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1、General consideration,Can affect any organ in the abdomen Importance of clinical context in diagnosis High-risk population：immunocompromised patients, especially AIDS（免疫抑制的病人） Typical symptoms: such as diarrhea, fever etc（腹泻、发热等） Laboratory findings（实验室检查）：serum and culture（血清和培养） Histologic analysi
2、s（组织学检查） Radiological findings might mimic many different disease Inflammatory disease：Crohns disease Neoplastic disease: Lymphomatosis, Peritoneal carcinomatosis,Classification,Gastrointestinal tuberculosis（胃肠道结核） Tuberculous lymphadenopathy（结核性淋巴结炎） Tuberculous peritonitis （结核性腹膜炎） Solid organ inv
3、olvement （实性器官累及） Hepatic and splenic TB Pancreatic TB,Different pathways,Pathophysiology of Gastrointestinal TB （胃肠道TB的病理生理学）,Bacteria,Mucosa 粘膜 Submucosa 粘膜下层,Epithelioid tubercles 表皮样结节,Ulceration 溃疡,Granuloma formation 肉芽肿形成,Caseous necrosis 干酪性坏死,Cicatrization 瘢痕形成,Sloughing 脱落,Surrounding muco
4、sa thickening 邻近粘膜增厚,Lymph nodes 淋巴结,Peritoneum 腹膜,Circulation liver肝 pancreas胰spleen脾,Spreading,Complications of intestinal tuberculosis Bowel obstruction（肠梗阻） Perforation（穿孔） Abscess formation（脓肿形成） Fistula（瘘道形成） Intussusception（肠套叠） Bowel wall ischemia（肠壁缺血）,1 ileocecal junction(90%),2,3,4,5,6,Fi
5、xed and narrowed ileum（回肠固定及变窄）; Conical and shrunken cecum（锥形和萎缩的盲肠）,mimic Crohns disease,Uniform and concentric thickening of terminal ileum wall （回肠末端肠壁向心性均匀增厚）,ileocecal tuberculosis 回盲部结核 Mild wall thickening of the cecum（盲肠壁轻度增厚） Pericecal lymph nodes（盲肠周围淋巴结）,ileocecal tuberculosis 回盲部结核 Circ
6、umferential thickening of the cecum and terminal ileum（盲肠和末端回肠壁环形增厚） Adjacent lymph nodes（邻近淋巴结）,Progressing,Differentiating imaging features,Colonic tuberculosis (A) Two strictures in descending and transverse colon (B) Marked infiltration and asymmetrical thickening of the ascending colon and mese
7、nteric enlarged lymph node,Tuberculosis of the ileum Symmetric mural thickning ileum (arrows) and adjacent enlarged lymph node,Tuberculous lymphadenopathy,Multiple enlarged lymph nodes Hypodense centers and peripheral enhancement 低密度中心伴有周围强化 Conglomerate lymph nodes 淋巴结融合,Caseation and liquefaction
8、substances at the center （中心干酪样和液化坏死） Peripheral inflammatory lymphatic tissue（周围炎性组织）,Multiple enlarged lymph nodes Rim enhancement and Necross inside （环形强化和内部坏死） Calcification（钙化） Large psoas abscess（腰大肌脓肿）,Tuberculous peritonitis 结核性腹膜炎,Wet type 90%,Fibrotic-fixed type 7%,High density,Large volum
9、e of ascites,Protein and cellular content,Small volume of ascites,Fixed bowel loops,Omental masses,Dry type 3%,Dense peritoneal adhesions,Fibrous peritoneal reaction,Caseous nodules,Thickening, enhancement, and nodularity of peritoneum 腹膜增厚、强化、结节状 ileocolic adenopathy 回盲部淋巴结,Mesentery involvement: m
10、ost common Omental involvement: nodular, smudged Peritoneal involvement: smooth, tiny nodules Ascites: 30-100% of cases &multiple stands of fibrin and debris（纤维素或碎片）& septa（分隔）,Wet type 湿型 Ascites: septa （分隔） Peritoneum: smooth thickening & enhancement（光滑增厚&强化）,Fibrous type 纤维型 Omentum&peritoneum: t
11、hickening （增厚） Bowel loops: conglomerate（聚拢）,Dry type 干型,Sclerosing encapsulating peritonitis (abdominal cocoon) “茧” Clustering of small bowel loops in the center of abdomen 腹部中央肠袢聚拢,Ascites lymph nodes: mesenteric& retroperitoneal Necrosis inside and ring-like enhancement Omentum: Thickening Perito
12、neum: Enhancement & Regular thickening,Hepatic, Splenic and pancreatic TB 肝、脾、胰腺结核,Usually in a fine miliary pattern（粟粒样）, below the resolving capacity of CT Most common presentation: non-specific hepatosplenomegaly（肝脾肿大） Occasionally, tiny scattering low-density foci（微小低密度灶） Rarely, macronodular fo
13、rm（大结节）：pseudotumor or tuberculoma（假瘤或结核球）1-3cm or a single tumor-like mass,Miliary hepatic TB 粟粒型,Enlarged liver 肝大 Heterogeneous parenchyma 密度不均 Multiple hypoenhancing nodules in the spleen 伴有脾脏多发小结节，低强化,Tiny hypovascular nodules scattering in the liver and spleen 低血供结节 Enlarged liver and spleen 肝
14、脾大 slightly rim enhancement 轻度环形强化,Micronodular tuberculosis 微小结节型,Macronodular 大结节 Hypovascular 低血供,Macronodular hepatic & splenic tuberculosis 大结节型,Pancreatic tuberculosis 胰腺结核,Slight increase in the dimension of pancreas 体积稍增大 Loss of lobulated contour 边缘变光滑,Associated Findings,Thoracic findings:
15、 15% 合并胸部结核 Genitourinary tuberculosis 泌尿生殖道结核 Musculoskeletal tuberculosis 骨骼肌肉结核 Central nervous system tuberculousis CNS TB 中枢神经系统结核,A painting is more than the sum of its parts. A cow by itself is just a cow. A meadow by itself is merely grass and flowers. The sunshine peeking through the trees is merely a beam of light. But you put them all together, it can be magic. You have to see the whole landscape.,Thank you,