《肝膽疾病超聲診斷》

肝膽超聲編輯ppt編輯ppt編輯ppt編輯ppt編輯ppt編輯ppt編輯ppt編輯pptMirror-imageatifact編輯pptBecausethesoundtravelsmoreslowlyinfluidthanintheliverparenchyma,alargecystcandelaythepassageofsound,causingthediaphragmtoappearfartherawaythanitis.編輯ppt編輯ppt編輯ppt編輯ppt編輯ppt編輯ppt編輯ppt編輯ppt編輯pptCT:alow-density

lesion編輯pptdrainageofHepaticabscess

編輯pptTransabdominalandtranscervicalchorionicvillussampling(CVS),編輯ppt編輯pptThecatheterisfollowedsonographicallythroughoutitscoursefromthecervixtoanappropriatepositionwithintheplacenta編輯ppt編輯ppt編輯ppt編輯ppt編輯ppt編輯pptRAIRPIRPSRAS編輯ppt編輯ppt編輯ppt編輯ppt2234編輯pptRHVThenormalmeanvelocityinthemainportalveinisabout15to18cmpersecond,butthenormalrangeiswide.Thenormalportalveinflowisantegrade(hepatopetal)throughouttheentirecardiaccycle.編輯ppt編輯pptfissurefortheligamentumvenosum(arrows)編輯pptsagittalviews:Thefissurefortheligamentumvenosumseparatesthecaudatelobe(C)fromthelateralsegmentoftheleftlobe(LL).編輯ppt編輯ppt編輯ppt編輯ppt編輯ppt編輯ppt.(1)alargeantegradesystolicwavecausedbythemovementofthetricuspidannulustowardthecardiacapex;(2)asmallretrogradeV-wavecausedbyrightatrialoverfilling;theV-waveisusuallybelowthebaselinebutmaybeabovethebaseline;(3)anantegradediastolicwavecausedbytheopeningofthetricuspidvalveandflowofthebloodfromtherightatriumtotherightventricle;(4)aretrogradeA-wavecausedbyrightatrialcontraction;and(5)aretrogradeC-wavecausedbytheclosureofthetricuspidvalveatthebeginningofsystole,whichmaybeseeninafewpatients編輯ppt1.

Thenormalhepaticveinwaveformconsistsofwavesinthefollowingsequence:(1)alargeantegradesystolicwavecausedbythemovementofthetricuspidannulustowardthecardiacapex;(2)asmallretrogradeV-wavecausedbyrightatrialoverfilling;theV-waveisusuallybelowthebaselinebutmaybeabovethebaseline;(3)anantegradediastolicwavecausedbytheopeningofthetricuspidvalveandflowofthebloodfromtherightatriumtotherightventricle;(4)aretrogradeA-wavecausedbyrightatrialcontraction;and(5)aretrogradeC-wavecausedbytheclosureofthetricuspidvalveatthebeginningofsystole,whichmaybeseeninafewpatients編輯ppt編輯ppt編輯ppt編輯ppt編輯ppt編輯pptA編輯pptB編輯pptDEBRISCYST編輯ppt1.Thecystsbecomeincreasinglycommonwithage,andtheincidenceishigherafter40yearsofage,reaching7%inpersonsover80yearsold.Whenlargerthan4cm,theyaretermedgianthemangiomas編輯ppt編輯ppt

Hemangiomasmayincreaseinsizeduringpregnancyorafterestrogenadministration.However,mosthemangiomasinadultsdonotchangeinsizeorappearance.編輯ppt

Pathologically,hemangiomaiscomposedofmanyvascularchannelsofdifferentsizessupportedbyfibroussepta.Thevascularspacesmaycontainthrombi.編輯pptRarely,colorfloworcalcificationisseenwithinthehemangioma.編輯ppt1.

athickechogenicrindorathinechogenicrim,wasseenin93%ofatypicalsolidhemangiomas.Thisfindingwasconsideredsuggestiveofhemangioma.Atypical2.

Atypicalhemangiomaswithhypoechoicareasmaycontainasingleechogenicseptumormultiplesepta.3.

targetpatternisrarelyseeninahemangioma.4.

internalcolorflowisrarelyseenwithinahemangioma.Whencolorflowisdetectedwithinalesionthathasthegray-scaleappearanceofahemangioma,furtherevaluationisindicated.編輯pptUnlikehyperechoicmetastasisorhyperechoicHCC,arecompressedduringexamination,theymaybecomelessechogenic編輯ppt1.

