《呼吸系统影像诊断》PPT课件.ppt

呼吸系统影像诊断,Bronchial Obstruction,局部支气管狭窄 stenosis 支气管闭塞 Obstruction 肿块 mass in bronchial cavity 管壁增厚 thickened of bronchial wall,directness signs,重点复习,Indirectness signs ： 阻塞性肺气肿：部分阻塞 Incomplete obstruction obstructive emphysema 阻塞性肺不张：完全阻塞. Complete obstruction obstructive atelectasis.,centrilobular emphysema,肺体积膨大 Overinflation 密度减低 Density reduce,panlobular emphysema,肺体积缩小 Incomplete expansion of the lung, The size of lung shrunken 密度增高 Increased density,obstructive atelectasis.,obstructive emphysema,X线表现 x-ray appearances 肺泡、肺小叶实变consolidation 支气管气像（air bronchogram） No any loss of volume,渗出与实变 Exudation and consolidation,纤维化 fibrosis,局部病灶纤维化 Local fibrosis,弥漫性间质纤维化 Diffuse interstitial fibrosis,Calcification,nodule and mass,Benign,Malignant,lobulation,spiculation,血管集束征,病灶胸膜侧小片状浸润,支气管充气征,worm-eaten cavities,Thin-walled cavity,thick-walled cavity,air containing space,cavity and air containing space,空气半月征 Air crescent sign,曲菌球,支气管血管束增粗 peribronchovascularburdle interstitial thicking,Signet-ring sign 印戒征,小叶间隔增厚 Interlobular septal thicking,小叶核增大 Lobular core thicking,树芽征（tree-budded sign）,肺间质病变,interstitial nodules multinodular and miliary diseases,air-space nodule,磨玻璃影ground-glass opacity,GGO： 肺内密度增高的模糊影，但肺纹理可见,胸腔积液 （pleural effusion） 游离性胸腔积液 free pleural effusion 少量积液 中量积液： 大量积液： 局限性胸腔积液localized pleural effusion 包裹性积液 叶间积液 肺底积液,胸膜凹陷征,胸膜凹陷征pleural indentation sign,支气管扩张bronchiectasis 肺炎pneumonia 大叶性肺炎 小叶性肺炎 间质性肺炎 支原体肺炎 肺结核Pulmonary tuberculosis 肺癌Lung cancer 纵隔肿瘤mediastinal tumor,本节课内容,支气管扩张 bronchiectasis,支气管内径不同程度异常增宽 多数为后天性，少数为先天性，好发于儿童及青壮年 好发于段以下3-5级小支气管,bronchiectasis,临床表现：咳嗽、咳血、咳痰 Continuous cough, purulent sputum,recurrent haemoptysis 分 型：柱状型(Cylindrical bronchiectasis)、 囊状型(Cystic bronchiectasis)、 曲张型(Varicose bronchiectasis),病 理：pathologic changings,支气管壁组织破坏（慢性感染） 管内压增高（分泌物淤积、长期剧烈咳嗽） 外在性牵拉（肺不张、纤维化等）,bronchiectasis,平片： plain chest radiographic findings often nonspecific 肺纹理增粗紊乱 ，囊状透亮影， an increase of lung markings Surrounding infiltrate or fibrosis 合并感染时有液平及囊壁增厚。 dilated bronchi, sometimes with air-fluid levels,bronchiectasis,支气管造影bronchography ： 支气管呈囊状、柱状 囊柱状扩张 Tubular,Varicose or Cystic bronchial dilatation,囊状、柱状,bronchiectasis,曲张型扩张,Tubular and Cystic bronchial dilatation,念珠状,粗细不均,囊柱状,bronchiectasis,平片价值有限,支气管造影病人痛苦,主要依靠CT诊断 HRCT ( high resolution CT),bronchiectasis,戒指征 The signet ring sign,HRCT表现,轨道征,轨道征Tram-track sign,囊柱状 粗细不均 念珠状,柱状型 曲张型,bronchiectasis,葡萄串征clusters of grapes sign,囊状型,葡萄串征clusters of grapes sign,液平 air-fluid levels 囊壁增厚,囊状型,bronchiectasis,Dilatation of the bronchus, Bronchial wall thickening Sometimes air-fluid levels,粘液栓塞-“指状征” Gloved finger sign,bronchiectasis,bronchiectasis,Bronchial wall thickening “戒指征The signet ring sign和” “轨道征track sign” 支气管管径粗细不均-囊柱状改变 Varicose type 葡萄串样囊状阴影，合并感染时有液平 clusters of grapes sign with