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1、Abdominal Tuberculosis 腹部结核病Zhou Liu Cancer Hospital Chinese Academy of Medical Sciences, Shenzhen centerGeneral consideration Can affect any organ in the abdomen Importance of clinical context in diagnosisHigh-risk population：immunocompromised patients, especially AIDS（免疫抑制的病人）Typical symptoms: suc
2、h as diarrhea, fever etc（腹泻、发热等）Laboratory findings（实验室检查）：serum and culture（血清和培养）Histologic analysis（组织学检查） Radiological findings might mimic many different diseaseInflammatory disease：Crohns diseaseNeoplastic disease: Lymphomatosis, Peritoneal carcinomatosisClassification Gastrointestinal tubercu
3、losis（胃肠道结核） Tuberculous lymphadenopathy（结核性淋巴结炎） Tuberculous peritonitis （结核性腹膜炎） Solid organ involvement （实性器官累及）Hepatic and splenic TBPancreatic TBDifferent pathwaysModes of involvement in abdominal tuberculosisBy ingestion（吞咽）Infected food or milk- Primary intestinal tuberculosis（原发性肠结核）Infected
4、 sputum（痰）-Secondary intestinal tuberculosis（继发性肠结核）Hematogenous spread from distant tubercular focus（血性播散）Contagious spread from infected adjacent foci（邻近累及）Through lymphatic channel（淋巴扩散）Pathophysiology of Gastrointestinal TB （胃肠道TB的病理生理学） BacteriaMucosa 粘膜Submucos a 粘膜下层Epithelioid tubercles 表皮样结
5、节Ulceration 溃疡Granuloma formation 肉芽肿形成Caseous necrosis 干酪性坏死Cicatrization 瘢痕形成Sloughing 脱落Surrounding mucosa thickening 邻近粘膜增厚Lymph nodes 淋巴结Peritoneum 腹膜Circulation liver肝 pancreas胰 spleen脾Spreading Complications of intestinal tuberculosisBowel obstruction（肠梗阻）Perforation（穿孔）Abscess formation（脓肿形成
6、）Fistula（瘘道形成）Intussusception（肠套叠）Bowel wall ischemia（肠壁缺血）1 ileocecal junction( 90%)23456Fixed and narrowed ileum（回肠 固定及变窄）; Conical and shrunken cecum（锥 形和萎缩的盲肠）mimic Crohns diseaseUniform and concentric thickening of terminal ileum wall （回肠末端肠壁向心性均匀增厚）ileocecal tuberculosis 回盲部结核 Mild wall thicke
7、ning of the cecum（盲肠壁轻 度增厚） Pericecal lymph nodes（盲肠周围淋巴结）ileocecal tuberculosis 回盲部结核 Circumferential thickening of the cecum and terminal ileum（盲肠和末端回肠壁环形增厚 ） Adjacent lymph nodes（邻近淋巴结）ProgressingDifferentiating imaging featuresTuberculosisCrohns diseaseAsymmetric, irregular wall thickeningCircum
8、ferential bowel wall thickeningFleischner sign on barium studiesCobblestone appearance on bariumNo creeping fat Creeping fat (abnormal quantity of mesenteric fatPositive chest film (50%)Negative chest filmOmental and peritoneal thickeningNormal omentum and peritoneumEnlarged lymph nodes with low-den
9、stity centersEnlarged soft-tissue density lymph nodesColonic tuberculosis (A) Two strictures in descending and transverse colon (B) Marked infiltration and asymmetrical thickening of the ascending colon and mesenteric enlarged lymph nodeTuberculosis of the ileum Symmetric mural thickning ileum (arro
10、ws) and adjacent enlarged lymph nodeTuberculous lymphadenopathyMultiple enlarged lymph nodes Hypodense centers and peripheral enhancement 低密度中心伴有周围强化 Conglomerate lymph nodes 淋巴结融合Caseation and liquefaction substances at the center （中心 干酪样和液化坏死） Peripheral inflammatory lymphatic tissue（周围炎性组织）Multip
11、le enlarged lymph nodes Rim enhancement and Necross inside （环形强化和内部坏死） Calcification（钙化） Large psoas abscess（腰大肌脓肿）Tuberculous peritonitis 结核性腹膜炎Wet type 90%Fibrotic-fixed type7%High density Large volume of ascites Protein and cellular content Small volume of ascites Fixed bowel loops Omental masses
12、 Dry type3%Dense peritoneal adhesions Fibrous peritoneal reaction Caseous nodulesThickening, enhancement, and nodularity of peritoneum 腹膜增厚、强化、结节状 ileocolic adenopathy 回盲部淋巴结 Mesentery involvement: most common Omental involvement: nodular, smudged Peritoneal involvement: smooth, tiny nodules Ascites
13、: 30-100% of cases &multiple stands of fibrin and debris（纤维素或碎片）& septa（分隔）Wet type 湿型Ascites: septa （分隔）Peritoneum: smooth thickening & enhancement（光滑增厚&强化）Fibrous type 纤维型Omentum&peritoneum: thickening （增厚）Bowel loops: conglomerate（聚拢）Dry type 干型Sclerosing encapsulating peritonitis (abdominal coco
14、on) “茧” Clustering of small bowel loops in the center of abdomen 腹部中央肠袢聚拢Signs assisting in guiding diagnosis of tuberculous peritonitisPresence of mesenteric macronodulesEnhancement and regular thickening of the parietal peritoneumSplenomegaly and calcification of the spleenInvolvement of the ileoc
15、ecal wallRetroperitoneal and peri-pancreatic lymphadenopathy with a hypodense center and ring-enhancementAsciteslymph nodes: mesenteric& retroperitonealNecrosis inside and ring-like enhancement Omentum: Thickening Peritoneum: Enhancement & Regular thickening Hepatic, Splenic and pancreatic TB 肝、脾、胰腺
16、结核 Usually in a fine miliary pattern（粟粒样）, below the resolving capacity of CT Most common presentation: non-specific hepatosplenomegaly（肝脾肿大） Occasionally, tiny scattering low-density foci（微小低密度灶） Rarely, macronodular form（大结节）：pseudotumor or tuberculoma（假瘤或结核球）1-3cm or a single tumor-like massMiliary hepatic TB 粟粒型Enlarged liver 肝大 Heterogeneous parenchyma 密度不均 Multiple hypoenhancing nodules in the spleen 伴有脾脏多发小结节，低强化Tiny hypovascular no
