胸膜病变PPT课件.ppt

胸膜病变,胸膜炎气胸和液气胸胸膜肥厚、粘连和钙化胸膜肿瘤,胸膜炎,结核性胸膜炎（最常见）化脓性胸膜炎,胸膜炎的影像学表现急性期：胸腔积液（主要）慢性期：胸膜肥厚、粘连,胸腔积液,游离性胸腔积液局限性胸腔积液：叶间积液、包裹性积液,胸腔积液,胸腔积液,大量胸腔积液,叶间积液,胸腔积液,叶间裂积液,气胸和液气胸,pneumothoraxandhydropneumothorax,气胸和液气胸的病理机制,慢支肺气肿剧烈的咳嗽胸内压骤升胸膜有破裂气胸(自发性)胸壁外伤胸膜的破裂气体从创道破裂胸膜腔气胸(外伤性)胸膜裂口呈活瓣样气体易进难出张力性气胸胸腔内气体与液体并存称为液气胸,pneumothoraxandhydropneumothorax,临床特点,突发呼吸困难胸痛,pneumothoraxandhydropneumothorax,X线影像学表现,胸腔的气体呈低密度少量时其形态呈弧形受压的肺向肺根收缩液气胸则出现液平面,pneumothoraxandhydropneumothorax,pneumothoraxandhydropneumothorax,pneumothoraxandhydropneumothorax,pneumothoraxandhydropneumothorax,pneumothoraxandhydropneumothorax,pneumothoraxandhydropneumothorax,pneumothoraxandhydropneumothorax,气胸和液气胸的CT表现,无肺组织的透亮区脏层胸膜线的显示是可靠的征象：弧形细线状软组织影，与胸壁平行敏感地发现少量的气体及液体清楚地显示肺组织的受压情况,pneumothoraxandhydropneumothorax,pneumothoraxandhydropneumothorax,pneumothoraxandhydropneumothorax,pneumothoraxandhydropneumothorax,pneumothoraxandhydropneumothorax,液气胸,气胸,诊断与鉴别诊断,肺浅表肺大泡：类似张力性气胸体积逐渐增大，但增大之速度很慢位置固定，不随体位而变化,胸膜肥厚、粘连和钙化,pleuralthickening,adhesionandcalcification,临床与病理,病理改变：纤维素、纤维蛋白沉积、肉芽组织增生；钙盐沉积；临床表现：脏层胸膜肥厚为主限制肺的扩张及收缩运动，壁层胸膜肥厚为主则以胸壁下陷为主,pleuralthickening,adhesionandcalcification,影像学表现,X线:胸膜走行区可见条片状高密度影转动体位多轴观察可找到切线位进行深呼吸观察可见肺活动受限CT:轻微胸膜肥厚为细线样软组织密度钙化时其CT值可高达100HU以上同时也可对其病因做出推测或诊断,pleuralthickening,adhesionandcalcification,pleuralthickening,adhesionandcalcification,pleuralthickening,adhesionandcalcification,胸膜肥厚粘连和钙化,pleuralthickening,adhesionandcalcification,胸膜肥厚粘连钙化,胸膜肥厚粘连钙化,胸膜肿瘤,Pleuraltumor,分类,原发肿瘤：间皮瘤、纤维瘤、血管瘤、脂肪瘤继发肿瘤：胸膜转移瘤（肺癌、乳腺癌、胃肠道肿瘤等）,Pleuraltumor,胸膜间皮瘤,病理分型：上皮型、纤维型和混合型解剖分型：局限型、弥漫型危险因素（文献报道，半数病例）石棉接触史,mesotheliomaofpleura,临床表现局限性良性者可无临床症状恶性胸膜间皮瘤的临床症状胸痛、呼吸困难、咳嗽、体重下降，部分病人可有肺性肥大性骨关节病,影像表现,mesotheliomaofpleura,X线影像表现,难显示小的病灶可仅见胸腔积液（恶性）病灶大时显示突入肺野结节影，呼吸时随肋骨运动（肺内肿块呼吸时随膈肌上下运动）,mesotheliomaofpleura,多发生于肋胸膜呈类圆形或分叶状边缘光滑锐利可带蒂与胸膜呈锐角或钝角偶可钙化及出血坏死增强多呈均匀性强化,局限型胸膜间皮瘤CT影像表现,mesotheliomaofpleura,胸膜广泛结节状或不规则状增厚，伴胸腔积液纵隔胸膜受累可引起纵隔固定肿大淋巴结影（恶性）可有椎体或肋骨破坏,弥漫型胸膜间皮瘤CT影像表现,mesotheliomaofpleura,胸膜间皮瘤,mesotheliomaofpleura,胸膜间皮瘤的诊断与鉴别诊断,胸膜间皮瘤的诊断良性光整结节影常偶然发现恶性不规则结节伴胸腔积液需鉴别病变肺外围病变胸膜转移瘤,mesotheliomaofpleura,mesotheliomaofpleura,胸膜间皮瘤,胸膜间皮瘤,胸膜间皮瘤气腹,胸膜间皮瘤气腹,胸膜间皮瘤气腹,胸膜神经鞘瘤,胸膜神经鞘瘤,间皮肉瘤,胸膜转移瘤,病理改变：胸膜散在多发的转移结节，伴胸腔积液临床表现：胸痛、进行性呼吸困难,Pleuraltumor,1.胸膜转移的X线表现,难以发现小的转移病灶胸腔积液,metastatictumorofpleura,大量胸腔积液，无明显结节病灶胸膜腔散在的结节或不规则结节状增厚，同时有胸腔积液纵隔淋巴结增大增强检查胸膜转移结节影明显强化,胸膜转移的CT表现,metastatictumorofpleura,胸膜转移瘤的诊断,找到原发灶胸膜活检胸水脱落细胞胸