肝脓肿肾脓肿.ppt

Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,2020/11/3,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,2020/11/3,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,2020/11/3,*,肝脓肿,2020/11/3,1,165360-wang-M-59,2020/11/3,2,165946-xin-m-59,2020/11/3,3,Pyogenic abscesses,spectrum of appearances.,与产气细菌感染有关的脓肿,G,境界不清晰的低回声占位、内部大量点状强回声为气泡。,H,超声,I,和,CT,显示肝脏占位、含有大量气体。,2020/11/3,4,185265-qu-m-54,2020/11/3,5,肝脓肿,158036,，,谷建国，,M,，,52,2020/11/3,6,不典型肝脓肿,石福荣，F，48,140769,2020/11/3,7,pyogenic liver abscess,Variable appearance of.,化脓性肝脓肿表现多样,肝脓肿以囊性为主,(A);,实性：类似局限性占位,(B),部分病例多发、类似转移,(C).,2020/11/3,8,013665-xu-m-76,陈旧性脑梗塞发热,2020/11/3,9,189139-wang-m-44,2020/11/3,10,079268-zou-f-44,2020/11/3,11,019867-wang-m-50,脓肿吸收期,2020/11/3,12,0525592-liu M-47,2020/11/3,13,034964 wu-f-26,2020/11/3,14,193575-li-m-62,2020/11/3,15,wu,M,70,肝囊肿合并感染,2020/11/3,16,231034 zhang M 60,肝囊肿合并感染,2020/11/3,17,bai,M,69,2020/11/3,18,M,87,2020/11/3,19,M,、,52,岁,-,胆道术后,2020/11/3,20,148407-chen-f-71-,2020/11/3,21,F-24,岁,-,车祸、肝破裂修补术后高热,2020/11/3,22,F-26,岁，右侧上腹部疼痛,2020/11/3,23,M-54-,右上腹部疼痛一个月、发热,2020/11/3,24,M-54-,右上腹部疼痛一个月、发热,2020/11/3,25,HEPATIC CANDIDIASIS:Fungal infection,“Bulls-eye”24-,岁男性、急性淋巴细胞白血病、发热,A,脾脏局限性靶环型病灶,B,肝脏多发病灶。厚的有回声晕、薄的,低回声内环伴有 稠密的高回声病灶,活检提示 假菌丝,pseudohyphae.,Bulls-eye:1,到,4 cm,占位、伴有中心高回声和低回声晕,白细胞计数恢复至正常时的表现,中心高回声含有炎性细胞,2020/11/3,26,Candidiasis,A,Uniformly hypoechoic,pattern.,多发的肝脏低回声病灶、急性白血病,B,Echogenic pattern after medical therapy.,小钙化,(arrow),在另一患者可见,Uniformly hypoechoic:,最常见、与进行性肝脏纤维化一致,（,A,）,Echogenic:,不同程度钙化、代表瘢痕形成,(,B),2020/11/3,27,Hepatic candidiasis.,肝脏念珠菌病,A and B:2,患者均为免疫功能缺陷，,II,型 散在低回声占位、中心强回声,化脓性肝脓肿、穿刺抽吸、有助于获取病源微生物、,真菌性肝脓肿穿刺常为,Candida organisms,假阴性。,由于没有取材中心坏死部分，这里含有假菌丝,pseudohyphae,2020/11/3,28,Amebic liver abscess,classic morphology.,椭圆形、界限清晰、后方回声增强,内部均匀、低回声、没有界限清晰的脓肿壁,2020/11/3,29,Amoebic liver abscesses,A:,类似实性、相对均匀、后方可见增强,B:,更典型得阿米巴脓肿、虽然轮廓不规则。,C:,轮廓清晰、低水平积液。,(1),肝内体积较大单发的无回声区，内部有细点状回声。,脓腔较大的病理基础是，阿米巴的溶组织酶直接破坏肝细胞和原虫大量繁殖阻塞肝静脉等，造成肝组织梗死引起；,（,2,）脓腔的壁较细菌性肝脓肿为薄，脓肿多位于右肝膈顶部,2020/11/3,30,Brucellar hepatic abscesses,肝脏右叶低回声脓肿、中心钙化伴有后方声影,29,岁女性 住院,3-,周、每日发热、大汗、,weakness,厌食、体重减轻,5-kg,既望体健、,24,岁患溃疡,经常食用 新鲜的山羊乳干酪,fresh goat cheese.,temperature,39.5C,右侧中上腹部中度触痛,6-cm,低回声实性占位，边界不清晰、中心钙化（周边肉芽组织干酪样坏死）,2020/11/3,31,肾脏感染性疾病,Ultrasonographic evaluation of renal infections,2020/11/3,32,肾脓肿,右肾肾上极边缘清楚地低回声病灶,(A),，后方回声增强（箭）。