腹腔积液良恶性表现与鉴别.ppt

腹腔腹腔积液良液良恶性表性表现与与鉴别No.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University腹腹腹腹No.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University腔腔腔腔积积积积液液液液的的的的良良良良恶恶恶恶性性性性表表表表 现现现现 与与与与 鉴鉴鉴鉴 别别别别一、概述No.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University腹腹腹腹No.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University腔腔腔腔积积积积液液液液的的的的良良良良恶恶恶恶性性性性表表表表 现现现现 与与与与 鉴鉴鉴鉴 别别别别定 义正常人体腹腔内约有正常人体腹腔内约有50ml液体，起润滑、肠曲间液体，起润滑、肠曲间及肠道蠕动作用。及肠道蠕动作用。任何病理状态下导致的腹腔液体量增加，超过任何病理状态下导致的腹腔液体量增加，超过200ml时称为腹腔积液，亦称腹水。时称为腹腔积液，亦称腹水。No.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University腹腹腹腹No.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University腔腔腔腔积积积积液液液液的的的的良良良良恶恶恶恶性性性性表表表表 现现现现 与与与与 鉴鉴鉴鉴 别别别别形成原因病因分类病因分类病病 种种肝源性腹水肝源性腹水硬化性肝病（乙、丙肝炎后肝硬化、自身免疫性肝炎）硬化性肝病（乙、丙肝炎后肝硬化、自身免疫性肝炎）非硬化性肝病（酒精性肝炎、肝细胞性肝癌、布非硬化性肝病（酒精性肝炎、肝细胞性肝癌、布-加综合加综合征、暴发性肝衰竭、门静脉血栓形成）征、暴发性肝衰竭、门静脉血栓形成）心源性腹水心源性腹水充血性心衰、缩窄性心包炎、原发性限制性心肌病、粘充血性心衰、缩窄性心包炎、原发性限制性心肌病、粘液水肿液水肿肾源性腹水肾源性腹水肾病综合征、尿毒症肾病综合征、尿毒症胆、胰源性腹胆、胰源性腹水水重症胰腺炎，胆道或上消化道穿孔重症胰腺炎，胆道或上消化道穿孔感染性腹水感染性腹水结核、胃肠道穿孔、自发性细菌性腹膜炎结核、胃肠道穿孔、自发性细菌性腹膜炎No.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University腹腹腹腹No.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University腔腔腔腔积积积积液液液液的的的的良良良良恶恶恶恶性性性性表表表表 现现现现 与与与与 鉴鉴鉴鉴 别别别别形成原因肿瘤性腹水肿瘤性腹水腹腔转移性肿瘤（胃、结肠、胰腺）腹腔转移性肿瘤（胃、结肠、胰腺）原发性肝癌、卵巢肿瘤、腹膜间皮瘤、恶性淋巴原发性肝癌、卵巢肿瘤、腹膜间皮瘤、恶性淋巴瘤等瘤等结缔组织病结缔组织病系统性红斑狼疮系统性红斑狼疮营养不良营养不良各种原因引起严重营养障碍各种原因引起严重营养障碍混合性混合性腹膜结核腹膜结核+肝硬化肝硬化酒精性肝病酒精性肝病+酒精性心肌病酒精性心肌病No.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University腹腹腹腹No.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University腔腔腔腔积积积积液液液液的的的的良良良良恶恶恶恶性性性性表表表表 现现现现 与与与与 鉴鉴鉴鉴 别别别别 腹水的形成是腹腔内液体的产生和吸收失去腹水的形成是腹腔内液体的产生和吸收失去动态平衡的结果，每种疾病腹水的形成机制是动态平衡的结果，每种疾病腹水的形成机制是几个因素联合或单独作用所致，分为全身性及几个因素联合或单独作用所致，分为全身性及局部性因素局部性因素。形成机制No.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University腹腹腹腹No.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University腔腔腔腔积积积积液液液液的的的的良良良良恶恶恶恶性性性性表表表表 现现现现 与与与与 鉴鉴鉴鉴 别别别别H2OH2OH2OH2OH2OH2OH2OH2OH2OH2OH2OH2OH2O毛细血管毛细血管毛细血管毛细血管血浆胶体渗透压降低血浆胶体渗透压降低钠、水潴留钠、水潴留淋巴流量增多、回流受阻淋巴流量增多、回流受阻血管通透性增加血管通透性增加H2OH2OH2OH2OH2OH2OH2O腹腹水水生生成成细胞细胞组织间液组织间液淋巴管淋巴管No.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University腹腹腹腹No.