高分辨率胸部CT高清图片PPT课件.ppt

高分辨率肺部CT 1 HRCT扫描技术 2 正常HRCT 3 中央肺动脉 4 支气管与相邻肺动脉直径大致相等 5 肺动脉常分为两个直径相当的分支 6 肺静脉常分成许多细小的分支 这些分支与主支构成直角 7 叶间裂 厚度小于1mm 边缘光滑 均一厚度 8 常见伪影 双侧下肺近心脏处 肺血管脉动伪影 低密度区 可以错当作扩大的支气管 9 常见伪影 主叶裂伪影 10 常见伪影 血管双重伪影 11 TheSecondaryPulmonaryLobule肺小叶 直径1 2 5CM 12 小叶支气管 终末细支气管 13 肺动脉pulmonaryartery 14 小叶间隔interlobularsepta 15 肺静脉pulmonaryvein 16 腺泡pulmonaryacini 17 正常小叶间隔normalsepta 18 正常小叶中心动脉 19 centrilobularartery2 20 肺静脉Pulmonaryveins 21 RETICULAROPACITIES 网状结构 22 肺间质病变 发生于 慢性间质性肺炎 弥漫性间质纤维化 结节病 癌性淋巴管炎 结缔组织病 红斑狼疮 类风湿性关节炎 硬皮病 皮肌炎 尘肺 矽肺 煤矽肺 石棉肺 组织细胞病 淋巴管平滑肌瘤病 界面征 小叶间隔增厚 小叶中心结构增厚 胸膜下线 长疤痕线 扭曲肺结构 蜂窝样改变 结节影 牵拉性支扩 磨玻璃样改变 23 网状结构reticularopacities F 60y乳腺癌术后 现呼吸困难 24 分析 1 小叶间隔增厚thickeningofinterlobularsepta 25 分析 2 支气管血管周围间质增厚thickeningoftheperibronchovascularinterstitium 支气管袖口症 peribronchialcuffing 26 分析 3 斜裂增厚thickeningofthemajorfissure 27 分析 3 大结节影Largenodules 28 上病例为癌性淋巴管炎 网状阴影 病理上主要为小叶间隔增厚 小叶内间隔增厚 小叶核心增厚 胸膜下线影 蜂窝肺和支气管血管周围间质增厚等改变 可见于特发性间质性肺炎 结节病 癌性淋巴管炎 特发性含铁血黄素沉积 感染性疾病等 双肺网状阴影多见与特发性间质性肺炎 结缔组织病肺浸润 结节病等 单侧以癌性淋巴管炎和放射性肺炎为主 29 测试 M 73y 咳嗽 喘憋 30 31 Isseptalthickeningapredominantfinding Isseptalthickeningapredominantfinding a Yes b No小叶间隔增厚 32 右侧肺小叶间隔增厚 33 Aretheseptasmoothornodularinappearance a Smooth b Nodular小叶间隔光滑增厚还是结节状增厚 34 smooth光滑增厚 35 支气管血管间质Istherethickeningoftheperibronchovascularinterstitium a Yes b No支气管血管间质是增厚的 36 支气管袖口症peribronchialcuffing 37 胸膜下间质Istherethickeningofthesubpleuralinterstitium a Yes b No胸膜下间质是增厚的 38 斜裂增厚thickeningofthemajorfissure 39 Whatisthemostlikelydiagnosis 可能的诊断 a Pulmonaryedema肺水肿 b Interstitialfibrosis间质纤维化 c Lymphangiticspreadofcarcinoma癌性淋巴管炎 40 右肺门肿块 纵隔淋巴结肿大 41 PLCresultsfromhematogenousspreadtolung withsubsequentinterstitialandlymphaticinvasion or asinthiscase directlymphaticspreadoftumorfromhilarormediastinallymphnodes 癌性淋巴管炎 血性播散到肺淋巴系统 42 淋巴播散图表 43 79 year oldmanwithknownlymphoma79岁 淋巴瘤病史 44 45 AreHRCTfindingsofinterlobularseptalseptalthickeningvisible a Yes b No小叶间隔增厚 46 双侧光滑增厚的小叶间隔 Allscansshowmarkedsmooththickeningofinterlobularseptainvolvingbothlungsinasymmetricalfashion 47 Istherethickeningoftheperibronchovascularinterstitium a Yes b No支气管血管间质是否增厚 48 增厚的支气管血管间质 49 Istherethickeningofthesubpleuralinterstitium a Yes b No胸膜下间质增厚 50 斜裂增厚 51 Whatisthemostlikelydiagnosis 最可能的诊断 a Pulmonaryedema b Interstitialfibrosis c Lymphangiticspreadoflymphoma 52 Diagnosis Lymphangiticspreadoflymphoma withinterlobularseptalthickening 癌性淋巴管炎 小叶间隔增厚 53 lymphocyticinterstitialpneumonitis LIP 淋巴间质局限性肺炎 54 58 year oldmanwithheartdisease 55 DoHRCTfindingsincludeinterlobularseptalthickening a Yes b No小叶间隔增厚 56 