air-fluid levels 粘液栓塞时呈“指状征”改变Gloved finger sign,Abstract CT features,肺 炎(pneumonia),Classfication of pneumonia,According to the anatomic position of the lesion: Lobar pneumonia Bronchopneumonia or Lobular pneumonia Interstitial pneumonia According to the etiology of the pneumonia,按病变分布分为：,大叶性肺炎Lobar pneumonia 炎症累及肺叶或肺段 支气管肺炎(小叶性肺炎) bronchopneumonia or Lobular pneumonia 炎症累及多个肺小叶为主 间质性肺炎Interstitial pneumonia 炎症累及肺间质为主,Lobar pneumonia大叶性肺炎临床,Caused by pneumococcus肺炎链球菌致病 Onset suddenly ,rapid development of high pyrexia , pleuritic pain cough A characteristic rusty color sputum铁锈色痰,pathologic changings of Lobar pneumonia,The basic pathologic lesion:Acute inflammatory exudation of the pulmonary parenchyma 病理分四期： 充血期The congestive stage: 毛细血管充血为主Inflammatory edema 红色肝样变期The red consolidation stage : 肺泡内充满渗出液,有较多红细胞,肺组织切面呈红色 灰色肝样变期The gray consolidation stage : 肺泡内有较多白细胞,肺组织切面呈灰色 消散期Resolution stage: 肺泡内渗出物溶解,吸收,X线表现 X-ray features,影像学表现与病理改变密切相关,是病理改变在影像学上的反映 充血期 The congestive stage 可无阳性发现, 临床症状出现3-12小时后才出现X线征象 No X-ray changes 病变区肺纹理增多，透亮度减低 an increase of lung marking,Lobar pneumonia,实变期（红色或灰色肝样变期） The consolidation stage 密度均匀的致密影 a large homogeneous radiopaque shadow in the lung field No volume loss Air bronchogram is common,累及肺叶：以叶间裂为界的大片致密影,但体积不缩小,无叶间裂的移位,右中叶肺炎,Lobar pneumonia,Lobar pneumonia,The X-ray feature is a large homogenous radiopaque shadow there is no volume loss air bronchogram is common Borders of the shadow appear as a sharply defined margin,实变期（红色或灰色肝样变期） 密度均匀的致密影homogeneous radiopaque shadow,累及肺段： 片状或三角形, 尖端指向肺门,下叶节段性肺炎,Lobar pneumonia,Lobar pneumonia,实变期（红色或灰色肝样变期）,支气管气像 Air bronchogram 致密阴影内,可见透亮支气管影,Lobar pneumonia,消散期X线改变 Resolution stage,病变密度逐渐减低，呈大小不等、分布不规则的斑片状阴影 The shadow of consolidation becomes scatter 可完全吸收或遗留少量索条影 起病1周后病变开始吸收，多在 2 周内完全吸收，少数可延迟吸收或演变为机化性肺炎,发病10后,Lobar pneumonia,CT表现 CT manifestations,一般平片就可诊断,不需要CT CT优势是: 充血期可发现磨玻璃样改变 ground-glass opacity,GGO 更容易发现支气管气像 Air bronchogram 如消散缓慢,反复发作,年龄较大的患者,与阻塞性肺炎鉴别,大叶性肺炎CT表现,支气管气象 Air bronchogram,right lower lobe pulmonary consolidation with air bronchograms.,支气管肺炎 （bronchopneumonia）,又称小叶性肺炎(lobular pneumonia) 致病菌为链球菌、葡萄球菌、肺炎双球菌streptococcus, staphylococcus, pneumococcus 多见于婴幼儿、老年及极度衰弱患者，或手术后,bronchopneumonia,临床表现Symptoms: 起病急，高热寒战 high pyrexia 咳嗽、咳泡沫粘液脓性痰、胸痛 cough,purulent sputum,pleuritic pain 呼吸困难甚至紫绀 shortness of breath,pathologic changings病理变化,肺小叶渗出与实变 lobular consolidation 小支气管壁充血水肿、间质内炎性浸润 Small bronchus wall congest and swelling,interstitial inflammation immersing 小支气管壁充血水肿 -不同程度阻塞- 小叶性肺气肿、小叶性肺不张 lobular emphysema or lobular atelectasis,X 线 表 现 X-ray features,bronchopneumonia,肺纹理增多、增粗、模糊Intensification of lung markings 病变多在两肺中下野的内中带,沿肺纹理分布的斑片状影，密度不均，边缘模糊，密集的病变可融合成较大的片状 Small patchy opaque shadows in the middle and lower lung fields, Confluence of these patchy opacities,Intensification of lung