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University腔腔腔腔积积积积液液液液的的的的良良良良恶恶恶恶性性性性表表表表 现现现现 与与与与 鉴鉴鉴鉴 别别别别全身性因素全身性因素血浆胶体渗透压降低：常见于重度肝功能不全、中晚期肝血浆胶体渗透压降低：常见于重度肝功能不全、中晚期肝硬化硬化(蛋白合成减少蛋白合成减少)、营养缺乏、营养缺乏(蛋白摄入不足蛋白摄入不足)、肾病综合、肾病综合征与蛋白丢失性胃肠病等情况。征与蛋白丢失性胃肠病等情况。钠、水潴留：常见于心、肾功能不全及中晚期肝硬化伴继钠、水潴留：常见于心、肾功能不全及中晚期肝硬化伴继发性醛固酮增多症。发性醛固酮增多症。内分泌障碍：肝硬化或肝功能不全时，肝降解功能减退。内分泌障碍：肝硬化或肝功能不全时，肝降解功能减退。抗利尿激素与醛固酮等灭活功能降低致钠、水潴留。抗利尿激素与醛固酮等灭活功能降低致钠、水潴留。形成机制No.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University腹腹腹腹No.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University腔腔腔腔积积积积液液液液的的的的良良良良恶恶恶恶性性性性表表表表 现现现现 与与与与 鉴鉴鉴鉴 别别别别全身性因素全身性因素：甲状腺功能低下时：甲状腺功能低下时：TSH使浆膜腔中透明质酸酶分泌增加使浆膜腔中透明质酸酶分泌增加;黏多糖、黏蛋白在组织中堆积黏多糖、黏蛋白在组织中堆积;血管通透性增加血管通透性增加;局部淋巴回流减慢局部淋巴回流减慢;抗利尿激素分泌不当抗利尿激素分泌不当;心功能不全可加重腹水形成；心功能不全可加重腹水形成；低蛋白血症、贫血的影响。低蛋白血症、贫血的影响。形成机制No.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University腹腹腹腹No.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University腔腔腔腔积积积积液液液液的的的的良良良良恶恶恶恶性性性性表表表表 现现现现 与与与与 鉴鉴鉴鉴 别别别别局部性因素局部性因素液体静水压增高：肝硬化等导致门静脉及其毛细血管内压液体静水压增高：肝硬化等导致门静脉及其毛细血管内压力增高力增高，引起腹水。，引起腹水。淋巴流量增多、回流受阻：淋巴流量增多、回流受阻：肝硬化时窦压增高，淋巴液生长增加，引起淋巴液淤积。肝硬化时窦压增高，淋巴液生长增加，引起淋巴液淤积。腹膜后及纵隔肿瘤、丝虫病等所引起的胸导管或乳糜池阻腹膜后及纵隔肿瘤、丝虫病等所引起的胸导管或乳糜池阻塞，以及损伤性破裂、乳糜漏入腹腔形成乳糜性腹水。塞，以及损伤性破裂、乳糜漏入腹腔形成乳糜性腹水。形成机制No.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University腹腹腹腹No.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University腔腔腔腔积积积积液液液液的的的的良良良良恶恶恶恶性性性性表表表表 现现现现 与与与与 鉴鉴鉴鉴 别别别别局部性因素局部性因素腹膜血管通透性增加：腹膜的炎症、癌肿浸润或脏器穿腹膜血管通透性增加：腹膜的炎症、癌肿浸润或脏器穿孔，引起胆汁、胰液、胃液、血液的刺激，均可促使腹孔，引起胆汁、胰液、胃液、血液的刺激，均可促使腹膜的血管通透性增加引起腹水。膜的血管通透性增加引起腹水。腹腔内脏破裂：实质性或空腔脏器破裂与穿孔可分别引腹腔内脏破裂：实质性或空腔脏器破裂与穿孔可分别引起胰性腹水、胆汁性腹水、血性腹水及血腹。起胰性腹水、胆汁性腹水、血性腹水及血腹。形成机制No.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University腹腹腹腹No.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University腔腔腔腔积积积积液液液液的的的的良良良良恶恶恶恶性性性性表表表表 现现现现 与与与与 鉴鉴鉴鉴 别别别别二、基本影像学表现 B超超 MRI CTNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University腹腹腹腹No.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University腔腔腔腔积积积积液液液液的的的的良良良良恶恶恶恶性性性性表表表表 现现现现 与与与与 鉴鉴鉴鉴 别别别别B超表现表现为腹腔内液性无回声区表现为腹腔内液性无回声区No.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University腹腹腹腹No.