双侧小叶间隔增厚 57 Istherethickeningoftheperibronchovascularinterstitium a Yes b No支气管血管间质增厚 58 支气管血管间质增厚 59 Istherethickeningofthesubpleuralinterstitium a Yes b No胸膜下间质增厚 60 NO 61 Whatisthemostlikelydiagnosis a Pulmonaryedema肺水肿 b Interstitialfibrosis间质纤维化 c Lymphangiticspreadofcarcinoma癌性淋巴管炎最可能的诊断 62 a Pulmonaryedema肺水肿Correct Becauseofthehistoryofheartdisease心脏病史 characteristicabnormalities典型的异常 symmetry对称 andthepredominanceofseptalthickeningindependentlung thisdiagnosismustbeconsidered考虑mostlikely 63 文献 间质性肺水肿 1 肺血重新分布 左心衰 肺淤血 2 支气管周围袖口症 正常厚度约1mm 结缔组织内液体存积 增厚 X 肺纹理及肺门血管增粗 模糊 3 肺透过度下降 液体分布到支气管血管周围 小叶间隔 小叶内支气管血管周围 肺泡间隔 透过度下降 4 间隔线 KerleyB线 x上与肋膈角处与胸膜垂直 5 胸膜增厚 液体 入脏层胸膜下薄层结缔组织 胸膜下结缔组织水肿 水肿位于脏层胸膜与结体组织间 不随体位移动 胸腔积液 胸膜腔内液体来自壁层胸膜 64 不同原因的肺水肿 心源性肺水肿 左心衰 见于心梗 二尖瓣病变 肾性肺水肿 急慢性肾功能衰竭 可合并尿毒症 水钠潴留 左心衰 肺水肿 上腔静脉 奇静脉增宽 血管蒂增宽 3 肺微血管损伤性肺水肿 除肺水肿外 还可见出血及细胞渗出 肺血分布正常 无袖口症 间隔线 肺泡实变斑片状 肺野外为分布 毒性气体吸入 胃液吸入 药物 溺水 颅内压升高 高原性肺水肿 复张性肺水肿 65 66 9 a53 year oldwomanwithandabnormalchestradiographandmildshortness 短缺 ofbreath 67 68 Isseptalthickeningpresent a Yes b No小叶间隔增厚吗 69 增厚的小叶间隔 70 Aretheseptasmoothornodularinappearance a Smooth b Nodular小叶间隔增厚是结节状还是光滑增厚 71 小叶间隔结节状增厚 72 胸膜下间质结节影 73 支气管袖口症 74 Possiblediagnosesinclude a pulmonaryedema肺水肿 b interstitialfibrosis间质纤维化 c lymphangiticspreadoflymphoma d sarcoidosis结节病最可能的诊断 75 sarcoidosis结节病Correct Nodularthickeningofinterlobularseptaandfissurescanbeseeninthisdiseaseandlymphangiticspreadofcarcinoma 小叶间隔结节状改变可见于结节病 癌性淋巴管炎 尘肺 支气管血管间质 胸膜下间质结节状改变 对结节病有特征性的诊断 76 Case10ina42 year oldmanwithmildshortness 短缺 ofbreathforanumberofyears 77 Isseptalthickeningvisible a Yes b NoNextPage小叶间隔增厚吗 78 增厚的小叶间隔 79 扭曲的肺结构 80 叶间裂的扭曲 81 Diagnosis End stagesarcoidosiswithfibrosisandinterlobularseptalthickening 结节病伴随征象 肺结构扭曲 小叶间隔结节状增厚 牵拉性支扩 蜂窝肺等 82 文献 肺间质病变 界面征 支气管血管间质增厚 支气管血管束增粗 支气管袖口症 液体 边缘光滑 肿瘤或肉芽组织 结节状界面 胸膜下线 近胸膜面1cm内弧线状影 为肺纤维化征象 长疤痕线 蜂窝肺 结节影 小结节 2 5mm 肉芽 肿瘤 纤维组织 肺结构扭曲变形及牵拉支扩 磨玻璃样改变 83 Case11ina68 year oldwomanwithrheumatoidarthritis 风湿性关节炎 andprogressive累计shortness短缺ofbreathovera2 yearperiod 84 85 Thepredominantabnormalfindingonthesescansis a interlobularseptalthickening小叶间隔增厚 b honeycombing蜂窝肺主要的异常表现 86 蜂窝肺 87 部分层面小叶间隔增厚 88 Whatdoeshoneycombingreflecthistologically a Interstitialedema肺间质水肿 b Interstitialinfiltration渗透bycells c Interstitialfibrosis蜂窝肺的组织学 肺间质纤维化的后期表现 89 Diagnosis Rheumatoidlungdisease withfibrosisandhoneycombing 风湿性肺疾病 肺纤维化 蜂窝肺 壁厚0 8 1MM 胸膜下3 4cm范围内或近叶裂处 早期囊腔小而少 囊壁为折叠破坏的肺泡壁及气道壁 90 91 Case12ina74 year oldwomanwithprogressiveshortnessofbreathover6months 92 Themostsignificantabnormalfindinginthisstudyis a interlobularseptalthickening小叶间隔增厚 