,L,肝脏,肾脏增大，轮廓变形。,能量多普勒,(C),示病灶周围血管增生。,2020/11/3,33,Renal abscess,局限性囊性占位,(arrow),肾脏的中极,.,患者发热、疼痛。,2020/11/3,34,Renal abscess.,A,Transverse sonogram shows a large cystic lesion with minimal layering debris.,B,Transverse sonogram in second patient,shows a smaller complex abscess.,2020/11/3,35,Early and mature abscess cavities,(a),地图样低回声病灶,右肾上极脓肿,(b),更成熟脓肿,脓腔更清晰，可见假包膜、后方回声增强。,2020/11/3,36,Renal abscess,a,右肾边界清晰低回声区、周围有回声壁,(,arrow).,b,增强,CT,弥漫性肾盂肾炎和脓肿、扩展进入肾周间隙,(,arrow),2020/11/3,37,193681-LI-F-57,2020/11/3,38,231107,WANG-F-43,2020/11/3,39,80536512-WANG-M-47,2020/11/3,40,肾囊肿合并感染,2020/11/3,41,囊肿感染,与 厚壁脓肿类似、内部回声一致,(A).,碎屑可能分层,(B).,2020/11/3,42,囊肿合并感染,Debris.,囊肿感染后，碎屑分层,2020/11/3,43,153863,XING-M-68,2020/11/3,44,ZHANG,F,54,2020/11/3,45,肾盂积脓,dilated collecting systems with dependent internal debris.,A,Obstructing stone in ureteropelvic junction.,2020/11/3,46,80583061-F-LIU-66,2020/11/3,47,肾盂积脓,右肾,),体积增大、肾盂积水，,扩张的肾盏内见液液平面（箭），脓汁表现为收集系统的低垂部位有回声的碎屑，变动体位碎屑发生移动。,2020/11/3,48,152549-ZHU-F-39,2020/11/3,49,Pyonephrosis,收集系统扩张、几乎充满有回声的碎屑,(arrow),2020/11/3,50,Duplex collecting,system with associated perinephric,abscess.,a,上极收集系统扩张,(,arrow).,B CT,下极水平扫查 输尿管扩张,(,arrow),肾周脓肿,2020/11/3,51,气肿性肾盂肾炎,This term is applied to gas,bubble formation in the renal parenchyma or perirenal tissues;it is often,accompanied by abscess and cortical infarcts.,a,teenaged diabetic female who died of urosepsis.,Tiny gas bubbles are,visible within the purulent infiltrates in the renal cortex,2020/11/3,52,气肿性肾盂肾炎,左肾肾实质内气体伴声影（箭头）,典型表现为肾体积增大、肾实质内高回声团伴后方低水平声影,2020/11/3,53,气肿性肾盂肾炎,Emphysematous pyelonephritis,.,2020/11/3,54,Emphysematous,pyelitis,2020/11/3,55,122773-LI-F-50,2020/11/3,56,气肿性肾盂肾炎,Emphysematous pyelonephritis,(A),移植肾、多发点状强回声、伴有脏声影、符合气体。但是超声难以确定气体精确的位置和程度。,(B),CT,肾内气体存在、累及肾实质,2020/11/3,57,169896-MA-F-46,2020/11/3,58,气肿性肾盂肾炎,Emphysematous pyelonephritis.,(a),左肾内反重力的强回声伴有,ring-down artifact.,(b),CT,实质内气体,2020/11/3,59,Acute pyelonephritis,免疫功能低下患者，右肾扩张的肾盏中高回声团,2020/11/3,60,Acute pyelonephritis,Fungus ball.,Sagittal sonogram shows an,echogenic soft tissue mass within a dilated upper-pole cortex.,2020/11/3,61,Acute pyelonephritis,Fungal balls.,左肾收集系统内高回声真菌球,早产儿、新生儿监护室,2020/11/3,62,