1、Abdominal Tuberculosis腹部结核病Zhou LiuCancer Hospital Chinese Academy of Medical Sciences,Shenzhen center1uberculousperitonitis结核性腹膜炎General consideration Can affect any organ in the abdomen Importance of clinical context in diagnosisHigh-risk population：immunocompromised patients,especially AIDS（免疫抑制的
2、病人）Typical symptoms:such as diarrhea,fever etc（腹泻、发热等）Laboratory findings（实验室检查）：serum and culture（血清和培养）Histologic analysis（组织学检查）Radiological findings might mimic many different diseaseInflammatory disease：Crohns diseaseNeoplastic disease:Lymphomatosis,Peritoneal carcinomatosis2uberculousperitonit
3、is结核性腹膜炎Classification Gastrointestinal tuberculosis（胃肠道结核）Tuberculous lymphadenopathy（结核性淋巴结炎）Tuberculous peritonitis（结核性腹膜炎）Solid organ involvement（实性器官累及）Hepatic and splenic TBPancreatic TB3uberculousperitonitis结核性腹膜炎Different pathwaysModes of involvement in abdominal tuberculosisBy ingestion（吞咽）
4、Infected food or milk-Primary intestinal tuberculosis（原发性肠结核）Infected sputum（痰）-Secondary intestinal tuberculosis（继发性肠结核）Hematogenous spread from distant tubercular focus（血性播散）Contagious spread from infected adjacent foci（邻近累及）Through lymphatic channel（淋巴扩散）4uberculousperitonitis结核性腹膜炎Pathophysiolog
5、y of Gastrointestinal TB（胃肠道TB的病理生理学）BacteriaMucosa粘膜Submucosa粘膜下层Epithelioid tubercles表皮样结节Ulceration溃疡Granuloma formation肉芽肿形成Caseous necrosis干酪性坏死Cicatrization瘢痕形成Sloughing脱落Surrounding mucosa thickening邻近粘膜增厚Lymph nodes淋巴结Peritoneum腹膜Circulationliver肝 pancreas胰spleen脾Spreading5uberculousperitoni
6、tis结核性腹膜炎 Complications of intestinal tuberculosisBowel obstruction（肠梗阻）Perforation（穿孔）Abscess formation（脓肿形成）Fistula（瘘道形成）Intussusception（肠套叠）Bowel wall ischemia（肠壁缺血）1 ileocecal junction(90%)234566uberculousperitonitis结核性腹膜炎Fixed and narrowed ileum（回肠固定及变窄）;Conical and shrunken cecum（锥形和萎缩的盲肠）mimi
7、c Crohns diseaseUniform and concentric thickening of terminal ileum wall（回肠末端肠壁向心性均匀增厚）7uberculousperitonitis结核性腹膜炎ileocecal tuberculosis 回盲部结核Mild wall thickening of the cecum（盲肠壁轻度增厚）Pericecal lymph nodes（盲肠周围淋巴结）ileocecal tuberculosis 回盲部结核Circumferential thickening of the cecum and terminal ileu
8、m（盲肠和末端回肠壁环形增厚）Adjacent lymph nodes（邻近淋巴结）Progressing8uberculousperitonitis结核性腹膜炎Differentiating imaging featuresTuberculosisCrohns diseaseAsymmetric,irregular wall thickeningCircumferential bowel wall thickeningFleischner sign on barium studiesCobblestone appearance on bariumNo creeping fat Creepin
9、g fat(abnormal quantity of mesenteric fatPositive chest film(50%)Negative chest filmOmental and peritoneal thickeningNormal omentum and peritoneumEnlarged lymph nodes with low-denstity centersEnlarged soft-tissue density lymph nodes9uberculousperitonitis结核性腹膜炎Colonic tuberculosis(A)Two strictures in
10、 descending and transverse colon(B)Marked infiltration and asymmetrical thickening of the ascending colon and mesenteric enlarged lymph nodeTuberculosis of the ileumSymmetric mural thickning ileum(arrows)and adjacent enlarged lymph node10uberculousperitonitis结核性腹膜炎Tuberculous lymphadenopathyMultiple
11、 enlarged lymph nodes Hypodense centers and peripheral enhancement 低密度中心伴有周围强化Conglomerate lymph nodes 淋巴结融合Caseation and liquefaction substances at the center（中心干酪样和液化坏死）Peripheral inflammatory lymphatic tissue（周围炎性组织）11uberculousperitonitis结核性腹膜炎Multiple enlarged lymph nodesRim enhancement and Nec