b honeycombing蜂窝肺 c subpleuralemphysema胸膜下肺气肿主要的异常表现 93 蜂窝肺 94 Whatisthemostlikelydiagnosis a Idiopathicpulmonaryfibrosis IPF 特发性肺间质纤维化 b Autoimmunedisease e g rheumatoidlungdisease 自身免疫性疾病 c End stagehypersensitivitypneumonitis过敏性肺炎 d Asbestosis石棉肺 e Drug relatedlunginjury麻醉药物肺损害 f Sarcoidosis结节病最可能的诊断 95 IPF 特发性肺间质纤维化 磨玻璃密度 肺野周围 活动性肺泡炎症 网状改变 小叶间隔 小叶中心结构增厚 蜂窝状改变的前期 蜂窝状改变 胸膜下间质纤维化 胸膜下弧线状影 脏层胸膜及叶间胸膜增厚 肺气肿 小叶中心型肺气肿 肺实变 支扩 96 蜂窝肺 97 牵拉性支扩 98 小叶间隔增厚 99 Case1386 year oldmanwithchronicmyelogenousleukemia骨髓性的白血病 treatedusingmethotrexate化疗 nowcomplainsofshortnessofbreath气短 100 101 DoesthismanshowevidenceoffibrosisandUIP a Yes b No显示明显的纤维化和普通间质性肺炎 屑性间质性肺炎 DIP 普通性间质性肺炎 UIP 102 a YesCorrect Findingsindicativeofusualinterstitialpneumonitis UIP visibleinthispatientinclude honeycombing 蜂窝肺irregularfissures 叶裂扭曲irregularinterlobularseptalthickening 小叶间隔不规则增厚 tractionbronchiectasis 牵拉性支扩 103 蜂窝肺 104 叶裂扭曲 105 不规则小叶间隔增厚 106 牵拉性支扩 107 Themostlikelydiagnosisis 可能的诊断 a idiopathicpulmonaryfibrosis IPF b lunginvolvementbyleukemia白血病肺浸润 c drug relatedlunginjury化疗药物肺损害 108 c drug relatedlunginjuryCorrect Thepatternoffibrosisseeninthispatientisnonspecific andcouldbecausedbyIPF Therecenthistoryoftreatmentwithmethotrexatemakesdrug relatedfibrosismostlikely Lunginvolvementbyleukemiawouldlikelyresultinanappearancesimilartothatoflymphangiticspreadofcarcinomawithseptalthickeningbeingthepredominantfinding IPF一可有同种表现 但患者有最近化疗史 白血病肺浸润小叶间隔增厚明显 109 110 Case14ina63 year oldmanwithahistoryofscleroderma硬皮病andprogressiveshortnessofbreath进行性喘憋 111 Findingsinclude interlobularseptalthickening 小叶间隔增厚 tractionbronchiectasis 牵拉性支扩subpleuralhoneycombing 胸膜下蜂窝肺irregularfissures 叶裂扭曲 112 小叶间隔增厚 113 牵拉性支扩 114 胸膜下蜂窝肺 115 斜裂扭曲 116 Canyoubeconfidentthatlungfibrosisispresent a Yes b No你能确定肺纤维化存在 117 YesCorrect Thepresenceofhoneycombingisdiagnosticoffibrosis Tractionbronchiectasisisalsostronglysuggestiveoffibrosis Interlobularseptalthickeningandirregularfissuresarenonspecific andcannotbereliedupontodiagnosefibrosis 蜂窝肺 牵拉性支扩 肺纤维化存在 小叶间隔增厚 斜裂扭曲对肺纤维化的诊断意义不大 118 Diagnosis Scleroderma withlungfibrosis honeycombing andtractionbronchiectasis硬皮病 肺纤维化 蜂窝肺 牵拉性支扩 结缔组织病及肺血管炎 主要为肺间质病变 肺内实变 肺泡内渗出 肉芽肿形成 肺泡内出血 水肿 肺内多发结节 肺内血管炎 肉芽肿 肺栓塞所形成 常见于 wengner 类风湿性关节炎 肺间质病变 肺间质性肺炎 肺泡炎 间质纤维化 蜂窝肺 119 120 Case15ina61 year oldwomanwithprogressiveshortnessofbreath进行性喘憋 121 Whichofthefollowingfindingsareshownonthisscan 上图包含症像 a Honeycombing蜂窝肺 b Asubpleuralline胸膜下线 c Aperipheralandsubpleuraldistribution外围胸膜下分布 d Alloftheabove以上全包括 122 AlloftheaboveCorrect Smallsubpleuralcystsarepresenttypicalofmildhoneycombing 