解剖概念：腹腔、腹膜腔、腹膜 1.腹腔、腹膜腔 腹腔有广义和狭义两种解释。广义的腹腔：指膈肌以下﹑盆底以上,腹壁围成的体腔。狭义的腹腔：指膈肌以下、骨盆入口以上,腹壁围成的体腔。 腹膜腔：脏层腹膜和壁层腹膜之间相互移行围成的潜在性间隙。腹膜腔分为小腹膜腔和大腹膜腔两个部分。 ◇小腹膜腔又称小网膜囊位于小网膜与胃后方,为一潜在腔隙,形态不规则。正常情况下,在CT和MRI上不能显示其边界,其所在位置呈脂肪密度。小腹膜腔有积液时,其大小、形状变化很大。 ◇大腹膜腔则为小网膜囊以外的腹膜腔隙。其内含有实质脏器﹐如肝脏、脾脏等;含有空腔脏器,如肠管、胆囊等;含有各种腹膜折叠形成的各种韧带、陷窝等结构。 ◇大,小腹膜腔借网膜孔相交通。 ◇男性腹膜腔是完全封闭的女性腹膜腔借输卵管、子宫腔、阴道与体外形成潜在性通道。 ◇以横结肠和骨盆人口为基准人为地将腹腔分为上腹腔、下腹腔和盆腔。 2.腹膜 腹膜是一种浆膜,由间皮细胞及少量结缔组织构成。腹膜分为两层，一层衬覆于腹壁、盆壁的表面,称为璧腹膜;另一层覆盖于腹腔﹑盆腔内脏器的表面,称为脏腹膜。 ◇腹膜薄而光滑﹐呈半透明状,璧腹膜厚于脏腹膜,其外面有一层疏松结缔组织,内含丰富的脂肪。 ◇正常情况下，腹膜在X线片上不能显示。在CT和MRI上,当腹膜与X线平行,且周围有脂肪衬托时可以显示,CT表现为细线状稍高密度影﹐厚薄均匀,密度均匀。在常规T1WI和T2WI上为高信号脂肪内的细线状等信号影。如果没有脂肪衬托,无法将其与腹壁、肠壁区分开来。 ◇腹膜折叠形成大网膜、小网膜、系膜、韧带、隐窝等结构。√这些结构在X线上不能显示,在CT及MRI上呈脂肪密度,脂肪信号的基础上夹杂血管影。 早期诊断腹腔结核很重要！ 结核病患病率不断上升，这引起了发展中国家和发达国家的关注。腹部结核是肺外结核最常见的部位，几乎累及所有内脏器官。腹部结核的临床表现通常是非特异性的。因此，有一个高指数的临床怀疑是必要的，以协助早期诊断和指导及时开始适当的治疗。 腹部结核的CT表现与鉴别 文献来源：中国防痨杂志2012年1月第34卷第1期。 来看看国外的一篇SCI文章（Clin Imaging. 2021）注：文末有附件，喜欢自己下载 在这篇综述中，我们着重于腹部结核病和模仿它的其他疾病的整个谱图，重点是影像学发现。 腹腔结核的影像表现及鉴别诊断要点 各种腹腔结核的影像表现实例 Fig. 1. 结核性淋巴结炎 Tuberculous lymphadenitis. Contrast-enhanced CT demonstrates multiple A) mediastinal, B) retrocrural, C) mesenteric/omental (arrow) and retroperitoneal (arrowhead) necrotic lymph nodes with peripheral capsular rim-enhancement and low central density. A small right-sided pleural effusion is also seen in image A. Fig. 2.食管结核 Esophageal tuberculosis. A low-density heterogenous soft tissue mass (arrowhead) involving the mid-thoracic esophagus is seen, which was formed possibly from the conglomeration of irregular esophageal wall thickening and paraesophageal lymphadenopathy. Multiple enlarged and matted medistinal lymph nodes with central necrosis are seen (asterisk). Fig. 3.胃结核 Gastric tuberculosis. A and B) Contrast-enhanced CT demonstrates diffuse irregular thickening of the antrum of the stomach with surrounding fat stranding.Mild proximal dilation of stomach could be suggestive for gastric outlet obstruction. Small multi-loculated abscess is identified in the left lobe of the liver. C) T1-weighted MRI redemonstrates the diffuse irregular thickening of the gastric wall with surrounding inflammatory changes, D) diffusion restriction and E) postcontrast enhancement. Fig. 4.空肠和回肠结核 Jejunal and ileal tuberculosis. A) Contrast-enhanced CT demonstrates diffuse jejunal and ileal thickening (arrow) as well as a few tiny extraluminal air bubbles (asterisk) which indicate micro perforation. Omental nodularity (arrowhead) and mesenteric fat stranding (arrow) are also evident in image B. Fig. 5.回盲部结核(晚期)。Ileocecal tuberculosis (late stage).A and B) Contrast-enhanced CT demonstrates a deformed ileocecal junction with a conical cecum (white arrow) and a shrunken right colon with a stricture (arrowhead) at the hepatic flexure and proximal dilation (red arrow). Terminal ileum is marked by the blue arrow. C, D and E) .Multiple calcified mesenteric and omental lymph nodes are also seen (circles). (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.) Fig. 6. 盲肠和结肠结核。Cecal and colonic tuberculosis. A) Contrast-enhanced CT demonstrates mural thickening and enhancement of the cecum and ascending colon with surrounding inflammatory changes (arrow). B and C) Multiple regional necrotic mesenteric lymph nodes are also evident (arrowhead). Fig. 7.肝结核 Hepatic tuberculosis. A) US of liver shows multiple hypoechoic liver lesions. MRI of the same patient reveals B) multiple T2 fat sat hyperintense liver lesions with C) associated diffusion restriction and D) post-contrast enhancement. Fig. 8.脾结核 Splenic tuberculosis. A) US of spleen demonstrates a heterogenous hypoechoic structure (4.9 cm × 4.3 cm) without internal vascularity, suggestive of an abscess. B) T2-weighted image shows a hyperintense lobulated mass (arrow), suggestive of an abscess. Left pleural effusion is also identified. C) MRI 7 months post anti-TB treatment reveals near complete resolution of the splenic lesion with a small residual and scarring (arrow). Fig. 9. 一例新近诊断为HIV的年轻女性肝脾结核。