Hemangiomasmayincreaseinsizeduringpregnancyorafterestrogenadministration.However,mosthemangiomasinadultsdonotchangeinsizeorappearance.2.

Whenlargerthan4cm,theyaretermedgianthemangiomas.編輯ppt編輯ppthemangiomaswithhypoechoicareasmaycontainechogenicseptum編輯pptAdenomas1.

Hepaticadenomaisararebenignlivertumor,mostcommonlyrelatedtooralcontraceptiveuseandthereforemostoftenseeninwomenofchildbearingageandinyoungmen.2.

AdenomasassociatedwithtypeIglycogenstoragediseasearemultipleinabout50%ofpatients..

編輯ppt

Becauseofthehighincidenceofhemorrhageorrupture,surgeryisrecommendedwheneverpossible.Adenomasmayundergomalignanttransformation.編輯ppt

Evidencedoessuggestthatthisdisordermaybehormone-dependent,becauseregressionofthelesionafterdiscontinuanceoforalcontraceptiveagentshasbeenreported.Adenomawithhemorrhage編輯pptHepaticadenoma(livercelladenomaorhepatocellularadenoma)isararebenignlivertumor,mostcommonlyrelatedtooralcontraceptiveuseandthereforemostoftenseeninwomenofchildbearingage.Anabolicsteroid-inducedhepaticadenomaisseenmorecommonlyinyoungmen.AdenomasassociatedwithtypeIglycogenstoragediseasearemultipleinabout50%ofpatients.編輯ppt

Adenoma編輯ppt

Focalnodularhyperplasiaabout75%ofpatientsareasymptomatic,andthemassisdiscoveredincidentally.

Hepatocytesappearnormal,buttheylackthenormalcordarrangement.Kupffercellsarepresent,andthefibrousseptacontainnumerousbileductulesandvessels.編輯ppt1.

radiatingperipherallyfromacentralvesselinastellateconfiguration,hasbeenreported.Inaseriesof269hepaticneoplasms,thispatternwasseenonlyinfocalnodularhyperplasia.Eventhoughsmallnumberofreportedcases,thiscolorflowpatternmaysuggestthediagnosisoffocalnodularhyperplasia.2.

Increaseduptakeoftheradiocolloid,technetium-99msulfurcolloid,maybeaspecificfeatureoffocalnodularhyperplasia.focalnodularhyperplasia編輯pptfocalnodularhyperplasia編輯ppt編輯pptHepaticlipomas編輯pptlipomaFocaldisplacementanddiscontinuityofthediaphragmdeeptothelipomamayoccurbecauseoftheslowerspeedofsoundinfatcomparedwiththenormalliverandrefractionoftheultrasoundbeamattheedgeofthemass編輯pptComputedtomographyishelpfultoconfirmthediagnosisoflipoma,bydemonstratinglowdensity(-20to-70HU)編輯pptHepaticlipomas編輯pptlipomasmayappearsimilartohemangiomasandhyperechoicmetastases,Hemangiomasmaycauseacousticenhancementandrarelycauseacousticshadowing.Hyperechoicmetastasesareofteninhomogeneous,arerarelysolitary,andcauseacousticshadowingonlywhencalcified.Moreover,hemangiomasandhyperechoicmetastasesdonotcauseartifactualdisplacementanddiscontinuityofthediaphragmdeeptothemass編輯pptAdenomawithfat編輯ppt編輯ppt21-64.Detoursignaroundametastaticlesion.thehepaticvein(largearrow)displacedaroundthemetastaticlesion編輯pptInfantilehemangioendothelioma編輯ppt1.

Infantilehemangioendothelioma,

althoughrare,isthemostcommonsymptomaticvascularlivertumorofinfancy.Morethan85%ofthetumorspresentbefore6monthsofage.Thefemale-to-maleratiois2:1.themostcommonclinicalpresentationishepatomegalywithorwithoutapalpablemass.