轻度的蜂窝肺Anirregularlineparallelsthepleuralsurface termedasubpleuralline 胸膜下线 123 Whichofthefollowingismostlikelyinthiscase 最符合的诊断 a Idiopathicpulmonaryfibrosis IPF 特发性间质纤维化 b Autoimmunedisease e g rheumatoidlungdisease 自身免疫性疾病 c End stagehypersensitivityPneumonitis过敏性肺炎 d Asbestosis石棉肺 e Drug relatedlunginjury药物肺损害 f Sarcoidosis结节病 124 Idiopathicpulmonaryfibrosis IPF Correct Idiopathicpulmonaryfibrosis IPF Intheabsenceahistorytosuggestoneofthespecificdiagnosesonthislist IPFismostlikely Itaccountsfor60 ofcaseshavingthisappearance IPF在该病例无特异性 60 有该表现 125 126 Case16ina34 year oldmanwithprogressiveshortnessofbreath喘憋 127 128 Thepredominantabnormalityinthiscaseis 明显的异常表现 a honeycombing蜂窝肺 b intralobularinterstitialthickening小叶间质增厚 129 intralobularinterstitialthickeningCorrect Honeycombingisnotvisibleinthispatient Afineirregularreticular不规则的网状改变patternispresentinthelungperiphery representingintralobularinterstitialthickening 小叶间质增厚Insomepatientswithpulmonaryfibrosis thisfindingwillpredominate Otherfindingsoffibrosisinthispatientincludetractionbronchiectasis 牵拉性支扩Thedifferentialdiagnosisofthisappearanceisidenticalasthatforhoneycombing 130 小叶间质增厚 131 牵拉性支扩 132 Diagnosis Idiopathicpulmonaryfibrosis特发性间质纤维化 withintralobularinterstitialthickening 133 134 Case17ina71 year oldmanwithprogressiveshortnessofbreath 135 136 Thepredominantabnormalityinthiscaseis 突出的表现 a honeycombing蜂窝肺 b intralobularinterstitialthickening小叶间质增厚 137 intralobularinterstitialthickeningCorrect Honeycombingisnotclearlyseeninthispatient Afinebutirregularreticularpattern不规则的网状改变ispresentinthelungperiphery外围 representingintralobularinterstitialthickening小叶间质增厚 Insomepatientswithpulmonaryfibrosis thisfindingwillpredominate Otherfindings其他征象offibrosisinthispatientincludetractionbronchiectasis牵拉性支扩 andirregularinterlobularseptalthickening不规则小叶间隔增厚 Thedifferentialdiagnosisofthisappearanceisidenticaltothatforhoneycombing 138 小叶间质增厚 139 牵拉性支扩 140 不规则小叶间隔增厚 141 Diagnosis Idiopathicpulmonaryfibrosis特发性间质纤维化 withintralobularinterstitialthickening 142 143 Case18 ina55 year oldsalamimanufacturer腊肠制造商withprogressiveshortnessofbreath 144 Themostlikelydiagnosisinthiscaseis 最可能的诊断 a Idiopathicpulmonaryfibrosis IPF 特发性间质纤维化 b Autoimmunedisease e g rheumatoidlungdisease 自身免疫系统疾病 c End stagehypersensitivitypneumonitis过敏性肺炎 d Asbestosis石棉肺 e Drug relatedlunginjury药物肺损害 f Sarcoidosis结节病 145 Anydiagnosisispossible 任何诊断都是可能的 146 Case19in34 year oldwomanwithlupuserytematosus狼疮红斑 147 148 Canyoudiagnosefibrosis 能诊断纤维化 a Yes b No 149 YesCorrect HRCTobtainedinthesupineandpronepositions仰卧和俯卧位showsanumberoffindingsindicatingfibrosis指示 