Hepatosplenic tuberculosis in a young female with newly diagnosed HIV.A and B) Contrast-enhanced CT demonstrates hypo-enhancing nodules of variable size in the liver (arrows) and spleen (arrowheads). Periportal necrotic lymph nodes are also evident (asterisk). Bilateral pleural effusion and small volume ascites are present. Fig. 10.肾结核Renal tuberculosis. A) Contrast-enhanced CT shows a hypo-enhancing cystic lesion in the left kidney (arrow). MRI demonstrates a well-defined, septate cystic lesion which is B) T1 hypointense and C) T2 hyperintense in the interpolar region. The lesion also has a thick T2 hypointense wall which shows D) post-contrast enhancement and E and F) diffusion restriction. G, H and I) MRI 3-months post anti-TB treatment shows a reduction in size of the lesion along with presence of caseating material within the lesion as apparent by increased diffusion restriction within the fluid content enhancement and E and F) diffusion restriction. G, H and I) MRI 3-months post anti-TB treatment shows caseating material within the lesion as apparent by increased diffusion restriction within the fluid content. Fig. 11. 已知粟粒结核患者的盆腔腔结核。Pelvicalyceal tuberculosis in a patient with known miliary tuberculosis.Contrast-enhanced CT demonstrates diffuse caliectasis with extensive thinning and calcification of the left renal parenchyma. Fig. 12. 肺结核史患者的输卵管卵巢结核 Tubo-ovarian tuberculosis in a patient with a history of pulmonary tuberculosis. A) US of right adnexa demonstrates a heterogenous hypoechoic lesion. Right ovary is not seen separately. B and C) Coronal T2 and post-contrast T1 sequences demonstrate bilateral hydrosalpinx (white arrows) and pyosalpinx (asterisks) with thick enhancing walls and surrounding fat stranding, suggestive of pelvic inflammatory disease. Bilateral vaginal cysts with thick enhancing walls are also noted (blue arrows). (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.) Fig. 13. 粟粒结核患者的结核性附睾-睾丸炎。Tuberculous epididymo-orchitis in a patient with miliary tuberculosis.US of the testes demonstrates heterogenous collection with peripheral vascularity in the lower testicle and epididymal tail region. Fig. 14. 肺结核患者的结核性附睾睾丸炎。Tuberculous epididymo-orchitis in a patient with known pulmonary tuberculosis.A and B) US of the right testicle shows an ill-defined hypoechoic lesion and an enlarged epididymis with some peripheral vascularity. MRI demonstrates an ill-defined C) T2 hypointense lesion and D) T1 intermediate signal lesion with E and F) multiloculated peripheral enhancement involving the epididymal head and thick enhancing spermatic cord on the right side an enlarged epididymis with some peripheral vascularity. MRI demonstrates an ill-defined C) T2 hypointense lesion and D) T1 int F) multiloculated peripheral enhancement involving the epididymal head and thick enhancing spermatic cord on the right side. Fig. 15.结核性腹膜炎 Tuberculous peritonitis. Contrast-enhanced CT demonstrates ascites with omental thickening and caking (arrow) along with peritoneal thickening and enhancement (arrowhead). Fig. 16.结核性腹膜炎 Tuberculous peritonitis. A and B) Contrast-enhanced CT demonstrates diffuse thickening of proximal bowel with matted loops and loculated ascites. C and D) Contrast-enhanced CT 6 months post anti-TB treatment shows a thick enhancing sac-like structure with matted bowel loops in the center of the abdomen and proximal bowel dilation, indicating encapsulating peritoneal sclerosis (abdominal cocoon). Fig. 17.结核性脓肿 Tuberculous abscess. Contrast-enhanced CT demonstrates a peripherally enhancing collection in the enlarged right psoas muscle (arrow) which appears connected (asterisk) to adjacent multiple necrotic lymph nodes (arrowhead). Fig. 18. 多发性结核性脓肿Tuberculous abscess in multiple different patients. Contrast-enhanced CT demonstrates a peripherally enhancing A) mesenteric, B) left diaphragmatic crus，C) pericolic abscess (asterisk). A small left gluteal abscess is also seen (arrow). 原文下载： 参考文献： 1.王秋萍. 结核病影像诊断学教程[M]. 20182.马红霞、张喆、郭佑民.腹部结核的CT表现与鉴别.中国防痨杂志2012年1月第34卷第1期3.Ladumor H, et al. TB or not TB: A comprehensive review of imaging manifestations of abdominal tuberculosis and its mimics.Clin Imaging. 2021.