小肠梗阻CT表现幻灯片.pptVIP

A Pattern Approach to the Abnormal Small Bowel: Observations at MDCT and CT Enterography（2） 胡娟 2011-8- 4 早读片 Key points： The pattern of enhancement； The length of involvement； The degree of thickening； Whether the thickening is symmetric or asymmetric； location of the lesion along the course of the small bowel (proximal or distal)； Location of the lesion in the wall of the small bowel (mucosal, submucosal, or serosal )； Associated abnormalities in the mesentery and vessels. Length of Involvement Pathologic conditions tend to cause Focal involvement(≤ 5 cm), Segmental involvement(6–40 cm), Diffuse involvement ( 40 cm). Focal Involvement Neoplasms -Metastasis, adenocarcinoma, and GIST. Others: -endometriosis, small-bowel diverticulitis, foreign-body perforations, small-bowel ulcers from the use of nonsteroidal antiinflammatory drugs, and, occasionally, granulomatous processes such as tuberculosis and Crohn’s disease Segmental Involvement ■ Intramural hemorrhage ■ Crohn’s disease ■ Lymphoma ■ Infectious enteritis ■ Occasionally, intestinal ischemia particularly when the cause is SMA embolus or SMV thrombosis Diffuse Involvement ■Hypoalbuminemia ■ Low-flow intestinal ischemia ■ Proximal SMA embolus ■ Vasculitis ■ Angioedema ■ Graft-versus-host disease ■ Infectious enteritis Degree of Thickening When the normal small bowel is distended, the wall measures no greater than 2 mm. Mural thickening can be stratified into three categories: mild (3–4 mm), moderate (5–9 mm), marked (≥ 10 mm). Mild Thickening ■ Hypoalbuminemia, ■ Infectious enteritis, ■ Occasionally in patients with ischemia due to lack of arterial inflow or mild Crohn’s disease Moderate Thickening ■ Crohn’s disease, intestinal ischemia, intramural hemorrhage, angioedema, and vasculitis ■ Some neoplastic processes such as low-T-stage adenocarcinoma and some lymphomas can also show moderate thickening Marked Thickening ■ Lymphoma ■ Other neoplasms, vasculitis, Crohn’s disease, and intramural h