including honeycombingwhichismildindegree 轻度蜂窝肺tractionbronchiectasis 牵拉性支扩intralobularinterstitialthickening 小叶间质增厚interlobularseptalthickening小叶间隔增厚 andasubpleuraldistribution 胸膜下分布 150 轻度蜂窝肺 151 牵拉性支扩 152 小叶间质增厚 153 小叶间隔增厚 154 Diagnosis Systemiclupuserythematosus SLE系统性红斑狼疮肺部表现 肺结缔组织病 withfibrosisandhoneycombing 155 156 Case20ina65 year oldwomanwithrheumatoidarthritis风湿性关节炎andmilddyspnea轻度呼吸困难 157 Canyoudiagnosefibrosis 能诊断纤维化 a Yes b No 158 Correctincluding tractionbronchiectasis 牵拉性支扩intralobularinterstitialthickening 小叶间质增厚asubpleuralline 胸膜下线 159 牵拉性支扩 160 小叶间质增厚 161 胸膜下线 162 Diagnosis Rheumatoidlungdisease肺结缔组织病 withmildpulmonaryfibrosis轻度肺纤维化andintralobularinterstitialthickening小叶间质增厚 163 164 Case21ina26 year oldwomanwithmixedconnectivetissuedisease混合结缔组织病 basilarcracklesonphysicalexamination双肺底水泡音 andrestrictivediseaseonpulmonaryfunctiontests肺功能受限 165 166 Canyoudiagnosefibrosis 能诊断纤维化 a Yes b No 167 YesCorrect Including tractionbronchiectasis 牵拉性支扩intralobularinterstitialthickening小叶间质增厚 asubpleuraldistribution胸膜下分布 168 牵拉性支扩 169 小叶间质增厚 170 Diagnosis Mixedconnectivetissuedisease混合结缔组织病 withpulmonaryfibrosis andintralobularinterstitialthickening 171 172 Case22 ina81 year oldmanwithsignificantoccupationalexposuretoasbestos石棉职业史 173 174 Ispulmonaryfibrosispresent 肺纤维化存在 a Yes b No 175 YesCorrect Findingsoffibrosisinclude tractionbronchiectasis 牵拉性支扩intralobularinterstitialthickening 小叶间质增厚asubpleuraldistribution 胸膜下分布irregularinterlobularseptalthickening不规则的小叶间隔增厚 176 牵拉性支扩 177 小叶间质增厚 178 胸膜下分布 179 小叶间隔增厚 180 Diagnosis 石棉肺Asbestosiswithtractionbronchiectasis牵拉性支扩andintralobularinterstitialthickening小叶间质纤维化 181 纵隔窗 182 pleuralthickeningandcalcification胸膜增厚 钙化 椎旁区域 横膈胸膜肥厚钙化 183 Case24ina58 year oldmanwithahistoryofasbestosexposure石棉史 184 可见椎旁胸膜增厚 不规则线状影 185 Thepleuralthickeningistypicalofasbestosexposure胸膜增厚是典型的石棉肺表现 Wouldyoudiagnoseasbestosis诊断石棉肺吗 a Yes b No 186 NoCorrect Linearopacities线状影asseeninthiscase termedparenchymalbands肺实质带 arecommoninpatientswithpleuralthickening胸膜增厚 butarenotnecessarilyassociated不必须考虑withlungfibrosis肺纤维化 187 肺实质带parenchymalbands 位于下肺部 肺内条状影 肺实质内的纤维化 188 尽管如此 结合病史 考虑Asbestosexposurewithpleuraldiseaseandparenchymalbands石棉至椎旁胸膜增厚 肺实质带 189 190 Case25ina67 year oldmanwithahistoryofasbestosexposure石棉史 191 NoCorrect HRCTatlungwindowsshowsirregularlinearopacities不规则的线状影 crow sfeet 乌鸦脚 withoutevidenceofhoneycombing无蜂窝肺 intralobularinterstitialthickening小叶间质增厚 ortractionbronchiectasis牵拉性支扩 Thisappearancedoesnotindicateasbestosis无石棉特征 Linearopacities asseeninthiscase