腹腔积液良恶性表现与鉴别课件.ppt

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 别别别别图图木舒克市人民医院木舒克市人民医院木舒克市人民医院木舒克市人民医院 医学影像科医学影像科医学影像科医学影像科 杨杨友信友信友信友信 副主任医副主任医副主任医副主任医师师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 义正常人体腹腔内正常人体腹腔内约有有50ml50ml液体，起液体，起润滑、滑、肠曲曲间及及肠道蠕道蠕动作用。作用。任何病理状任何病理状态下下导致的腹腔液体量增加，超致的腹腔液体量增加，超过200ml200ml时称称为腹腔腹腔积液，亦称腹水。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、肝非硬化性肝病（酒精性肝炎、肝细胞性肝癌、布胞性肝癌、布-加加综合合征、暴征、暴发性肝衰竭、性肝衰竭、门静脉血栓形成）静脉血栓形成）心源性腹水心源性腹水充血性心衰、充血性心衰、缩窄性心包炎、原窄性心包炎、原发性限制性心肌病、粘性限制性心肌病、粘液水液水肿肾源性腹水源性腹水肾病病综合征、尿毒症合征、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、胃核、胃肠道穿孔、自道穿孔、自发性性细菌性腹膜炎菌性腹膜炎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瘤性腹水腹腔腹腔转移性移性肿瘤（胃、瘤（胃、结肠、胰腺）、胰腺）原原发性肝癌、卵巢性肝癌、卵巢肿瘤、腹膜瘤、腹膜间皮瘤、皮瘤、恶性淋巴性淋巴瘤等瘤等结缔组织病病系系统性性红斑狼斑狼疮营养不良养不良各种原因引起各种原因引起严重重营养障碍养障碍混合性混合性腹膜腹膜结核核+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腹水的形成是腹腔内液体的产生和吸收生和吸收失去失去动态平衡的平衡的结果，每种疾病腹水的形成机果，每种疾病腹水的形成机制是几个因素制是几个因素联合或合或单独作用所致，分独作用所致，分为全身全身性及局部性因素性及局部性因素。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毛毛细血管血管毛毛细血管血管血血浆胶体渗透胶体渗透压降低降低钠、水潴留、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胞组织间液液淋巴管淋巴管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血浆胶体渗透胶体渗透压降低：常降低：常见于重度肝功能不全、中晚期肝于重度肝功能不全、中晚期肝硬化硬化(蛋白合成减少蛋白合成减少)、营养缺乏养缺乏(蛋白蛋白摄入不足入不足)、肾病病综合征与蛋白合征与蛋白丢失性胃失性胃肠病等情况。病等情况。钠、水潴留：常、水潴留：常见于心、于心、肾功能不全及中晚期肝硬化伴功能不全及中晚期肝硬化伴继发性性醛固固酮增多症。增多症。内分泌障碍：肝硬化或肝功能不全内分泌障碍：肝硬化或肝功能不全时，肝降解功能减退。，肝降解功能减退。抗利尿激素与抗利尿激素与醛固固酮等等灭活功能降低致活功能降低致钠、水潴留。、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：甲状腺功能低下甲状腺功能低下时：TSHTSH使使浆膜腔中透明膜腔中透明质酸酸酶分泌增加分泌增加;黏多糖、黏蛋白在黏多糖、黏蛋白在组织中堆中堆积;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、低蛋白血症、贫血的影响。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液体静水压增高：肝硬化等增高：肝硬化等导致致门静脉及其毛静脉及其毛细血管内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：肝硬化肝硬化时窦压增高，淋巴液生增高，淋巴液生长增加，引起淋巴液淤增加，引起淋巴液淤积。腹膜后及腹膜后及纵隔隔肿瘤、瘤、丝虫病等所引起的胸虫病等所引起的胸导管或乳糜池阻管或乳糜池阻塞，以及塞，以及损伤性破裂、乳糜漏入腹腔形成乳糜性腹水。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、癌腹膜血管通透性增加：腹膜的炎症、癌肿浸浸润或或脏器穿器穿孔，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。腹腔内腹腔内脏破裂：破裂：实质性或空腔性或空腔脏器破裂与穿孔可分器破裂与穿孔可分别引引起胰性腹水、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 B超超 MRI MRI CTCTNo.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超表现表表现为腹腔内液性无回声区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 别别别别肝周肝周积液液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左前斜卧位反麦氏点积液液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，CTCT值约10-30Hu10-30Hu。