肝胆疾病超声诊断 ppt课件.ppt
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1、肝 胆 超 声,Mirror-image atifact,Because the sound travels more slowly in fluid than in the liver parenchyma, a large cyst can delay the passage of sound, causing the diaphragm to appear farther away than it is.,CT: a low-density lesion,drainage of Hepatic abscess,Transabdominal and transcervical chorio
2、nic villus sampling (CVS),The catheter is followed sonographically throughout its course from the cervix to an appropriate position within the placenta,RAI,RPI,RPS,RAS,2,2,3,4,RHV,The normal mean velocity in the main portal vein is about 15 to 18 cm per second, but the normal range is wide. The norm
3、al portal vein flow is antegrade( hepatopetal) throughout the entire cardiac cycle.,fissure for the ligamentum venosum (arrows),sagittal views: The fissure for the ligamentum venosumseparates the caudate lobe (C) from the lateral segment of the left lobe (LL).,.(1) a large antegrade systolic wave ca
4、used by the movement of the tricuspid annulus toward the cardiac apex; (2) a small retrograde V-wave caused by right atrial overfilling; the V-wave is usually below the baseline but may be above the baseline; (3) an antegrade diastolic wave caused by the opening of the tricuspid valve and flow of th
5、e blood from the right atrium to the right ventricle; (4) a retrograde A-wave caused by right atrial contraction; and (5) a retrograde C-wave caused by the closure of the tricuspid valve at the beginning of systole, which may be seen in a few patients,1. The normal hepatic vein waveform consists of
6、waves in the following sequence: (1) a large antegrade systolic wave caused by the movement of the tricuspid annulus toward the cardiac apex; (2) a small retrogradeV-wave caused by right atrial overfilling; the V-wave is usually below the baseline but may be above the baseline; (3) an antegrade dias
7、tolic wave caused by the opening of the tricuspid valve and flow of the blood from the right atrium to the right ventricle; (4) a retrograde A-wave caused by right atrial contraction; and (5) a retrograde C-wave caused by the closure of the tricuspid valve at the beginning of systole, which may be s
8、een in a few patients,A,B,DEBRIS CYST,1.The cysts become increasingly common with age, and the incidence is higher after 40 years of age, reaching 7% in persons over 80 years old. When larger than 4 cm, they are termed giant hemangiomas,Hemangiomas may increase in size during pregnancy or after estr
9、ogen administration. However, most hemangiomas in adults do not change in size or appearance.,Pathologically, hemangioma is composed of many vascular channels of different sizes supported by fibrous septa. The vascular spaces may contain thrombi.,Rarely, color flow or calcification is seen within th
10、e hemangioma.,1. a thick echogenic rind or a thin echogenic rim , was seen in 93% of atypical solid hemangiomas. This finding was considered suggestive of hemangioma. Atypical 2. Atypical hemangiomas with hypoechoic areas may contain a single echogenic septum or multiple septa . 3. target pattern is
11、 rarely seen in a hemangioma. 4. internal color flow is rarely seen within a hemangioma. When color flow is detected within a lesion that has the gray-scale appearance of a hemangioma, further evaluation is indicated.,Unlike hyperechoic metastasis or hyperechoic HCC, are compressed during examinatio
12、n , they may become less echogenic,1. Hemangiomas may increase in size during pregnancy or after estrogen administration. However, most hemangiomas in adults do not change in size or appearance. 2. When larger than 4 cm, they are termed giant hemangiomas.,hemangiomas with hypoechoic areas may contai
13、n echogenic septum,Adenomas 1. Hepatic adenoma is a rare benign liver tumor, most commonly related to oral contraceptive use and therefore most often seen in women of childbearing age and in young men. 2. Adenomas associated with type I glycogen storage disease are multiple in about 50% of patients,
14、Because of the high incidence of hemorrhage or rupture, surgery is recommended whenever possible. Adenomas may undergo malignant transformation.,Evidence does suggest that this disorder may be hormone-dependent, because regressionof the lesion after discontinuance of oral contraceptive agents has be
15、en reported.,Adenoma with hemorrhage,Hepatic adenoma (liver cell adenoma or hepatocellular adenoma) is a rare benign liver tumor, most commonly related to oral contraceptive use and therefore most often seen in women of childbearing age. Anabolic steroid-induced hepatic adenoma is seen more commonly
16、 in young men. Adenomas associated with type I glycogen storage disease are multiple in about 50% of patients.,Adenoma,Focal nodular hyperplasia about 75% of patients are asymptomatic, and the mass is discovered incidentally. Hepatocytes appear normal, but they lack the normal cord arrangement. Kupf
17、fer cells are present, and the fibrous septa contain numerous bile ductules and vessels.,1. radiating peripherally from a central vessel in a stellate configuration, has been reported. In a series of 269 hepatic neoplasms, this pattern was seen only in focal nodular hyperplasia. Even though small nu
18、mber of reported cases, this color flow pattern may suggest the diagnosis of focal nodular hyperplasia. 2. Increased uptake of the radiocolloid, technetium-99m sulfur colloid, may be a specific feature of focal nodular hyperplasia.,focal nodular hyperplasia,focal nodular hyperplasia,Hepatic lipomas,
19、lipoma Focal displacement and discontinuity of the diaphragm deep to the lipoma may occur because of the slower speed of sound in fat compared with the normal liver and refraction of the ultrasound beam at the edge of the mass,Computed tomography is helpful to confirm the diagnosis of lipoma, by dem
20、onstrating low density (-20 to -70 HU),Hepatic lipomas,lipomas may appear similar to hemangiomas and hyperechoic metastases, Hemangiomas may cause acoustic enhancement and rarely cause acoustic shadowing. Hyperechoic metastases are often inhomogeneous, are rarely solitary, and cause acoustic shadowi
21、ng only when calcified. Moreover, hemangiomas and hyperechoic metastases do not cause artifactual displacement and discontinuity of the diaphragm deep to the mass,Adenoma with fat,21-64. Detour sign around a metastatic lesion. the hepatic vein (large arrow) displaced around the metastatic lesion,Inf
22、antile hemangioendothelioma,1. Infantile hemangioendothelioma, although rare, is the most common symptomatic vascular liver tumor of infancy. More than 85% of the tumors present before 6 months of age. The female-to-male ratio is 2:1. the most common clinical presentation is hepatomegaly with or wit
23、hout a palpable mass.,婴儿肝血管内皮瘤 良性罕见病 年龄小于6月; 体征: 肝肿大,右心衰 贫血,血小板减少,The incidence of congestive heart failure in hemangioendothelioma is high because of arteriovenous shunting within the mass, Complications include anemia, thrombocytopenia, and hemorrhage. It is considered a benign tumor; however, rar
24、ely distant metastases have been reported.,They may be hyperechoic, hypoechoic, or of mixed echogenicity, and they may contain cystic areas or calcifications.,错构瘤,Mesenchymal hamartoma Malignant transformation has not been reported.,Hepatocellular carcinoma,when the peripheral hypoechoic rim is thin
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