甲状腺超声诊断(2)

甲状腺超声诊断(2) 一、甲状腺的解剖 甲状腺位于颈前的中部，分左、右两侧叶，形似盾牌，上起自甲状软骨，下至第6颈椎平面，气管的前方。它贴附在喉及气管的两侧，随吞咽而上下移动。甲状腺两侧叶的连接处称峡部，呈方形，约2cm*2cm，位于第2——4气管软管环之前。约有40%的人，峡部上缘有一垂直向上的锥体叶。甲状腺的平均重量为20g~25g，不大于30g。侧叶长3~5cm，宽2~3cm,厚约1~2cm。 甲状腺的大体结构，外观呈黄红色，质软，表面有包膜，切面可见分隔胶状组织。甲状腺的主要组成结构为滤泡，由上皮细胞及胶质组成。滤泡有丰富的血窦。纤维组织将其分成小叶，小叶间有少量淋巴组织。 甲状腺的生理功能:甲状腺素对能量代谢有重要的影响，能促进蛋白质、脂肪及碳水化合物的代谢分解。分泌过多，可产生尿内氮的排出量增加，脂肪贮量降低，肝糖原减少;同时也影响水的代谢和耗氧量增加，临床可出现消瘦、多汗及心率快等。分泌减少，则引起人体代谢降低及体内水的积蓄，而出现粘液性水肿等。 1、功能:甲状腺是人体最大的内分泌腺体,内部结构为滤泡。 2、形态:呈“H”形或蝶形, 分为左右叶及峡部。 3、位置:为距体表1-1.5cm的浅表脏器。上至甲状软骨，下至第6颈椎。 application; infection and antibacterial drug of clinical application; transfusion refers to levy; nutrition support of adapted card and clinical application; common life support technology (as cycle breathing support, and nutrition support,) and emergency technology of application; common guardianship instrument using. Look: shock, cardiac respiratory arrest and acute organ failure, systemic inflammatory response syndrome and severe infection and multiple organ dysfunction syndrome (MODS), severe disturbance of body fluid environment such as critical theory and progress of the illness. 2. basic requirements (1) species and cases of study requirements: severe pneumonia in disease-disease myocardial infarction ... 3. high requirements (1) learning disease species: disease species disease species image radiation: rheumatic heart congenital heart intestinal Crohn's (Crohn) disease intestinal tuberculosis bile duct cancer chronic pancreatic inflammatory urinary system stone urinary system tumor adrenal disease thyroid disease cranial within infection nervous system tumor nuclear medical: Digest road bleeding explicit like brain blood flow perfusion explicit like testicular blood pool explicit like salivary glands explicit like (2) clinical knowledge, and skills requirements: understand various image check 大小:约4 cm x 2cm x 2cm。 二、 正常甲状腺超声表现 1、甲状腺切面呈蝶形或马蹄形。 2、包膜完整，边缘规则，境界清晰。 3、两侧基本对称，由位于中央的峡部相连。 4、内部分布细弱密集的光点，呈均匀的中 等回声。 前后径1~2cm，左右径2~2.5cm，上下径4~6cm。 甲状腺超声检查适应证 1、弥漫性病变: 1)甲状腺肿(弥漫性/单纯性/结节性) 2)甲状腺炎(急性/慢性/亚急性/桥本氏) 2、局限性病变: 1)甲状腺腺瘤 2)甲状腺囊肿 3)甲状腺囊腺瘤 4)甲状腺癌 5)甲状腺脓肿等 二、弥漫性甲状腺肿 又称毒性甲状腺肿/甲状腺功能亢进。 临床表现:甲状腺分泌过多引起甲状腺组织增生或腺体增大。年轻妇女多见，与精神因素有关。其症状为:神经过敏、application; infection and antibacterial drug of clinical application; transfusion refers to levy; nutrition support of adapted card and clinical application; common life support technology (as cycle breathing support, and nutrition support,) and emergency technology of application; common guardianship instrument using. Look: shock, cardiac respiratory arrest and acute organ failure, systemic inflammatory response syndrome and severe infection and multiple organ dysfunction syndrome (MODS), severe disturbance of body fluid environment such as critical theory and progress of the illness. 2. basic requirements (1) species and cases of study requirements: severe pneumonia in disease-disease myocardial infarction ... 3. high requirements (1) learning disease species: disease species disease species image radiation: rheumatic heart congenital heart intestinal Crohn's (Crohn) disease intestinal tuberculosis bile duct cancer chronic pancreatic inflammatory urinary system stone urinary system tumor adrenal disease thyroid disease cranial within infection nervous system tumor nuclear medical: Digest road bleeding explicit like brain blood flow perfusion explicit like testicular blood pool explicit like salivary glands explicit like (2) clinical knowledge, and skills requirements: understand various image check 情绪易激动、心悸、多汗、食欲亢进、但有消瘦及体重减轻。