉插管的间接法门静脉造影●CT表现平扫食管壁增厚,食管周围可见管状或圆点状软组织密度影。增强扫描和静脉密度一致,显示更清晰6263CTatmid-chestleveldemonstratesmultipletubularandroundedcontrastenhancedstructuressurroundingtheesophagusandrepresentingperioesophagealvarices(largearrows).Enhancementofthethickenedesophagealwall(smallarrow)isduetoenlargedsubmucosalcontrastenhancedvarices.Oesophagealvarices64AzygosveinHemiazygosvein65贲门失驰缓症achalasiaHistologicalexaminationofesophagususuallydemonstratesdegenerationofthevagusnerveplexusintheregionofthegastro-esophagealjunction,ordegenerationornucleusofvagusnerve.Theendresultisafailureofrelaxationofthegastro-esophagealjunction.迷走神经丛或迷走神经核变性,贲门括约肌不能松弛。66轻度中度重度6768•Clinicalmanifestations临床表现Itisoftenoccurredinfemale,themainsymptomsincludedysphagia,retrosternalblockage.Theclinicalhistoryisverylong.Thepatientmayhaveperiodicalvomiting,andthesymptomscanberelievedbywarmwaterormedicines(suchas654-2oratropine).女性多于男性,下咽不畅,胸骨后阻塞感,病程长,周期性呕吐,有时可用热水、药物缓解(654-2和阿托品)。69•影像学表现–轻度:食管轻度扩张,食管下端光滑,呈纺锤状、鸟嘴状,有锯齿样收缩–中度:食管中度扩张,4~6cm,典型为鸟嘴状–重度:食管高度扩张,6cm,正位可见纵隔增宽,常有呼吸道并发症70食管癌(carcinomaofesophagus)Esophagealcarcinomaisoneofthemostcommonmalignanttumors,themajorityismale.About80%-90%issqumouscellcarcinomas,andtheothers10%-20%isadeno-carcinomas.Thelesionsareoftenlocatedinthemiddlethirdofesophagus.Themainsymptomsisprogressivedysphagia,accompanyingretrosternalburning-likeorthorn-likepain.71•常见的恶性肿瘤,男多于女,40岁以上•细胞类型:多为鳞状上皮癌,少数为腺癌多见于(食管下端),以食管中段为好发部位。•临床症状:进行性吞咽困难为主要症状,伴胸骨后疼痛,灼疼、刺疼。72–Definition:thelesionisdefinedhistologicallyascancerlimitedtothemucosaorsubm