晕征与反晕征PPT课件

晕征与反晕征halosignandreversedhalosign,晕征与反晕征,结节与肿块,CT表现：致密影,直径5mm称微结节（23mm粟粒结节）直径510mm称小结节10mm者统称结节,一般将小于等3cm者称为结节，大于3cm者称为肿块。,基本概念,晕征与反晕征,是指肺部CT或薄层CT上，肺密度轻度增加，支气管和血管轮廓可见，形似磨玻璃，称磨玻璃密度影。,意义非特异，任何使肺实变、远端气腔内空气含量减少而又不使肺泡全部闭塞的因素都可产生磨玻璃影。,磨玻璃密度影（GGO）,基本概念,晕征与反晕征,晕征,CT表现在CT上肺内结节或肿块周围的晕状磨玻璃密度影，低于中央结节，但高于正常肺组织，形似日晕。,晕征与反晕征,分类,一、出血性肺结节(一)感染性疾病中的出血性结节(毛霉菌病、念珠菌病、结核病、病毒性肺炎、侵袭性曲菌病)(二)非感染性疾病中的出血性结节（韦格纳肉芽肿病，Kabosi肉瘤，）二、肿瘤细胞浸润性结节（细支气管肺泡癌，淋巴瘤、肺泡内肿瘤生长）三、非出血性结节（肉状瘤病，机化性肺炎）,晕征与反晕征,晕征病因,ArchBronconeumol.2008;44(7):386-92,晕征与反晕征,免疫功能不全侵袭性曲霉菌、毛霉菌、念珠菌及隐球菌,一晕征-感染性疾病-真菌,晕征与反晕征,一晕征-感染性疾病-真菌,KuhlmanJE1985,Invasivepulmonaryaspergillosis.A:Computedtomography(CT)scanofapatientwithacutelymphoidleukemiaandneutropeniashowinganodulesurroundedbyahalointherightupperlobe,withadjacentacinarinvolvement(arrows).B:Macroscopicsagittalsliceofanotherpatientslungshowingaroundnecroticlesion(asterisk)surroundedbyahemorrhagichalo(arrowheads),correspondingtoinvasivepulmonaryaspergillosis.C:MicroscopicimageofthemarginofthelesiondescribedinB,withvisiblepulmonarynecrosisandhemorrhage.TheimagealsoshowsthehyphaeofAspergillusfumigatus(arrows),whichareofregularcaliber,septate,andbranchingatacuteangles(hematoxylin-eosin,magnification2).,晕征与反晕征,中国CT和磁共振杂志2014年6月12卷3期,一晕征-感染性疾病-真菌,晕征与反晕征,免疫功能不全常见单纯疱疹病毒、巨细胞病毒、水痘带状疱疹病毒及粘病毒,一晕征-感染性疾病-病毒,晕征与反晕征,slow-resolvingbacterialpneumonia(吸收延迟性肺炎)放线菌结核分枝杆菌,一晕征-感染性疾病-细菌,晕征与反晕征,1.64岁男，退休，咳嗽、间断咯血2月来诊。吸烟，既往健康，痰涂片革兰阴性菌，培养：卡他布兰汉菌；2.45岁，既往心梗，吸烟，咳嗽1月间断咯血10天，痰培养：流感嗜血杆菌,中国实用内科杂志20097月29卷增刊1,一晕征-感染性疾病-细菌,晕征与反晕征,立克次体寄生虫,一晕征-感染性疾病-其他,晕征与反晕征,肾上腺嗜铬细胞瘤血管肉瘤转移瘤肾细胞癌绒毛膜癌肺血管肉瘤Kaposi肉瘤,二晕征-肿瘤性疾病-出血性瘤结节,晕征与反晕征,Hemorrhagicmetastasisinapatientwithchoriocarcinoma（绒毛膜癌）whopresentedwithmassivehemoptysis.A:Computedtomographyscanofthechestshowsmultiplehemorrhagicpulmonarynoduleswithahalosignthathavecoalescedintheposteriorsegmentsoftherightlung.B:Macroscopiclungsliceshowingseveralroundhemorrhagiclesions.C:Macroscopicimageofnodulescontaininghemorrhagicareas,fibrin,andtumorcells(hematoxylin-eosin,magnification10).,二晕征-肿瘤性疾病-出血性瘤结节,晕征与反晕征,细支气管肺泡癌消化系、胰腺、肺腺癌淋巴瘤,二晕征-肿瘤性疾病-瘤细胞浸润,晕征与反晕征,Bronchioloalveolarcarcinomainapatientwithchroniccough.A:Computedtomographyscanofthechestshowsnoduleswithahalosignintherightlung,withsomepseudocavitation(arrow).Alsovisibleisaconsiderableareaofconsolidationintheleftlung.B:Microscopicimageshowingthickenedalveolarwalls(asterisks)duetoinfiltrationbytumorcells(arrows)ematoxylin-eosin,magnification10).,二晕征-肿瘤性疾病-瘤细胞浸润,晕征与反晕征,Pulmonarylymphomaina73-year-oldpatientwhovisitedtheemergencyservicewithdyspnea.A:Anaxialscanofthelowerpulmonarylobesshowsmultiplepulmonarynoduleswithahalosignandatendencytocoalesceintheposteriorsegments.Thereisalsobilateralpleuraleffusion,somewhatgreaterontherightside.Thepatientdied3weeksafteradmission.B:Lowmagnificationimageofpulmonarynoduleshowingmainlyperibronchovasculartumorcellinfiltrationandmarkednecrosis(hematoxylin-eosin,magnification4).C:Ahigher-magnificationimageoftheperipheryofthenoduleshowstheinfiltrationoftumorcellsalongthealveolarwalls(arrows)(hematoxylineosin,magnification10).,晕征与反晕征,出血性结节非出血性结节,三晕征-非感染性疾病,晕征与反晕征,三晕征-非感染性疾病-出血性结节,韦格纳肉芽肿子宫内膜异位症活检,晕征与反晕征,Wegenergranulomatosis.A:Computedtomographyscanshowing2pulmonarynodulessurroundedbyahalo(arrows)andanareaofconsolidationintheleftlowerlobe(asterisk),alsowithahalosign.Thepatient,whosefirstsymptomwashemoptysis,alsohadrapidlyprogressingglomerulonephritis肾小球肾炎B:Microscopicimageshowinginflammatoryinfiltrationofthearterialwallwithamultinucleatedgiantcell(arrow)andendothelialdestruction(arrowheads)(hematoxylin-eosin,magnification20).,三晕征-非感染性疾病出血性结节,晕征与反晕征,结节病机化性肺炎闭塞性细支气管炎嗜酸细胞肺炎肺淀粉样变,三晕征-非感染性疾病非出血性结节,晕征与反晕征,反晕征,是CT肺窗，中心为磨玻璃样密度影，周围是高密度新月形或环形条带，与晕征的周围稍低密密度磨玻璃影相反，称反晕征。Voloudakietal1996cop,晕征与反晕征,反晕征病因,晕征与反晕征,一反晕征-感染性疾病-真菌,肺曲菌接合菌属（Zygomycetes包括根霉和毛霉）地方性真菌感染（南美芽生菌病-拉丁美洲-巴西）隐球菌早期征象,晕征与反晕征,Invasivepulmonaryaspergillosisina54-year-oldfemalewithmultiplemyelomaandsecondaryplasmacellleukaemiawhohadundergonechemotherapy.(a)High-resolutionCTimageatthelungbaseshowsarightlower-lobepulmonarynodule(arrow)andthereversedhalosign(RHS)intheleftlowerlobe(curvedarrow)withadjacentground-glassopacities.(b)CTimagewithmediastinalwindowsettingsshowstheperipheralconsolidationoftheRHS(asterisks).Noteasmallrightpleuraleffusion.,晕征与反晕征,Pulmonaryzygomycosisina22-year-oldmalewithprecursorB-cellacutelymphocyticleukaemia.(a)CTimageshowsthereversedhalosign(RHS)intheleftupperlobe(arrows).(b)CTscanperformed2monthslatershowsintervaldevelopmentofcavitation(aircrescentsign).ThepresenceofRHSinanimmunosuppressedpatientishighlysuggestiveofpulmonaryzygomycosis,especiallyifthepatientisreceivingprophylaxisforaspergillosis.,晕征与反晕征,Paracoccidioidomycosisina49-year-oldmale,residentofaruralareainBrazil.CTimageshowsreversedhalosign(RHS)lesions(arrows)andbilateralsmallpoorlymarginatedpulmonarynodules.ThepresenceofRHSinapatientfromanendemicregionforfungalinfectionshouldraiseconcernforthatspecificfungalinfection.,晕征与反晕征,一反晕征-感染性疾病-结核,Tuberculosisina59-year-oldfemale.High-resolutionCTimageshowsbilateralsmallcentrilobularnodules,tree-in-budopacitiesandareasofreversedhalosign(RHS).NotethenodularappearanceoftheringofconsolidationoftheRHSlesions(arrows),whichmaybehelpfulinthedifferentiationbetweenactivegranulomatousdiseaseandcryptogenicorganisingpneumonia.Thepresenceofassociatedcentrilobularnodulesandtree-in-budopacitiesshouldraisesuspicionoftuberculosis.,晕征与反晕征,二反晕征-机化性肺炎（19%）,Organisingpneumoniaina53-year-oldmalewithgraft-vs-hostdiseaseafterstemcelltransplantionfortreatmentofacutemyelogenousleukaemia.CTscanshowsbilateralperipheralandperibronchovascularconsolidativeopacitieswiththereversedhalosign(arrows).Open-lungbiopsyshowedorganisingpneumonia.Thepatientwastreatedwithsteroidswithresolutionofthelesions.,晕征与反晕征,二反晕征-机化性肺炎,47-yr-oldfemalewasreferredtoatertiarycentre(StMichaelsHospital,Toronto,Canada)forfurtherevaluationofchroniccough,fever,progressiveexertionaldyspnoeaandfatigue.Coronalchestcomputedtomographyscanshowingmultipleareasofcentralground-glassopacity,surroundedbyringorcrescentic-shape,denseairspaceconsolidation,mainlyintheleftlowerlobeandtherightupperlobe.Transbronchialbiopsyshowingorganisingpneumonia,晕征与反晕征,三反晕征-非特异性间质性肺炎,TheBritishJournalofRadiology,May2011,A52-year-oldfemalepresentedwithacoughandNewYorkHeartAssociation(NYHA)class2dyspnoeaof4monthsduration，CTimagesshowacentralground-glassopacitysurroundedbycrescentorring-shapedareasofconsolidation,showingthereversedhalosign.(e)6daysand(f)6monthsofsteroidtherapy,bothshowedimprovement.,晕征与反晕征,四反晕征-结节病,Sarcoidosisina44-year-oldfemale.High-resolutionCTimageshowsbilateralnodularopacitieswiththereversedhalosign(RHS)(arrows)andsmallpulmonarynoduleswithpredominantperilymphaticdistribution.ThepresenceoftheRHSassociatedwithnodulesinperilymphaticdistributionandmediastinalandhilarlymphadenopathy(notshown)shouldraisesuspicionofsarcoidosis.,晕征与反晕征,五反晕征-肺栓塞,Acutepulmonaryembolismwithpulmonaryinfarctionina64-year-oldfemale.(a)CTimageshowsthereversedhalosigninthesuperiorsegmentoftherightlowerlobe.(b)CTimage(mediastinalwindowsettings)showsaclotinthedistalrightmainpulmonaryarteryextendingtothesuperiorsegmentalbranchoftherightlowerlobepulmonaryartery.(c)2monthfollow-upCTscanshowscavitationoftheinfarctedpulmonaryparenchyma.,晕征与反晕征,Multifocalpulmonaryadenocarcinomaina70-year-oldfemale.CTimageshowsbilateralulmonarynoduleswiththereversedhalosign(blackarrows)andground-glasspulmonarynodules(whitearrows).,六反晕征-肿瘤,晕征与反晕征,Metastaticrenalcellcarcinomaina73-year-oldmale.TheCTscanshowsmultiplebilaterallesionswithreversedhalosign(RHS),biopsyproventorepresentmetastaticrenalcellcarcinomainabackgroundoffibrosisandnecrosis.Inpatientswithaknownprimarymalignancy,RHSlesionsmayrepresentatypicalpresentationofmetastaticdisease.Themaindifferentialdiagnosisisorganisingpneumonia,whichcanberelatedtodrugtoxicityifthepatientisreceivingchemotherapy.,六反晕征-肿瘤,晕征与反晕征,Reversedhalosign(RHS)followingradiofrequencyablation(RFA)ofapulmonaryadenocarcinomaina64-year-oldfemale.(a)CTimageshowstheadenocarcinomaintheleftlowerlobe.(b)CTscanperformed1monthafterRFAofthetumourshowsdevelopmentoftheRHS.WhenpresentshortlyafterRFA,theRHSshouldnotbeconfusedwithrecurrenceofdisease.,七反晕征-射频消融术后改变,晕征与反晕征,放疗相关肺疾病急性期肿瘤坏死炎症反应，肺组织坏死继发性机化性肺炎,八反晕征-放疗后改变,晕征与反晕征,八反晕征-放疗后改变,Reversedhalosign(RHS)followingprotonradiationtherapyforapoorlydifferentiatedsquamous（鳞癌）cellcarcinomaina71-yearoldmale.(a)CTima