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University腔腔腔腔积积积积液液液液的的的的良良良良恶恶恶恶性性性性表表表表 现现现现 与与与与 鉴鉴鉴鉴 别别别别肝周积液肝周积液No.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University腹腹腹腹No.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University腔腔腔腔积积积积液液液液的的的的良良良良恶恶恶恶性性性性表表表表 现现现现 与与与与 鉴鉴鉴鉴 别别别别左前斜卧位反麦氏点积液左前斜卧位反麦氏点积液No.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University腹腹腹腹No.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University腔腔腔腔积积积积液液液液的的的的良良良良恶恶恶恶性性性性表表表表 现现现现 与与与与 鉴鉴鉴鉴 别别别别CT表现腹腔内液性低密度影，腹腔内液性低密度影，CT值约值约10-30Hu。No.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University腹腹腹腹No.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University腔腔腔腔积积积积液液液液的的的的良良良良恶恶恶恶性性性性表表表表 现现现现 与与与与 鉴鉴鉴鉴 别别别别MRI表现长长T1长长T2信号。信号。No.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University腹腹腹腹No.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University腔腔腔腔积积积积液液液液的的的的良良良良恶恶恶恶性性性性表表表表 现现现现 与与与与 鉴鉴鉴鉴 别别别别三、良恶性腹水的鉴别No.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University腹腹腹腹No.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University腔腔腔腔积积积积液液液液的的的的良良良良恶恶恶恶性性性性表表表表 现现现现 与与与与 鉴鉴鉴鉴 别别别别（一）一）良性良性一般为漏出液，蛋白少，一般为漏出液，蛋白少，CT值多小于值多小于20HU。若合并腹膜增厚，一般为均匀光滑增厚。若合并腹膜增厚，一般为均匀光滑增厚。肠系膜及大网膜一般为污迹样改变，也可呈饼肠系膜及大网膜一般为污迹样改变，也可呈饼状增厚。状增厚。肠管呈漂浮现象。肠管呈漂浮现象。腹水一般局限在大网膜囊内。腹水一般局限在大网膜囊内。No.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University腹腹腹腹No.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University腔腔腔腔积积积积液液液液的的的的良良良良恶恶恶恶性性性性表表表表 现现现现 与与与与 鉴鉴鉴鉴 别别别别良性腹水包含的病种结核性腹膜炎结核性腹膜炎急性胰腺炎急性胰腺炎肝硬化肝硬化甲状腺功能减低甲状腺功能减低心源性心源性布布-加综合征加综合征No.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University腹腹腹腹No.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University腔腔腔腔积积积积液液液液的的的的良良良良恶恶恶恶性性性性表表表表 现现现现 与与与与 鉴鉴鉴鉴 别别别别病例 1男性患者，男性患者，18岁，岁，MSCT示肋腹部壁腹膜光滑增厚，同时腹腔内大量积示肋腹部壁腹膜光滑增厚，同时腹腔内大量积液，液，CT值约值约12Hu，随访诊断为结核性腹膜炎，随访诊断为结核性腹膜炎No.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University腹腹腹腹No.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University腔腔腔腔积积积积液液液液的的的的良良良良恶恶恶恶性性性性表表表表 现现现现 与与与与 鉴鉴鉴鉴 别别别别病例 2男性患者，男性患者，52岁，腹盆腔大量积液，腹膜均匀性增厚，岁，腹盆腔大量积液，腹膜均匀性增厚，局部大网膜呈饼状改变，随访诊断为结核性腹膜炎局部大网膜呈饼状改变，随访诊断为结核性腹膜炎No.