parenchymalbands肺实质带 arecommoninpatientswithpleuralthickeningrelatedtoasbestosexposure butarenotnecessarilyassociatedwithlungfibrosis不必须考虑肺纤维化 Theyrepresentfocalareasofatelectasis焦点为肺膨胀不全 associated联系withthepleuralthickening orfocalareasofscarring焦点区疤痕 192 乌鸦脚 crow sfeet 193 即 尽管如此 结合病史考虑Asbestosexposurewithpleuraldiseaseandparenchymalbands 另一病例 胸膜下线椎旁胸膜增厚 194 195 Case26ina56 year oldmanwithsignificantoccupationalexposuretoasbestos石棉史 196 Istherepleuralthickening胸膜增厚youwouldconsider考虑likely可能duetoasbestosexposure石棉 a Yes b No 197 Yescorrect Afocal焦点 calcifiedpleuralplaque胸膜钙斑isvisibleanteriorly typicalofasbestosexposure石棉肺典型表现 Althoughplaquesaremorelikelyposteriorinlocation常见后胸膜 thisappearanceishighlysuggestive高度提示 198 Canadefinitediagnosisofpulmonaryfibrosisonthepronelungwindowscansbemade 肺窗能明确诊断肺纤维化吗 a Yes b No 199 NoCorrect Thereismildseptalthickening轻度间隔增厚andreticulation网状intheposteriorsubpleuralregion后胸膜下ontheright Thisisunassociated无联系withadjacent临近pleuralthickening Thisisaverysubtleabnormality轻微的异常whichcouldrepresenttheearlieststageofasbestosis石棉肺早期表现 However intheabsenceofamoredefiniteabnormality明确的异常orsimilar类似findingsontheleft itwouldbedifficult困难tomakeadefinitediagnosisoffibrosis石棉肺或肺纤维化的诊断orasbestosis 200 小叶间质增厚 轻度网状改变 201 Diagnosis Asbestosisexposure石棉肺 Possiblefibrosis可能纤维化 文献 石棉肺 1 胸膜改变 胸膜斑 弥漫性胸膜增厚 胸腔积液 2 肺改变 弥漫性肺间质纤维化 HRCT胸膜下弧线 胸膜下点状致密影 肺实质带 蜂窝状改变 胸膜下磨玻璃表现 肺泡壁小叶间隔增厚 圆形肺不张 支气管血管结构进入 彗星尾征 202 203 Case27ina57 year oldwomanwithyearsofprogressivedyspnea多年呼吸困难 204 205 Ispulmonaryfibrosispresent 肺纤维化存在吗 a Yes b No 206 YesCorrect Thispatientshowsanumberof许多findingsindicativeofpulmonaryfibrosis肺纤维化征象 Theseinclude Extensive广泛的tractionbronchiectasis牵拉性支扩involvingbothupperlobes双上叶 Irregularreticularopacities不规则的网状anddistortionoflungarchitecture肺结构扭曲associatedwithtractionbronchiectasis andHoneycombingatthelungbases下肺蜂窝状改变 207 牵拉性支扩 208 扭曲的肺结构 209 蜂窝肺 210 Isthedistributionofabnormalitiestypicalofidiopathicpulmonaryfibrosis 特发性间质纤维化的异常类型 a Yes b No 211 NoCorrect Withexceptionoftheposteriorhoneycombing后部蜂窝肺 thefindingsoffibrosisinthispatientlacktheperipheral不在外围 lowerlobe andsubpleuralpredominance胸膜下ofIPF Thesefindingsaretypical典型ofend stagesarcoidosis 212 Diagnosis End stagesarcoidosis结节病 withtractionbronchiectasis牵拉性支扩andhoneycombing蜂窝肺 213 DISCUSSIONInpatientswithsarcoidosis结节病 progressivefibrosisoftenleads累计纤维化常导致toperibronchovascularconglomeratemassesoffibroustissue支气管血管束聚集成纤维块 typicallymostmarkedintheupperlobes上叶显著 Bronchiandvesselsareclusteredtogetherbecauseofretraction andbronchiappeardilated i e tractionbronchiectasis