《肝胆疾病超声诊断PPT课件》由会员分享，可在线阅读，更多相关《肝胆疾病超声诊断PPT课件（171页珍藏版）》请在金锄头文库上搜索。
1、肝胆超声 1 2 3 4 5 6 7 8 Mirror imageatifact 9 Becausethesoundtravelsmoreslowlyinfluidthanintheliverparenchyma alargecystcandelaythepassageofsound causingthediaphragmtoappearfartherawaythanitis 10 11 12 13 14 15 16 17 18 CT alow densitylesion 19 drainageofHepaticabscess 20 Transabdominalandtranscervical
2、chorionicvillussampling CVS 21 22 Thecatheterisfollowedsonographicallythroughoutitscoursefromthecervixtoanappropriatepositionwithintheplacenta 23 24 25 26 27 28 RAI RPI RPS RAS 29 30 31 32 2 2 3 4 33 RHV Thenormalmeanvelocityinthemainportalveinisabout15to18cmpersecond butthenormalrangeiswide Thenorm
3、alportalveinflowisantegrade hepatopetal throughouttheentirecardiaccycle 34 35 fissurefortheligamentumvenosum arrows 36 sagittalviews Thefissurefortheligamentumvenosumseparatesthecaudatelobe C fromthelateralsegmentoftheleftlobe LL 37 38 39 40 41 42 1 alargeantegradesystolicwavecausedbythemovementofth
4、etricuspidannulustowardthecardiacapex 2 asmallretrogradeV wavecausedbyrightatrialoverfilling theV waveisusuallybelowthebaselinebutmaybeabovethebaseline 3 anantegradediastolicwavecausedbytheopeningofthetricuspidvalveandflowofthebloodfromtherightatriumtotherightventricle 4 aretrogradeA wavecausedbyrig
5、htatrialcontraction and 5 aretrogradeC wavecausedbytheclosureofthetricuspidvalveatthebeginningofsystole whichmaybeseeninafewpatients 43 1 Thenormalhepaticveinwaveformconsistsofwavesinthefollowingsequence 1 alargeantegradesystolicwavecausedbythemovementofthetricuspidannulustowardthecardiacapex 2 asma
6、llretrogradeV wavecausedbyrightatrialoverfilling theV waveisusuallybelowthebaselinebutmaybeabovethebaseline 3 anantegradediastolicwavecausedbytheopeningofthetricuspidvalveandflowofthebloodfromtherightatriumtotherightventricle 4 aretrogradeA wavecausedbyrightatrialcontraction and 5 aretrogradeC wavec
7、ausedbytheclosureofthetricuspidvalveatthebeginningofsystole whichmaybeseeninafewpatients 44 45 46 47 48 49 A 50 B 51 DEBRISCYST 52 1 Thecystsbecomeincreasinglycommonwithage andtheincidenceishigherafter40yearsofage reaching7 inpersonsover80yearsold Whenlargerthan4cm theyaretermedgianthemangiomas 53 5
8、4 Hemangiomasmayincreaseinsizeduringpregnancyorafterestrogenadministration However mosthemangiomasinadultsdonotchangeinsizeorappearance 55 Pathologically hemangiomaiscomposedofmanyvascularchannelsofdifferentsizessupportedbyfibroussepta Thevascularspacesmaycontainthrombi 56 Rarely colorfloworcalcific
9、ationisseenwithinthehemangioma 57 1 athickechogenicrindorathinechogenicrim wasseenin93 ofatypicalsolidhemangiomas Thisfindingwasconsideredsuggestiveofhemangioma Atypical2 Atypicalhemangiomaswithhypoechoicareasmaycontainasingleechogenicseptumormultiplesepta 3 targetpatternisrarelyseeninahemangioma 4
10、internalcolorflowisrarelyseenwithinahemangioma Whencolorflowisdetectedwithinalesionthathasthegray scaleappearanceofahemangioma furtherevaluationisindicated 58 UnlikehyperechoicmetastasisorhyperechoicHCC arecompressedduringexamination theymaybecomelessechogenic 59 1 Hemangiomasmayincreaseinsizeduring
11、pregnancyorafterestrogenadministration However mosthemangiomasinadultsdonotchangeinsizeorappearance 2 Whenlargerthan4cm theyaretermedgianthemangiomas 60 61 hemangiomaswithhypoechoicareasmaycontainechogenicseptum 62 Adenomas1 Hepaticadenomaisararebenignlivertumor mostcommonlyrelatedtooralcontraceptiv
12、euseandthereforemostoftenseeninwomenofchildbearingageandinyoungmen 2 AdenomasassociatedwithtypeIglycogenstoragediseasearemultipleinabout50 ofpatients 63 Becauseofthehighincidenceofhemorrhageorrupture surgeryisrecommendedwheneverpossible Adenomasmayundergomalignanttransformation 64 Evidencedoessugges
13、tthatthisdisordermaybehormone dependent becauseregressionofthelesionafterdiscontinuanceoforalcontraceptiveagentshasbeenreported Adenomawithhemorrhage 65 Hepaticadenoma livercelladenomaorhepatocellularadenoma isararebenignlivertumor mostcommonlyrelatedtooralcontraceptiveuseandthereforemostoftenseenin
14、womenofchildbearingage Anabolicsteroid inducedhepaticadenomaisseenmorecommonlyinyoungmen AdenomasassociatedwithtypeIglycogenstoragediseasearemultipleinabout50 ofpatients 66 Adenoma 67 Focalnodularhyperplasiaabout75 ofpatientsareasymptomatic andthemassisdiscoveredincidentally Hepatocytesappearnormal
15、buttheylackthenormalcordarrangement Kupffercellsarepresent andthefibrousseptacontainnumerousbileductulesandvessels 68 1 radiatingperipherallyfromacentralvesselinastellateconfiguration hasbeenreported Inaseriesof269hepaticneoplasms thispatternwasseenonlyinfocalnodularhyperplasia Eventhoughsmallnumber
16、ofreportedcases thiscolorflowpatternmaysuggestthediagnosisoffocalnodularhyperplasia 2 Increaseduptakeoftheradiocolloid technetium 99msulfurcolloid maybeaspecificfeatureoffocalnodularhyperplasia focalnodularhyperplasia 69 focalnodularhyperplasia 70 71 Hepaticlipomas 72 lipomaFocaldisplacementanddiscontinuityofthediaphragmdeeptothelipomamayoccurbecauseoftheslowerspeedofsoundinfatcomparedwiththenormalliverandrefractionoftheultrasoundbeamattheedgeofthemass 73 Computedtomographyishelpfultoconfirmthed