体检发现，心动过速、手震颤、甲状腺肿大、眼球突出等。 超声诊断: 1、甲状腺弥漫性、均匀性肿大，左右两侧对称。峡部前后径增大明显，常增大到1.0cm。 2、甲状腺内部回声正常或稍强，呈密集点状分布。 3、甲状腺内小血管增多、扩张，血流速度加速现象， 呈“火海征”。 单纯性甲状腺肿超声诊断 本病是缺碘引起甲状腺代偿性增生所致。常见于西北缺碘地区，具有地方性，也有散发性，妊娠及哺乳期多见。 超声诊断: 1、甲状腺呈弥漫性、对称性肿大，表面光滑。 2、甲状腺内滤泡高度扩张，充满大量胶质，显示为无回声区，呈弥漫、壁薄、多发特点。 3、正常甲状腺组织显示不清。 4、甲状腺内见点状、散在少许血流信号，血流 并不增加或接近正常。 六、结节性甲状腺肿 本病亦由于缺碘引起。甲状腺肿大、增生，一段时间又补充了碘可复原。由于反复缺碘及复原、交替进行而形成多个纤维间隔及结节。女性较多，呈散发性，年龄较大组中4%~7%application; infection and antibacterial drug of clinical application; transfusion refers to levy; nutrition support of adapted card and clinical application; common life support technology (as cycle breathing support, and nutrition support,) and emergency technology of application; common guardianship instrument using. Look: shock, cardiac respiratory arrest and acute organ failure, systemic inflammatory response syndrome and severe infection and multiple organ dysfunction syndrome (MODS), severe disturbance of body fluid environment such as critical theory and progress of the illness. 2. basic requirements (1) species and cases of study requirements: severe pneumonia in disease-disease myocardial infarction ... 3. high requirements (1) learning disease species: disease species disease species image radiation: rheumatic heart congenital heart intestinal Crohn's (Crohn) disease intestinal tuberculosis bile duct cancer chronic pancreatic inflammatory urinary system stone urinary system tumor adrenal disease thyroid disease cranial within infection nervous system tumor nuclear medical: Digest road bleeding explicit like brain blood flow perfusion explicit like testicular blood pool explicit like salivary glands explicit like (2) clinical knowledge, and skills requirements: understand various image check 可恶性变，应予注意。 超声诊断: 1、甲状腺两侧叶不对称性增大，表面不光滑。 2、甲状腺内回声不均，呈多发性、大小不等的 结节。 3、结节内部呈中低回声，无包膜，囊性变时可 见无回声区。结节之间有散在的光点或光条 形成，为纤维组织增生表现。 4、后期结节布满甲状腺内，不能显示正常甲状 腺结构。 5、结节周围呈点状或在结节间穿行的血流信号。 七、亚急性甲状腺炎 本病为病毒感染所致，病程数周或数月，患者有低烧、甲状腺肿大、局部压痛等。 超声诊断: 1、甲状腺对称性肿大，探头挤压有压痛。 2、甲状腺包膜增厚，内部不均，局部为低 回声区，其边界模糊，内可有散在强光 点/光团，后方回声增强。 application; infection and antibacterial drug of clinical application; transfusion refers to levy; nutrition support of adapted card and clinical application; common life support technology (as cycle breathing support, and nutrition support,) and emergency technology of application; common guardianship instrument using. Look: shock, cardiac respiratory arrest and acute organ failure, systemic inflammatory response syndrome and severe infection and multiple organ dysfunction syndrome (MODS), severe disturbance of body fluid environment such as critical theory and progress of the illness. 2. basic requirements (1) species and cases of study requirements: severe pneumonia in disease-disease myocardial infarction ... 3. high requirements (1) learning disease species: disease species disease species image radiation: rheumatic heart congenital heart intestinal Crohn's (Crohn) disease intestinal tuberculosis bile duct cancer chronic pancreatic inflammatory urinary system stone urinary system tumor adrenal disease thyroid disease cranial within infection nervous system tumor nuclear medical: Digest road bleeding explicit like brain blood flow perfusion explicit like testicular blood pool explicit like salivary glands explicit like (2) clinical knowledge, and skills requirements: understand various image check 3、甲状腺内血流增多，呈点状及散在分布， 无特异性表现。 