theonlyotherdiseasesthatcommonlyresultinthisappearancearesilicosis tuberculosis andtalcosis Posteriordisplacementoftheupperlobebronchiindicatingvolumelossintheposteriorsegmentsoftheupperlobesisacommonearlyfinding Honeycombingorlungcystscanbepresentinpatientswithsarcoidosis butthisfindingislesscommonthaninotherfibroticlungdiseasessuchasidiopathicpulmonaryfibrosis Honeycombingisusuallylimitedtopatientswithseverefibrosisandcentralconglomerationofbronchi Thehoneycombingseeninpatientswithsarcoidosisinvolvesmainlythemiddleandupperlungzones withrelativesparingofthelungbases However inanoccasionalcase findingscanmimicIPF 214 支气管血管束聚集成纤维块 215 216 217 Case28ina46 year oldmanhistoryofshortnessofbreath喘憋andhemoptysis咳血 218 219 Ispulmonaryfibrosispresent 肺纤维化 a Yes b No 220 YesCorrect Thispatientshowsanumberof许多的findingsindicativeofpulmonaryfibrosis肺纤维化征象 221 Arethefindingsweseetypicalofidiopathicpulmonaryfibrosis 能否诊断特发性间质纤维化 a Yes b No 222 NoCorrect Typicalsubpleuralhoneycombingorreticulation withabasal subpleural andposteriorpredominanceisabsentI特发间质纤维化肺的外围和肺底部网状 蜂窝状 向心性减轻 Findingsoffibrosisinthispatientinclude tractionbronchiectasis牵拉性支扩inassociationwithcentral peribronchovascularmassesoffibroustissueshownonlungwindowsandsofttissuewindows软组织窗支气管血管束纤维块 irregularinterlobularseptalthickening 不规则小叶间隔增厚distortionoffissures 叶裂扭曲lungcystsorbullae肺大泡sometimestermed paracicatricialemphysema andanupperlobepredominance withsparingofthelungbases Figure5 223 牵拉性支扩 224 支气管血管束纤维块 225 不规则的小叶间隔增厚 226 叶裂扭曲 227 肺大泡 228 Whatisthemostlikelydiagnosis 最可能的诊断 a Idiopathicpulmonaryfibrosis特发性间质纤维化 b Sarcoidosis结节病 c Asbestosis石棉肺 d Hypersensitivitypneumonitis过敏性肺炎 e Tuberculosis肺结核 229 SarcoidosisCorrect Thesefindingsaretypicalofend stagesarcoidosis 230 Animportantadditionalfinding额外的征象ispresent Thismostlikelyrepresents可能是 a anaspergilloma曲霉菌球 b alargesarcoidgranuloma大结节肉芽肿 c lungcancer肺癌 d tractionbronchiectaiswithamucousplug牵拉支扩粘液栓 231 232 anaspergilloma曲菌球Correct Thisistypicalofanaspergillomaarisinginapreexisting先前存在cyst囊orcavity洞 Diagnosis End stagesarcoidosis withtractionbronchiectasis牵拉性支扩andcysts complicatedbyanaspergilloma曲菌球 233 In20 25 ofpatientswithsarcoidosis fibrosisresultsfromhealingofgranulomas20 25 结节病纤维化来源于肉芽肿的治疗 Asfibrosisdevelops irregularreticularopacities includingirregularseptalthickening oftenbecomeaprominentfeature纤维化进一步呈网状 小叶间隔增厚 Progressivefibrosisleadstoabnormalcentralconglomerationofparahilarbronchiandvessels associatedwithmassesoffibroustissue肺门支气管血管纤维块 typicallymostmarkedintheupperlobes上叶多见 Thisfindingisfrequentlyassociatedwithbronchial