急腹症CT诊断腹部外伤ppt课件.ppt

急腹症CT诊断-腹部外伤技术影像诊断需提供信息表现示意图腹腔积血点评脾脏损伤脾损伤分类损伤分级1.有多处大小不一的低密度区。这些低密度影不是线状的，因此不是裂伤
2.伴有肋骨骨折和气胸、皮下气肿
3.无对比剂外溢线形低密度—裂伤
圆形和椭圆形低密度区——脾血肿
腹腔积液2013-10-22围绕脾和肝腹腔积液。
椭圆形或圆形低密度区符合脾脏血肿。
线性低密度影符合脾前部的裂伤。
脾门区对比剂外溢。Activearterialhemorrhage.Contrast-enhancedmultidetectorcomputedtomographyimagedemonstratesalinearfocusofextravasatedcontrast-enhancedblood(arrow)originatingfromthespleen.Thisfocusofactivehemorrhageissurroundedbyalargeperisplenichematoma(h)thatislowerinattenuationthantheextravasatedcontrast-enhancedblood.Perihepaticblood(arrowhead)isalsoevident.Subcapsularsplenichematoma.Contrast-enhancedcomputedtomographyimagedemonstratesalenticular-shapedsubcapsularhematoma(H)thatindentstheunderlyingsplenicparenchyma.Ahigherattenuationperisplenichematoma(arrow)isseenposteriorly.P,pancreatictail;K,leftkidney.Partialtransectionofthesplenichilumwithactivebleedingandmassivehemoperitoneum.A,B:Computedtomography(CT)scansthroughtheupperpoleoftherightkidneydemonstratealargeamountofhemoperitoneum,virtuallyabsentperfusionofthesplenicparenchyma,andactivebleeding(arrows)fromdisruptedhilarvessels.C:CTscanthroughthelowermarginofthespleen(S)showssomepreservationofsplenicenhancementconsistentwithpartialhilartransection.Asmalllacerationisnotedintheleftkidney.(CasecourtesyofChristineOMenias,M.D.,St.Louis,Missouri.)Congenitalsplenicclefts.A:Computedtomographyimagedemonstratesasharplymarginatedcleftintheposteriortipofthespleen.Thesmooth,roundedcontourofthecleftasitmeetsthemarginofthespleen,aswellastheabsenceofperisplenichematoma,ishelpfulindistinguishingacongenitalcleftfromaparenchymallaceration.B:Anotherpatientwithmultiplespleniccleftsalongthelateralmarginofthespleen.肝脏在后腹部实质性脏器损伤中位居第二位
肝损伤是死亡的最常见原因：肝下、肝静脉、肝动脉、门静脉分支丰富
肝右叶后段因体积大、位置固定为最易受伤部分。这部分还涉及裸区，伤及该区域，将会导致腹膜后出血而不是腹腔出血表现形式Ⅰ级：血肿：包膜下<10%表面面积；裂伤：包膜撕裂，涉及实质深度小于1cm
Ⅱ级：血肿：包膜下涉及10%-50%表面面积，实质内直径＜10cm，撕裂涉及实质深度1-3cm，长度小于10cm
Ⅲ级：血肿：包膜下大于50%表面面积，扩张性；包膜下血肿破裂伴活动性出血；实质内大于10cm或扩张，裂伤深度超过3cm
Ⅳ级：撕裂，实质破裂累及25-75%肝叶，或一个肝叶内1-3个肝段；
Ⅴ级：裂伤：实质破裂涉及大于75%肝叶或一个肝叶内3个以上肝段。血管：近肝静脉损伤，
Ⅵ级