八、桥本甲状腺炎超声诊断 1、甲状腺呈弥漫性、轻/中度肿大，前后 径及峡部增厚明显，切面可呈矩形。 2、早期腺体呈弥漫性回声减低，轻度不均。 进展期腺体内见散在条状光带，呈分隔 状或网络状。 3、弥漫性桥本病的甲状腺内，血流信号明 显丰富，亦可呈“火海征”。 九、甲状腺腺瘤 甲状腺腺瘤分为乳头状腺瘤和滤泡状腺瘤，女性多见，常为单侧及单发。约10%的腺瘤可癌变，20%的腺瘤可引起甲亢。 超声诊断: 1、甲状腺内见圆形或椭圆形肿块。 2、肿块:边界清楚光滑，有包膜。 滤泡状腺瘤:内部呈均质低回声，常有囊性变。 乳头状腺瘤:回声稍强。 3、腺瘤周围可见正常的甲状腺组织，两者之间 可出现“晕圈征”。 application; infection and antibacterial drug of clinical application; transfusion refers to levy; nutrition support of adapted card and clinical application; common life support technology (as cycle breathing support, and nutrition support,) and emergency technology of application; common guardianship instrument using. Look: shock, cardiac respiratory arrest and acute organ failure, systemic inflammatory response syndrome and severe infection and multiple organ dysfunction syndrome (MODS), severe disturbance of body fluid environment such as critical theory and progress of the illness. 2. basic requirements (1) species and cases of study requirements: severe pneumonia in disease-disease myocardial infarction ... 3. high requirements (1) learning disease species: disease species disease species image radiation: rheumatic heart congenital heart intestinal Crohn's (Crohn) disease intestinal tuberculosis bile duct cancer chronic pancreatic inflammatory urinary system stone urinary system tumor adrenal disease thyroid disease cranial within infection nervous system tumor nuclear medical: Digest road bleeding explicit like brain blood flow perfusion explicit like testicular blood pool explicit like salivary glands explicit like (2) clinical knowledge, and skills requirements: understand various image check 4、腺瘤周边可见血流彩环包绕。 十、甲状腺腺癌 病理、临 床表现: 甲状腺癌有80%为儿童胸腺、扁桃体、鼻咽部增殖以及淋巴组织接受过放射线治疗而引起。据临床经验，长期使用促甲状腺激素者，由于过度分泌甲状腺素的刺激，个别人也可发生癌变。从病理上分:乳头状癌占50-80%，滤泡状癌约占20%，其他有髓样癌、胚胎癌及未分化癌。可通过血行传播，转移至骨及肺。 超生检查: 1、甲状腺回声不均，见占位性光团。 2、占位: 1)癌瘤边界不整，界限不清，呈锯齿状。但 癌瘤较小时，边界可以光滑整齐。 2)癌瘤的内部常是低回声且不均质。 3)癌瘤内可出现点状、细小、微粒状的强回 声钙化点，具有特异性，但敏感性差。 4)癌瘤较大时，可出现坏死或囊性变，局部 呈无回声区，液化不全时，呈囊实性改变。 3、转移: 1)侵犯周围小血管时，可见血管内癌栓: 2)侵犯颈部淋巴结，可发现淋巴结肿大。 application; infection and antibacterial drug of clinical application; transfusion refers to levy; nutrition support of adapted card and clinical application; common life support technology (as cycle breathing support, and nutrition support,) and emergency technology of application; common guardianship instrument using. Look: shock, cardiac respiratory arrest and acute organ failure, systemic inflammatory response syndrome and severe infection and multiple organ dysfunction syndrome (MODS), severe disturbance of body fluid environment such as critical theory and progress of the illness. 2. basic requirements (1) species and cases of study requirements: severe pneumonia in disease-disease myocardial infarction ... 3. high requirements (1) learning disease species: disease species disease species image radiation: rheumatic heart congenital heart intestinal Crohn's (Crohn) disease intestinal tuberculosis bile duct cancer chronic pancreatic inflammatory urinary system stone urinary system tumor adrenal disease thyroid disease cranial within infection nervous system tumor nuclear medical: Digest road bleeding explicit like brain blood flow perfusion explicit like testicular blood pool explicit like salivary glands explicit like (2) clinical knowledge, and skills requirements: understand various image check 3)侵犯喉返神经时，有声音嘶哑及声带麻痹。 