几种特殊胸部影像学的典型学征ppt课件.ppt

几种特殊X线影像学征象,Contents,SignsinchestimagingTree-in-budPatternCrazy-pavingpatternHalosignAircrescentsignFinger-in-glovesign,Tree-In-BudPattern,树芽征tree-in-budpattern,HRCT上细支气管周围炎，小叶中央支气管及其远端气道扩张、粘液嵌塞，在不同的截面组合一起，形似“春天发芽”的征象树芽征最初用于描述肺结核并支气管播散，但也见于其他疾病最经典的是弥漫性泛细支气管炎（DPB）满肺的树芽征作为诊断依据之一,树芽征常见原因感染细菌、真菌、病毒先天性疾病囊性纤维化、Kartagener综合征特发性疾病闭塞性细支气管炎、弥漫性泛细支气管炎误吸或异物吸入免疫性疾病ABPA结缔组织疾病类风湿性关节炎、干燥综合征外周肺血管性疾病,High-resolutionCTscan(farleft)anddrawingsofthelung(middleleft),abuddingtree(middleright),andtreebuds(farright)showthetree-in-budpattern.Notethesimilarityoftheobstructedbronchiolestotheobjectsusedinthegameofjacks.,Thin-sectionCTscanobtainedina29-year-oldmanwithacutemyeloidleukemiaafterbonemarrowtransplantation.Thepatienthadahistoryoffeverandcough.Imageshowsmultiple,small,centrilobularnodulesofsoft-tissueattenuationconnectedtolinearbranchingopacities(arrows).Notethemorphologicsimilaritiestothephotographofthetreeinbud.Atserologicexamination,aninfectionwithMycoplasmapneumoniaewasconfirmed.,18-year-oldmanwithactivetuberculosis.High-resolutionCTscanshowsseverechangesofbronchiolardilatationandimpaction.Tree-in-budpatternisseeninrightlowerlobe(arrow)andrepresentsendobronchialspreadoftuberculosis.Directsignsofbronchiolarinvolvementarealsoseeninleftupperandlowerlobes.,弥漫性泛细支气管炎（DPB）,东亚的地区病，影像学上特征明显临床诊断标准症状：咳嗽、咳较多脓痰、活动后胸闷、气短体征：中细湿性罗音，可有哮鸣音影像学：弥漫性树芽征肺功能：阻塞性通气功能障碍，通常无弥散功能下降；低氧血症冷凝集试验效价升高，64倍以上升高慢性鼻窦炎,DPB确诊标准,确诊有赖于组织病理学检查(3条中2条以上)淋巴组织增生，表现为淋巴滤泡肥大增生，淋巴细胞和浆细胞浸润泡沫细胞细支气管周围纤维化诊断中的困惑冷凝集试验医院不做如此小的细支气管中心性病变，经皮肺穿的阳性率低,DPB、支气管扩张和树芽征,Crazy-pavingpattern,Photographofacolonial-erapavementstreetinBuenosAires,Argentina(left),drawingsofthelungs(center)andlungtissue(topright),andclose-uphigh-resolutionCTscan(bottomright)showthecrazy-pavingpattern.,Causesofthecrazy-pavingpattern,Adultrespiratorydistresssyndromeina27-year-oldmanwhodevelopedbarotraumaandpulmonaryinterstitialemphysema.High-resolutionCTscanshowsscatteredground-glassattenuationandthickeningoftheintra-andinterlobularsepta(crazypavingpattern).Notetheairwithintheareasofinterlobularthickening,afindingindicativeofpulmonaryemphysema.,Hematopoieticstemcelltransplantation(HSCT)38-year-oldmanwithadenoviruspneumoniaHRCTscanatlevelofupperlobesshowsbilateralareasofground-glassattenuationwithsuperimposedinterlobularseptalthickening(“crazy-paving”pattern),Halosign,Invasivepulmonaryaspergillosisina39-year-oldmanwithacutemyelogenousleukaemiaandneutropenia.Thin-sectionCTatthelevelofthelungapexshowsmultiplenodulessurroundedbyahaloofgroundglassopacityinbothupperlobes.,Cytomegaloviruspneumoniaina45-year-oldwomanwithrapidlyprogressiveglomerulonephritis.Thin-sectionCToftherightlungbasedemonstratesmultipletinynodules(arrows)withtheCThalosignintherightlowerlobe,Kaposisarcomaina29-year-oldwomanwithahistoryofrenaltransplantation.Thin-sectionCTatthelevelofthecarinashowsmultiplenoduleswithasurroundinghaloofgroundglassopacityinbothlungs,whicharedissimilartoflame-shapedlesions,theclassicfindingsofKaposisarcoma,aThemostcommonconditionshowingtheCThalosigninimmunocompromisedpatients.bThemostcommonconditionshowingtheCThalosigninimmunocompetentpatients.,Aircrescentsign,Aspergilloma(roundmassintheleftupperlobe)visualizedbycomputedtomographyinayoungman.Theetiologyoftheunderlyingcavitywasunknowninthiscase.,CThalosign.ThisfirstthoracicCTscan(day0)wasperformedinapatientwithfebrileneutropenicleukemia.Thegroundglassattenuationsurroundingthenodulewasconsideredatypicalhalosign.ThediagnosisofIPAwasconsideredhighlylikely,andantifungaltreatmentwasstarted.,Caillotetal.JClinOncol2001;19:253-9.,Invasiveaspergillosisinafebrileneutropenicpatient.Sequentialcone-downviewsoftheleftupperlobeshowprogressionfromroundedconsolidationtodevelopmentoftheclassicaircrescentsign(arrows).,TheaircrescentsignAcluetotheetiologyofchronicnecrotizingpneumonia,ThemostcommoncauseisthefungusballofangioinvasiveaspergillosisTheballcanbelargeorsmall,solitaryormultipleItmaymovewhenthepatientspositionchangesorremainfixedAdditionalcausesPulmonaryhydatidcyst肺包囊虫囊肿Otherfungi,bloodclotorRasmussenaneurysminatuberculouscavity拉斯穆森瘤Lungabscesswithinspissatedpus浓缩了的粘稠脓液Staphylococcalpneumonia金葡菌肺炎NocardialinfectionCarcinomaofthelungPulmonarygangreneorhematoma肺坏疽或血肿,Finger-in-glovesign,(A)Postoanteriorradiographshowingabranchingopacityintheleftupperlung(finger-in-glovesign)(B)AxialCTimagewithtubularopacityandadjacenthyperlucencyintheleftupperlobe(C)3D-reconstructionofthebronchialtree.Thereisnodivisionofcorrespondingbronchi,indicatingatresia(seearrows).,DefinitionofMucoidImpactionMucoidimpactionisdefinedasairwayfillingbymucoidsecretions.Iftheaffectedairwayislarg