12、ross inside（环形强化和内部坏死）Calcification（钙化）Large psoas abscess（腰大肌脓肿）12uberculousperitonitis结核性腹膜炎Tuberculous peritonitis 结核性腹膜炎Wet type90%Fibrotic-fixed type 7%High density Large volume of ascites Protein and cellular content Small volume of ascites Fixed bowel loops Omental masses Dry type 3%Dense per
13、itoneal adhesions Fibrous peritoneal reaction Caseous nodules13uberculousperitonitis结核性腹膜炎Thickening,enhancement,and nodularity of peritoneum 腹膜增厚、强化、结节状ileocolic adenopathy 回盲部淋巴结14uberculousperitonitis结核性腹膜炎 Mesentery involvement:most common Omental involvement:nodular,smudged Peritoneal involveme
14、nt:smooth,tiny nodules Ascites:30-100%of cases&multiple stands of fibrin and debris（纤维素或碎片）&septa（分隔）15uberculousperitonitis结核性腹膜炎Wet type 湿型Ascites:septa（分隔）Peritoneum:smooth thickening&enhancement（光滑增厚&强化）Fibrous type 纤维型Omentum&peritoneum:thickening（增厚）Bowel loops:conglomerate（聚拢）16uberculousperi
15、tonitis结核性腹膜炎Dry type 干型Sclerosing encapsulating peritonitis(abdominal cocoon)“茧”Clustering of small bowel loops in the center of abdomen 腹部中央肠袢聚拢17uberculousperitonitis结核性腹膜炎Signs assisting in guiding diagnosis of tuberculous peritonitisPresence of mesenteric macronodulesEnhancement and regular thi
16、ckening of the parietal peritoneumSplenomegaly and calcification of the spleenInvolvement of the ileocecal wallRetroperitoneal and peri-pancreatic lymphadenopathy with a hypodense center and ring-enhancement18uberculousperitonitis结核性腹膜炎Asciteslymph nodes:mesenteric&retroperitonealNecrosis inside and
17、 ring-like enhancement Omentum:Thickening Peritoneum:Enhancement&Regular thickening 19uberculousperitonitis结核性腹膜炎Hepatic,Splenic and pancreatic TB 肝、脾、胰腺结核 Usually in a fine miliary pattern（粟粒样）,below the resolving capacity of CT Most common presentation:non-specific hepatosplenomegaly（肝脾肿大）Occasion
18、ally,tiny scattering low-density foci（微小低密度灶）Rarely,macronodular form（大结节）：pseudotumor or tuberculoma（假瘤或结核球）1-3cm or a single tumor-like mass20uberculousperitonitis结核性腹膜炎Miliary hepatic TB 粟粒型Enlarged liver 肝大Heterogeneous parenchyma 密度不均Multiple hypoenhancing nodules in the spleen 伴有脾脏多发小结节，低强化21u
19、berculousperitonitis结核性腹膜炎Tiny hypovascular nodules scattering in the liver and spleen 低血供结节Enlarged liver and spleen 肝脾大slightly rim enhancement 轻度环形强化Micronodular tuberculosis 微小结节型22uberculousperitonitis结核性腹膜炎Macronodular 大结节Hypovascular 低血供Macronodular hepatic&splenic tuberculosis 大结节型23uberculo
20、usperitonitis结核性腹膜炎Pancreatic tuberculosis 胰腺结核Slight increase in the dimension of pancreas 体积稍增大Loss of lobulated contour 边缘变光滑 24uberculousperitonitis结核性腹膜炎Associated Findings Thoracic findings:15%合并胸部结核 Genitourinary tuberculosis 泌尿生殖道结核 Musculoskeletal tuberculosis 骨骼肌肉结核 Central nervous system
21、tuberculousis CNS TB 中枢神经系统结核25uberculousperitonitis结核性腹膜炎 A painting is more than the sum of its parts.A cow by itself is just a cow.A meadow by itself is merely grass and flowers.The sunshine peeking through the trees is merely a beam of light.But you put them all together,it can be magic.You have to see the whole landscape.26uberculousperitonitis结核性腹膜炎Thank you27uberculousperitonitis结核性腹膜炎