甲状旁腺疾患 甲状旁腺腺瘤 病理、临床表现: 肿瘤常引起甲状旁腺功能亢进，病人有全身骨关节疼痛、腰痛、尿路结石等，实验室检查有血钙过高，无机磷降低。严重时可引起病理性骨折。X线相骨质普遍疏松。典型的症状及化验结果对本病诊断并不困难。 超生检查: 声像图特点:位于甲状腺背侧，呈圆形或椭圆形，少数呈长方形或梭形，边界光滑、整齐，有包膜。内部呈均质低回声，部分呈现增强效应。位于甲状腺下极的甲状旁腺腺瘤，常常下垂或异位于颈侧方或胸骨上窝，少数可异位于胸骨后方或上纵隔处。 甲状旁腺增生 甲状旁腺增生多累及多个甲状旁腺。于甲状腺后方，气管及颈总动脉之间，可见增宽或增厚的梭形回声带，回声强度与甲状腺相似，如有典型的甲状旁腺功能亢进的症状，结合超生图像可以诊断本病。 原发性甲状旁腺功能亢进者，应首先用B型超生寻找病因，如发现腺瘤或增生，则手术切除，效果相当满意。如发现甲状旁腺肿瘤边界不规整，生长迅速，则应考虑癌肿。据统计application; infection and antibacterial drug of clinical application; transfusion refers to levy; nutrition support of adapted card and clinical application; common life support technology (as cycle breathing support, and nutrition support,) and emergency technology of application; common guardianship instrument using. Look: shock, cardiac respiratory arrest and acute organ failure, systemic inflammatory response syndrome and severe infection and multiple organ dysfunction syndrome (MODS), severe disturbance of body fluid environment such as critical theory and progress of the illness. 2. basic requirements (1) species and cases of study requirements: severe pneumonia in disease-disease myocardial infarction ... 3. high requirements (1) learning disease species: disease species disease species image radiation: rheumatic heart congenital heart intestinal Crohn's (Crohn) disease intestinal tuberculosis bile duct cancer chronic pancreatic inflammatory urinary system stone urinary system tumor adrenal disease thyroid disease cranial within infection nervous system tumor nuclear medical: Digest road bleeding explicit like brain blood flow perfusion explicit like testicular blood pool explicit like salivary glands explicit like (2) clinical knowledge, and skills requirements: understand various image check 甲状旁腺功能亢进的患者有1-2%可发生癌变，应引起注意。 application; infection and antibacterial drug of clinical application; transfusion refers to levy; nutrition support of adapted card and clinical application; common life support technology (as cycle breathing support, and nutrition support,) and emergency technology of application; common guardianship instrument using. Look: shock, cardiac respiratory arrest and acute organ failure, systemic inflammatory response syndrome and severe infection and multiple organ dysfunction syndrome (MODS), severe disturbance of body fluid environment such as critical theory and progress of the illness. 2. basic requirements (1) species and cases of study requirements: severe pneumonia in disease-disease myocardial infarction ... 3. high requirements (1) learning disease species: disease species disease species image radiation: rheumatic heart congenital heart intestinal Crohn's (Crohn) disease intestinal tuberculosis bile duct cancer chronic pancreatic inflammatory urinary system stone urinary system tumor adrenal disease thyroid disease cranial within infection nervous system tumor nuclear medical: Digest road bleeding explicit like brain blood flow perfusion explicit like testicular blood pool explicit like salivary glands explicit like (2) clinical knowledge, and skills requirements: understand various image check