嬰兒肝血管內(nèi)皮瘤良性罕見(jiàn)病年齡小于6月；體征:肝腫大，右心衰貧血，血小板減少Theincidenceofcongestiveheartfailureinhemangioendotheliomaishighbecauseofarteriovenousshuntingwithinthemass,Complicationsincludeanemia,thrombocytopenia,andhemorrhage.Itisconsideredabenigntumor;however,rarelydistantmetastaseshavebeenreported.編輯pptTheymaybehyperechoic,hypoechoic,orofmixedechogenicity,andtheymaycontaincysticareasorcalcifications.編輯ppt錯(cuò)構(gòu)瘤MesenchymalhamartomaMalignanttransformationhasnotbeenreported.編輯ppt編輯ppt編輯pptHepatocellularcarcinoma編輯pptwhentheperipheralhypoechoicrimisthin(<3mm),describedasthehalosign,whenthehypoechoicrimisthick(>3mm),itisthetargetorbull-eyepattern.編輯ppt

Thehaloortargetpatternisnotspecific,butitismostoftenseeninmalignanttumors,mostcommonlymetastaticlesionsintheliver,ratherthanbenigntumors.Inastudyof100livertumors,thetargetpatternwasseenin88%ofmalignanttumorsandinonly14%ofbenigntumors.ItisalsooccasionallyseeninHCC.編輯pptth編輯ppt乳腺癌肝轉(zhuǎn)移有脂肪肝背景編輯ppt編輯ppt編輯ppt編輯ppt編輯ppt編輯ppt編輯ppt編輯ppt編輯ppt21-57A.Peripheralcholangiocarcinoma.編輯ppt21-57b.Peripheralcholangiocarcinoma.編輯ppt編輯ppt編輯ppt編輯pptThesonographicappearanceoflivermetastasesisvariable,andnodefiniteassociationexistsbetweenthehistologictypeofthetumorandthesonographicappearance.Tumorsofthesameprimaryoriginmayhavedifferentsonographicappearances.Becauseofthenonspecificappearanceofthemetastases,ultrasound-guidedbiopsyofthemassisfrequentlynecessaryforthediagnosis.Metastaticdisease編輯ppt編輯pptmetastasesfromcoloncarcinoma.編輯ppt

Metastases

frombreastcarcinoma編輯pptHyperechoicmetastases(arrows)fromcoloncarcinoma編輯pptTheisoechoicmetastaticlesioncanberecognizedonlybecauseofathin,hypoechoichalo(whitearrows)aroundthemass.編輯pptmetastaticmassfromcoloncarcinomacontainsacalcification編輯pptHyperechoicmetastases(arrows)fromaprimarygastriccarcinoma編輯ppt

Calcifiedmetastasisfrom

aprimarycoloncarcinoma.編輯pptCheleftlobeoftheliverfrommucinouscarcinomaofthecolon.編輯ppt21-62B.acysticmetastasis(arrow)fromovariancarcinoma.編輯pptGenerally,whentheperipheralhypoechoicrimisthin(<3mm),theappearancehasbeendescribedasthehalosign,whenthehypoechoicrimisthick(>3mm),itisthetargetorbull-eyepattern.Thehypoechoicperipheralrimiscausedbycompressednormalliverparenchymaaroundthetumoror,morelikely,byazoneofproliferatingtumorintheperipheryofthelesion..Inastudyof100livertumors,thetargetpatternwasseenin88%ofmalignanttumorsandinonly14%ofbenigntumors.ItisalsooccasionallyseeninHCC.thehalotargetorbull-eyepattern.

聲暈靶環(huán)或牛眼征編輯ppt21-63.Diffusemetastasesfromcarcinomaofthepancreas.編輯ppt21-64.Detoursignaroundametastaticlesion.:thehepaticvein(largearrow)displacedaroundthemetastaticlesion編輯ppt21-65Alymphomaoftheliver編輯pptPrimarylymphomaoftheliverisextremelyrare.Diffuselyinfiltrativeinvolvementofthelivercannotberecognizedsonographically.themostcommonpatternissecondarylymphoma,編輯pptsecondarylymphoma,Focalnodularlesionsintheliver,isofmultiplehypoechoicsolidlesions,frequentlywithanirregularmargin.Solitarylesionsarelesscommon.

