空腔脏器常见疾病.pptVIP

空腔脏器常见疾病 北京协和医院放射科 薛华丹 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。 Possible causes of intestinal obstuction Congenital Inflammatory Lesion (extrinsic and intrinsic bowel) Trauma Classification Gastric outlet obstruction: only one/two air-fluid levels Homogeneous mass displacing transverse colon Duodenal obstruction: double-bubble sign; Frequently normal due to absence of gas from vomiting Classification Jejunal and ileal obstruction: Candy cane: 3 loops+3cm gas-fluid levels+3~5 hours onset Disparity in size between obstructed and normal loops Little/no gas + stool in colon with complete mechanical obstruction after 12-24 hours Stepladder appearance; string-of-bead; Classification Colonic obstruction Dilated colon only Dilated small bowel (incompetent ileo-cecal valve) Gas-fluid levels distal to hepatic flexure (fluid is normal in cecum and ascending colon) Cecum most dilated portion (10cm will be critical) 肠扭转 大肠扭转 Classification Closed-loop obstruction Fixation of bowel loop: Coffee bean sign: gas filled loop pseudotumor: fluid-filled loop U-shaped dilated bowel loop Increasing intraluminal fluid Beak sign: point of obstruction Whirl sign: twisting of bowel 肠梗阻 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 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Strangulated obstruction Triad: closed-loop obstruction of the involved segment (majority of cases) Mechanical obstruction proximal to the involved segment Venous congestion of the involved loop Abdominal plain film : signs for volvulus（肠扭转） or closed-loop obstruction + bowel thickening CT has 63%~100% detection rate!!! Poor/no enhancement of bowel wall Mesenteric haziness due to edema 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 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Ileus Causes: postoperative intraabdominal inf