markings Small patchy opaque shadows in the middle and lower lung fields, Confluence of these patchy opacities,Emphysema of the both lungs is usually visible,金黄色葡萄球菌支气管肺炎,Intensification of lung markings Small patchy opaque shadows in both lung fields, Pneumatoceles(肺气囊),支气管肺炎CT表现(CT features),支气管血管束增粗peribronchovascularburdle thicking 小片状影(小叶性实变或小叶性不张) Small patchy opaque 大片状影(小片状影融合) Confluence of these patchy opacities 1-2CM小圆形透亮影(小叶性肺气肿) centrilobular emphysema,Lobular pneumonia. CT demonstrates multifocal areas of consolidation and air bronchograms.,间质性肺炎 （interstitial pneumonia）,累及肺间质为主的炎症，包括支气管壁及周围间质和肺泡壁 Interstitial pneumonia involves mainly the interstitial tissue of lungs, including the bronchovascular bundles and interlobular and intralobular septa,可由细菌或病毒引起 viral or lacterial infection 多见于小儿，常继发于麻疹、百日咳、流行性感冒等急性传染病 原发传染病症状+咳嗽、气急 、紫绀 shortness of breath, cough,cyanosis 症状重，体征少、 wbc不高,病理 pathology,小支气管壁及肺间质炎性细胞浸润 Interstitial inflammation immersing 炎症沿淋巴管扩展引起淋巴管炎和淋巴结炎 Lymphatitis,lymphadenitis 小支气管的炎症阻塞小叶性肺气肿 肺不张 Small bronchus inflammation- obstruct emphysema and atelectasis 肺泡内可有轻度炎性浸润,interstitial pneumonia,病变广泛，累及两肺尤中下肺 肺纹理增粗、模糊， Intensification of lung markings 网状纹理 fine streak-like,net-like,nodular or nod-reticular shadows 肺门密度增高，模糊，肺门增大enlargement of the hilar shadow 小叶性肺气肿、肺不张， 婴幼儿弥漫性肺气肿 empyhsema of the both lungs 磨玻璃影、小斑片状影 GGO, Small patchy opaque shadows,interstitial pneumonia,X-ray features,interstitial pneumonia CT and HRCT,广泛的支气管血管束增粗Intensification of bronchovascular bundles 小叶间隔增厚 interlobular and intralobular septa thickening 胸模下线 Subpleural line 磨玻璃影、小片状影 GGO, Small patchy opaque shadows 肺门、纵膈淋巴结可增大,广泛的支气管血管束增粗 Intensification of bronchovascular bundles 小叶间隔增厚 Interlobular and intralobular septa thickening 胸模下线 Subpleural line,Ground-glass opacity,GGO,间质性肺炎与支气管肺炎鉴别 支气管肺炎:以小片状影为主, 累及中下肺野为主 间质性肺炎:以肺纹理增粗模糊为主,病变更广泛,累及两肺,interstitial pneumonia,支原体肺炎 Mycoplasma pneumonia,好发于青少年 临床症状轻,常表现发热,咳嗽. 白细胞总数正常或稍低 痰鼻喉拭子培养可获支原体 血清学检查:红细胞冷凝集试验大于1:32,补体结合试验大于1:16,间接凝血试验大于1:32,间接荧光试验大于1:16,病 理pathology,急性间质性肺炎及支气管炎 1-2周吸收 病变自限性,影像学表现Imaging manifestations,早期病变: 肺纹理增粗、模糊 Intensification of lung markings 网状纹理 fine streak-like, or nod-reticular shadows 病变发展后:Small or large patchy opaque 胸腔积液,肺门纵隔淋巴结肿大少见.,肺 脓 肿 (lung abscess),由化脓性细菌引起,早期为化脓性肺炎,坏死液化,形成脓肿 Purulence bacteria-inflammation focus-Necrosis and fluidify-abscess infect approach： inhale hematogenous direct spreed Stage： acute and chronic stage,lung abscess,临 床 急性期Acute stage： 有急性化脓性肺炎的表现，高热寒战、咳嗽咳痰、胸痛、咳大量脓臭痰 白细胞及中性粒细胞明显增高 慢性期Chronic stage： After 3 months the abscess was considered to be chronic 经常咳嗽、咳脓痰和血痰， 不规则发热及贫血消瘦等,lung abscess,病 理 化脓性肺炎（渗出和实变） 细支气管阻塞、小血管炎性栓塞 坏死 液化 形成空洞(脓腔) 脓液破溃到胸腔脓气胸、支气管胸膜瘘 持续不愈超过 3个月转为慢性，脓腔周围炎性浸润减少 但纤维组织增生,lung abscess,急性期Acute stage排脓之前： 化脓性肺炎 团状致密影,边缘模糊,X 线 表 现,lung abscess,急性期 排脓以后 边界模