肝脓肿与血肿课件.pptVIP

* * BENIGN FOCAL LIVER LESIONS Abscesses and Haematoma Clinical features of an abscess(脓肿) Patients present with fever, often accompanied by right upper quadrant (RUQ) pain and vomiting（呕吐）.Abnormal liver function tests (LFTs) and anaemia（贫血） can also be present. The clinical history helps the sonographer（超声医生） to establish the nature of the focal lesion and aetiology of the abscess. Abscesses of any type may be solitary or multiple. Because the ultrasound appearances of abscesses can be similar to those of necrotic（坏死的） tumours or haematoma（血肿）, the clinical picture is of particular importance to the sonographer. Ultrasound appearances Hepatic abscesses may display a variety of acoustic features. Their internal appearances vary considerably. In the very early stages there is a zone of infected, oedematous（水肿的） liver tissue which appears on ultrasound as a hypoechoic , solid focal lesion. As the infection develops, the liver tissue becomes necrotic（坏死的） and liquefaction takes place. The abscess may still appear full of homogeneous echoes from pus and can be mistaken for a solid lesion, but as it progresses,the fluid content may become apparent, usually with considerable debris（碎片） within it. Because they are fluid-filled, abscesses demonstrate posterior enhancement (Fig. 4.7A). (A) Early stages of a pyogenic abscess in a transplanted liver. The lesion looks quite solid, but note the posterior enhancement. The margins of an abscess are irregular and often ill-defined and frequently thickened. The inflammatory capsule of the abscess may demonstrate vascularity（多血管） on colour or power Doppler but this is not invariable and depends on equipment sensitivity and size of the lesion. Infection with gas-forming organisms may account for the presence of gas within some liver abscesses (Fig. 4.7B). The gas contained within this large abscess in the right lobe of the liver obscures the full extent of the lesion. (Large abscesses like this, which contain gas, may mimic the aco