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T1T1长T2T2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）良性良性一般一般为漏出液，蛋白少，漏出液，蛋白少，CTCT值多小于多小于20HU20HU。若合并腹膜增厚，一般若合并腹膜增厚，一般为均匀光滑增厚。均匀光滑增厚。肠系膜及大网膜一般系膜及大网膜一般为污迹迹样改改变，也可呈，也可呈饼状增厚。状增厚。肠管呈漂浮管呈漂浮现象。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-加加综合征合征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，1818岁，MSCTMSCT示肋腹部壁腹膜光滑增厚，同示肋腹部壁腹膜光滑增厚，同时腹腔内大量腹腔内大量积液，液，CTCT值约12Hu12Hu，随，随访诊断断为结核性腹膜炎核性腹膜炎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，5252岁，腹盆腔大量，腹盆腔大量积液，腹膜均匀性增厚，液，腹膜均匀性增厚，局部大网膜呈局部大网膜呈饼状改状改变，随，随访诊断断为结核性腹膜炎核性腹膜炎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，腹盆腔患者，女，腹盆腔患者，女，腹盆腔患者，女，腹盆腔积积液，液，液，液，大网膜增厚，大网膜增厚，大网膜增厚，大网膜增厚，术术中探中探中探中探查查，阑阑尾穿孔，其内可尾穿孔，其内可尾穿孔，其内可尾穿孔，其内可见粪见粪石。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 胰腺胰腺形形态饱满，其周，其周可可见多多发渗出影，渗出影，双双侧肾周筋膜增周筋膜增厚，腹腔内厚，腹腔内积液液影影病例 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 肝硬化，肝硬化，门脉高脉高压，胃底食管静脉曲，胃底食管静脉曲张（侧枝循枝循环），），腹水，脾大，腹水，脾大，肠壁水壁水肿增厚。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 肝硬化，肝硬化，门脉高脉高压，腹水，脾大，胆囊，腹水，脾大，胆囊结石。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 左心功能不左心功能不左心功能不左心功能不全全全全 心心心心脏脏明明明明显显增大，增大，增大，增大，左房左房左房左房为为著，腹腔内著，腹腔内著，腹腔内著，腹腔内大量大量大量大量积积液，腹壁可液，腹壁可液，腹壁可液，腹壁可见见皮下水皮下水皮下水皮下水肿肿 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-加加综合征合征 44 44 下腔静脉肝段明下腔静脉肝段明显变细，肝静脉，肝静脉显影不清，影不清，肝肝脏不均不均质强化，腹腔化，腹腔积液液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THANK YOUSUCCESS2024/2/25 周日29.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）恶性恶性腹水一般性腹水一般为渗出液，含蛋白渗出液，含蛋白较多，多，CTCT值多大多大于于20HU20HU。腹膜常腹膜常为结节状或不状或不规则增厚。增厚。肠系膜及大网膜呈系膜及大网膜呈饼状增厚。状增厚。肠管呈聚集管呈聚集现象。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 别别别别间皮瘤皮瘤病例病例1 1 恶性性间皮瘤是腹膜原皮瘤是腹膜原发性性恶性性肿瘤可以使腹膜板瘤可以使腹膜板层样或或结节样增厚，伴腹水，增厚，伴腹水，肿瘤可有瘤可有明明显强化。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 2 腹腔假性粘液瘤腹腔假性粘液瘤 肝肝脏表面扇表面扇贝状状压迹迹为较有特征的表有特征的表现，该例脾例脾脏基本全部被吞噬，左基本全部被吞噬，左侧腹腔腹腔钙化灶化灶钙化的形成与其粘液中含化的形成与其粘液中含有有类似似软骨内的粘多糖骨内的粘多糖样物物质有关。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 3：患者男性，：患者男性，4747岁，大网，大网膜呈膜呈饼状增厚，大量腹盆腔状增厚，大量腹盆腔积液，液，CTCT值约13Hu13Hu，重建，重建图像可像可见肠管管向右向右侧积聚，病理聚，病理证实为胃癌腹胃癌腹膜膜转移。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岁岁，腹盆腔内，腹盆腔内，腹盆腔内，腹盆腔内可可可可见见大量大量大量大量积积液，液，液，液，CTCTCTCT值约值约10Hu10Hu10Hu10Hu，大网膜，大网膜，大网膜，大网膜呈呈呈呈饼饼状增厚，病理状增厚，病理状增厚，病理状增厚，病理证实为证实为胃癌腹膜胃癌腹膜胃癌腹膜胃癌腹膜转转移。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 别别别别结肠癌癌 病例病例病例病例5 5 5 5 患者患者患者患者 女女女女 74747474岁岁 结肠结肠癌伴腹癌伴腹癌伴腹癌伴腹膜膜膜膜转转移移移移 右右右右侧侧升升升升结肠结肠管壁局限性增管壁局限性增管壁局限性增管壁局限性增厚，厚，厚，厚，邻邻近腹膜及近腹膜及近腹膜及近腹膜及肠肠系膜增厚，腹系膜增厚，腹系膜增厚，腹系膜增厚，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