胆系影像诊断学课件.ppt

1、u梗阻性黄疸与胆囊病变的诊断与鉴别诊断u平扫显示胆道系统梗阻的部位、含钙结石u增强显示和区别肝内血管、胆道系统，更好地显示胆囊形态和胆囊壁的病变u常由胆囊结石嵌顿和蛔虫阻塞，引起胆囊管阻塞，胆汁淤滞，胆囊内压力增高，压迫胆囊壁血管和淋巴管，胆囊血供障碍导致炎症发生u病理学表现三种类型：单纯性急性胆囊炎，胆囊黏膜充血、水肿，胆囊轻度肿胀；化脓性急性胆囊炎，为胆囊壁弥漫性白细胞浸润形成广泛蜂窝织炎，胆囊肿大，囊壁增厚，浆膜纤维素性脓性渗出，发生胆囊周围粘联或脓肿等；坏疽性急性胆囊炎，胆囊高度肿大，胆囊壁缺血、坏死、出血甚至穿孔，引起胆汁性腹膜炎。如为产气细菌感染，则胆囊坏疽的同时，胆囊内和胆囊壁积

2、气，为气肿性急性胆囊炎u常见于45岁以下，男女比1:2。临床表现为急性发作的右上腹痛，放射右肩胛部，为持续性疼痛并阵发性绞痛，伴有畏寒、高热、呕吐等u检查右上腹压痛，莫非（Murphy）征阳性，可扪及肿大的胆囊，重者出现黄疸u注射造影剂后，可见胆囊壁呈不规则增厚，与肝脏分界不清Gallbladder carcinomas Gallbladder carcinomasGallbladder carcinomas胰头部狭窄性病变，导致肝内胆管明显扩张、变形。门脉系统等的相对位置关系，保持在正常位置u发生在左右肝管以下的肝外胆管癌 上段，又称肝门部胆管，左、右肝管及其汇合部、肝总管，50%中段，肝总

3、管与胆囊管汇合部以下至胆总管中段 下段，胆总管下段、胰腺段和十二指肠壁内段u80%为腺癌，少数为鳞癌u生长方式：结节型、浸润型、乳头型（常见）u发病年龄在5070岁之间，男女比22.5:1u早期症状为右上腹隐痛或胀痛，继而出现进行性黄疸。体检右上腹部包块，胆囊肿大tumoral involve the right secondary confluence and common hepatic ductCT reveals a high-attenuation tumor on the anterior aspect of the right portal vein On a subsequen

4、t CT scan,the tumor appears as a high-attenuation lesion on the right side of the portal veinCT scans at a lower level show the mucosa of the cystic duct with strong enhancement,a finding that suggests tumoral involvement.Soft-tissue infiltration around the portal vein and lymphadenopathy are also n

5、oted Delayed-phase CT scans show a soft-tissue mass within a dilated left hepatic duct and common bile ductCholangiogram shows a polypoid mass at the confluence levelSpecimen reveals an extensive polypoid mass within the common bile ductCT scans show a dilated common bile duct filled with a papillar

6、y tumor;partial restoration of the ductal lumen in the intrapancreatic portion of the common bile duct.However,small papillary tumors are still evident.On a CT scan obtained at the level of the distal common bile duct,the lumen is again filled with an intraductal papillary tumor.Direct cholangiogram

7、 shows a large papillary tumor in the proximal two-thirds and the distal portion of the common bile ductAdenomyomatosis of the Gallbladderadenomyomatosis C-T2WI and c+T1WI show a diffusely thickened gallbladder wall and intramural cavities,which are hyperintense on the T2WI,hypointense on the T1WI,and nonenhancingThe cavities represent Rokitansky-Aschoff sinuses containing fluid bileAdenomyomatosis