Hyperechoiclesionandthetargetpatternseeareunusual,編輯pptNocauseisfoundforapproximately50%ofabscesses.Theabscessesmaybesolitaryormultiple,whensolitary,theyaremostfrequentlyseenintherightlobe.abscess編輯pptabscessAbscessesmayappearcysticwithanirregular,indistinctwall,awell-definedwall,or,lessfrequently,athickwall編輯ppt

Intheearlystage,abscessesmayappearhypoechoicandsolid(Fig.21-71),usuallywithdistalacousticenhancement;編輯ppt21-72gas-containingabscesses編輯ppt21-72A編輯pptAmebaabscesses編輯ppt21-73BAmebaabscesses編輯pptHydatidcystoftheliver編輯pptFattyliverresultsfromaccumulationoffatexceedingthenormal5%ofliverweight.Fattyliveriscausedbyincreasedaccumulationoftriglycerideswithinthehepatocytesandisareversiblecellularresponsetovariousdiseasestatesandalterationsinmetabolism.編輯pptIngrade1(mild),echogenicityisslightlyincreased,withnormalvisualizationofthediaphragmandtheintrahepaticvesselborders.Ingrade2(moderate),echogenicityismoderatelyincreased,withslightlyimpairedvisualizationofthediaphragmorintrahepaticvessels.Ingrade3(severe),echogenicityismarkedlyincreased,withpoorornovisualizationofthediaphragm,theintrahepaticvessels,andposteriorportionoftherightlobe.脂肪肝1度：回聲輕度增加，隔肌和肝內(nèi)血管界限可見(jiàn)。2度：回聲增加較多，編輯pptFattylivergrade2編輯pptFattylivergrade3編輯ppt編輯pptFattyliever編輯ppt編輯pptFattyliver編輯pptCoarseechopatternDiffuselyinhomogeneousechopatternIncreasedechogenicitySurfacenodularityVolumeredistributionEnlargedcaudatelobeandleftlobe/smallrightlobeCaudate:rightloberatio>0.65Rightlobe:leftloberatio<1.3LeftportalveindiameterrightportalveindiameterSignsofportalhypertension

TABLE21-14.SonographicSignsofCirrhosis編輯pptcirrhoiss編輯ppt編輯ppt編輯ppt編輯pptThefalciformligament(arrows)surroundedbyascitesisseenbetweentheanteriorabdominalwallandtheanteriorsurfaceoftheliver.dividingthemedialandlateralsegmentsoftheleftlobe.Openarrow,dilatedparaumbilicalveinwithintheligamentum編輯pptcirrhosisTo-and-froflowinthemainportalvein,anothersignofportalhypertension,isbestseenduringactivebreathing編輯pptcirrhosisThecausesofportalhypertensioncanbedividedintothreemajorgroups,accordingtothelevelofobstructionorincreasedresistancetotheportalvenousbloodflow:(1)prehepatic;(2)intrahepatic;and(3)posthepatic.編輯ppt編輯ppt21-17.SonographicSignsofPortalHypertension

門(mén)脈高壓超聲的表現(xiàn)Ascites腹水Splenomegaly脾大Portosystemicvenouscollaterals門(mén)脈側(cè)枝循環(huán)Hepatofugal(reversed)portalvenousflow門(mén)脈反向血流Portalveindiameter>13mm門(mén)脈大于13mmSplenicandsuperiormesentericveindiameter>10mmLackofnormalrespiratoryvariationsindiametersofsplenicandsuperiormesentericveins靜脈直徑不隨呼吸而變化

Coronaryveindiameter>5mm冠狀靜脈大于5mm

編輯pptInhealthypersons,thediameterofthesplenicandsuperiormesentericveinsincreases(about50%)ininspirationcomparedwiththediameterinexpiration.編輯pptA:Prehepaticportalhypertensioncanbecausedbyportalveinthrombosis,splenicveinthrombosis,splanchnicarteriovenousfistula,andsplenomegaly.B:Intrahepaticportalhypertensionbecausedbyalcoholiccirrhosis,schistosomiasis血吸蟲(chóng)病,hyperplasia,andidiopathic自發(fā)的portalhypertension.C:Posthepaticportalhypertensioncanbecausedbyinferiorvenacavaobstructionandcardiacdisease編輯ppt1.

Inhealthypersons,thediameterofthesplenicandsuperiormesentericveinsincreases(about50%)ininspirationcomparedwiththediameterinexpiration.Patientswithportalhypertensionlacknormaldiametervariation(<50%increaseduringdeepinspiration).Thelackofnormaldiametervariationhas