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University腹腹腹腹No.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University腔腔腔腔积积积积液液液液的的的的良良良良恶恶恶恶性性性性表表表表 现现现现 与与与与 鉴鉴鉴鉴 别别别别病例 3患者，女，腹盆腔积液，患者，女，腹盆腔积液，患者，女，腹盆腔积液，患者，女，腹盆腔积液，大网膜增厚，术中探查，大网膜增厚，术中探查，大网膜增厚，术中探查，大网膜增厚，术中探查，阑尾穿孔，其内可见粪阑尾穿孔，其内可见粪阑尾穿孔，其内可见粪阑尾穿孔，其内可见粪石。石。石。石。asciteNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University腹腹腹腹No.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University腔腔腔腔积积积积液液液液的的的的良良良良恶恶恶恶性性性性表表表表 现现现现 与与与与 鉴鉴鉴鉴 别别别别急性胰腺炎急性胰腺炎 胰腺胰腺形态饱满，其周形态饱满，其周可见多发渗出影，可见多发渗出影，双侧肾周筋膜增双侧肾周筋膜增厚，腹腔内积液厚，腹腔内积液影影病例 4No.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University腹腹腹腹No.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University腔腔腔腔积积积积液液液液的的的的良良良良恶恶恶恶性性性性表表表表 现现现现 与与与与 鉴鉴鉴鉴 别别别别病例5患者患者 男男 4444岁岁 肝硬化，门脉高压，胃底食管静脉曲张（侧枝循环）肝硬化，门脉高压，胃底食管静脉曲张（侧枝循环），腹水，脾大，肠壁水肿增厚。，腹水，脾大，肠壁水肿增厚。No.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University腹腹腹腹No.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University腔腔腔腔积积积积液液液液的的的的良良良良恶恶恶恶性性性性表表表表 现现现现 与与与与 鉴鉴鉴鉴 别别别别病例6患者患者 女女 43 43岁岁 肝硬化，门脉高压，腹水，脾大，胆囊结石。肝硬化，门脉高压，腹水，脾大，胆囊结石。No.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University腹腹腹腹No.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University腔腔腔腔积积积积液液液液的的的的良良良良恶恶恶恶性性性性表表表表 现现现现 与与与与 鉴鉴鉴鉴 别别别别病例 7患者患者患者患者 男男男男 左心功能左心功能左心功能左心功能不全不全不全不全 心脏明显增大，心脏明显增大，心脏明显增大，心脏明显增大，左房为著，腹腔内左房为著，腹腔内左房为著，腹腔内左房为著，腹腔内大量积液，腹壁可大量积液，腹壁可大量积液，腹壁可大量积液，腹壁可见皮下水肿见皮下水肿见皮下水肿见皮下水肿 No.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University腹腹腹腹No.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University腔腔腔腔积积积积液液液液的的的的良良良良恶恶恶恶性性性性表表表表 现现现现 与与与与 鉴鉴鉴鉴 别别别别病例8患者患者 男男 布布-加综合征加综合征 44 44 下腔静脉肝段明显变细，肝静脉显影不清，下腔静脉肝段明显变细，肝静脉显影不清，肝脏不均质强化，腹腔积液肝脏不均质强化，腹腔积液No.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University腹腹腹腹No.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University腔腔腔腔积积积积液液液液的的的的良良良良恶恶恶恶性性性性表表表表 现现现现 与与与与 鉴鉴鉴鉴 别别别别（二）恶性恶性腹水一般为渗出液，含蛋白较多，恶性腹水一般为渗出液，含蛋白较多，CT值多大值多大于于20HU。腹膜常为结节状或不规则增厚。腹膜常为结节状或不规则增厚。肠系膜及大网膜呈饼状增厚。肠系膜及大网膜呈饼状增厚。肠管呈聚集现象。肠管呈聚集现象。腹水位于大、小网膜囊内。腹水位于大、小网膜囊内。No.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University腹腹腹腹No.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University腔腔腔腔积积积积液液液液的的的的良良良良恶恶恶恶性性性性表表表表 现现现现 与与与与 鉴鉴鉴鉴 别别别别间皮瘤间皮瘤病例病例1 恶性间皮瘤是腹膜原发性恶性间皮瘤是腹膜原发性恶性肿瘤可以使腹膜板层样或结恶性肿瘤可以使腹膜板层样或结节样增厚，伴腹水，肿瘤可有明节样增厚，伴腹水，肿瘤可有明显强化。显强化。No.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University腹腹腹腹No.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University腔腔腔腔积积积积液液液液的的的的良良良良恶恶恶恶性性性性表表表表 现现现现 与与与与 鉴鉴鉴鉴 别别别别病例病例2 腹腔假性粘液瘤腹腔假性粘液瘤 肝脏表面扇贝状压迹为较有特征的表现，该肝脏表面扇贝状压迹为较有特征的表现，该例脾脏基本全部被吞噬，左侧腹腔钙化灶钙化的形成与其粘液中含有例脾脏基本全部被吞噬，左侧腹腔钙化灶钙化的形成与其粘液中含有类似软骨内的粘多糖样物质有关。类似软骨内的粘多糖样物质有关。No.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University腹腹腹腹No.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University腔腔腔腔积积积积液液液液的的的的良良良良恶恶恶恶性性性性表表表表 现现现现 与与与与 鉴鉴鉴鉴 别别别别病例病例3：患者男性，：患者男性，47岁，大网岁，大网膜呈饼状增厚，大量腹盆腔积液，膜呈饼状增厚，大量腹盆腔积液，CT值约值约13Hu，重建图像可见肠，重建图像可见肠管向右侧积聚，病理证实为胃癌管向右侧积聚，病理证实为胃癌腹膜转移。腹膜转移。No.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University腹腹腹腹No.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University腔腔腔腔积积积积液液液液的的的的良良良良恶恶恶恶性性性性表表表表 现现现现 与与与与 鉴鉴鉴鉴 别别别别病例病例病例病例4 4 4 4：患者男性，：患者男性，：患者男性，：患者男性，78787878岁，腹盆腔内岁，腹盆腔内岁，腹盆腔内岁，腹盆腔内可见大量积液，可见大量积液，可见大量积液，可见大量积液，CTCTCTCT值约值约值约值约10Hu10Hu10Hu10Hu，大网膜，大网膜，大网膜，大网膜呈饼状增厚，病理证实为胃癌腹膜转呈饼状增厚，病理证实为胃癌腹膜转呈饼状增厚，病理证实为胃癌腹膜转呈饼状增厚，病理证实为胃癌腹膜转移。移。移。移。No.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University腹腹腹腹No.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University腔腔腔腔积积积积液液液液的的的的良良良良恶恶恶恶性性性性表表表表 现现现现 与与与与 鉴鉴鉴鉴 别别别别结肠癌结肠癌 病例病例病例病例5 5 患者患者患者患者 女女女女 7474岁岁岁岁 结肠癌伴腹结肠癌伴腹结肠癌伴腹结肠癌伴腹膜转移膜转移膜转移膜转移 右侧升结肠管壁局限性增右侧升结肠管壁局限性增右侧升结肠管壁局限性增右侧升结肠管壁局限性增厚，邻近腹膜及肠系膜增厚，腹厚，邻近腹膜及肠系膜增厚，腹厚，邻近腹膜及肠系膜增厚，腹厚，邻近腹膜及肠系膜增厚，腹盆腔内大量液性密度影。盆腔内大量液性密度影。盆腔内大量液性密度影。盆腔内大量液性密度影。No.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University腹腹腹腹No.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University腔腔腔腔积积积积液液液液的的的的良良良良恶恶恶恶性性性性表表表表 现现现现 与与与与 鉴鉴鉴鉴 别别别别病例病例6 6 浆液性囊腺癌浆液性囊腺癌 女，女，5252岁，岁，CA-125CA-125明显升高，腹水检出腺癌细胞。明显升高，腹水检出腺癌细胞。CTCT示肝脏右缘前方腹膜不规则增厚；腹腔内强化结节影，左侧附件区囊示肝脏右缘前方腹膜不规则增厚；腹腔内强化结节影，左侧附件区囊实性肿块影，大量腹水。实性肿块影，大量腹水。No.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical University腹腹腹腹No.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi medical UniversityNo.1 hospital of Shanxi med