呼吸系统影像诊断学

呼吸系统影像诊断学ImagingdiagnosticsoftheRespiratorysystem

1精选ppt（四）肺结核Pulmonarytuberculosis:2精选ppt1.临床特点：clinicalcharacters（1）病原：pathogeny人或牛结核杆菌BacillustuberculosisorBacillustuberculosisbovis3精选ppt（2）病理：pathology①结核菌侵入人体后引起的基本病理变化为:basicpathologicalchangecausedbytuberculosis渗出及增殖exudationandproliferation

②机体抵抗力低下时，病变则出现:pathologicalchangeoflowresistance干酪样坏死，液化及空洞形成caseousnecrosis,colliquationandporosis.4精选ppt③机体抵抗力强或经适当治疗后病灶：pathologicalchangeoflowresistanceorpost–treatment吸收absorption纤维化fibrosis钙化calcification空洞瘢痕闭合或净化空洞cavitycloseorasepsiscavity5精选ppt（3）分期:stages①进展期：progression新发现病灶，病灶扩大newlesionandexpansion病灶边界变模糊obscureborder出现空洞或空洞增大，痰结核菌阳性cavityappearanceorexpansion,spitpositive②好转期：resolvingstage病灶缩小，边界变清楚，病灶消失

clarityofborderandlesseningordisppearanceoflesion空洞缩小或消失lessenordisappearofnidus

痰结核菌转阴性（连续3月，1次/月）spitnegative(3monthscontinous,1time/month)6精选ppt③稳定期：stationarystage病灶无活动lesioninactivity，空洞闭合cavitycloseup，痰结核菌连续6个月阴性（至少1次/月）spitnegative(6monthscontinus,1time/month)如有空洞，连续1年以上阴性，属临床治愈spitnegativecontinousmorethan1yearisclinicalcureifthecavityexsist再经观察2年仍无活动，结核菌仍阴性focusinactivityformore2yearsandspitnegativecontinous

如有空洞，需观察3年以上为临床痊愈clinicalcureshouldbeobservefor3yearsifthecavityexist7精选ppt2.影像表现：1978年全国结核病防治会议natinalconferenceforcureandprevetionoftuberculosis分为五个类型：Ⅰ型type：原发性肺结核primarypulmonarytuberculosis（原发综合征primarysyndrome，胸内淋巴结核intrathoracicscrofula）Ⅱ型type：

血行播散型肺结核hematogenouspulmonarytuberculosis（急性粟粒型肺结核acutemilitarytuberculosis，亚急性或慢性血行播散型肺结核subacuteorchronichematogenouspulmonarytuberculosis）8精选pptⅢ型：浸润型肺结核（含结核瘤和干酪肺炎）exudativepulmonarytuberculosis(tuberculomaandcaseouspneumonia)Ⅳ型：慢性纤维空洞型肺结核chronicfibro-cavernouspulmonarytuberculosisⅤ型：胸膜炎型肺结核tuberculouspleurisy

9精选ppt1998新制定中国结核病分类法：chinesegroupingoftuberculosis：Ⅰ型原发性肺结核primarypulmonary

tuberculosis（原发综合征primarysyndrome，胸内淋巴结核intrathoracicscrofula）Ⅱ型血行播散型肺结核hematogenouspulmonarytuberculosis（急性粟粒型肺结核acutemilitarytuberculosis，亚急性或慢性血行播散型肺结核subacuteorchronichematogenouspulmonarytuberculosis）

10精选pptⅢ型：继发性肺结核secondarypulmonarytuberculosis（含结核瘤tuberculoma、干酪肺炎caseouspneumonia、慢性纤维空洞型肺结核chronicfibro-cavernouspulmonarytuberculosis）Ⅳ型：结核性胸膜炎tuberculouspleurisyⅤ型：其他肺外结核如骨结核、肾结核和结核性脑膜炎等extrapulmonarytuberculosissuchasbasaltuberculosis，nephrotuberculosisandtubercularmeningitis11精选ppt（1）原发型肺结核:（Ⅰ型）primarypulmonarytuberculosis①原发综合征(primarysyndrome)：典型表现呈“哑铃状或双极期”:dumbbellorbipolarstage

12精选pptA.肺野原发病灶：primarylesionoflungfeild

边界模糊的云絮状阴影，可大可小patchyshadowofobscureborderandInequalityofsizeB.肺门及纵隔淋巴结肿大：enlargementofhilarandmediastinallymphnodes

边界清晰或模糊、圆或分叶状块影

the

borderisclearorobscureandthelesionisrotateorsublobe

C.淋巴管炎：angialymphitis

连接淋巴结和原发灶之间索条状影thestreakshadowisconnectionoflymphnodesandprimarylesion13精选ppt②胸内淋巴结结核(tuberculosisofintrathoraciclymphonodes)：原发病灶吸收absorptionofprimarylesion但淋巴结核因干酪化而愈合缓慢，slowcicatrizationofscrofulabecauseofcaseation

故只有淋巴结炎adenolymphitis14精选ppt典型表现:classicalcharacters肺门或纵隔有圆或椭圆结节状阴影，单个或多个singleormultiplenodositasrotateorellipselesionofhilusoflungormediastinal

边界清晰者clearborder

：肿瘤型tumortype

边界模糊者obscureboder：炎症型Inflammatorytype

15精选ppt16精选ppt原发综合征肺结核胸内淋巴结肺结核

primarysyndrometuberculosisofintrathoraciclymphonodes17精选ppt（2）血行播散型肺结核hematogenouspulmonarytuberculosis

（Ⅱ型）①急性粟粒型肺结核（acutemiliarytuberculosis）：结核菌一次大量进入肺循环massofBacillustuberculosiscomeintopulmonarycircuIation所以肺部病变广泛，临床症状较重pulmonarylesioniswideandclinicalsymptomissevere18精选ppt1.病变早期：earlystage

只见肺呈磨玻璃样groundglasspulmonary2.发病10天大约后：10daysafteronste

见1.5~2mm大小的粟粒状影miliarylesion大小一致，分布均匀，密度相似normalsize,densityandequalityofdistribution正常肺纹理看不清

normallungmarkingcannotbeobserved3.治疗后数月内吸收absorptionafterseveralmonths’treatment恶化则融合，出现空洞amalgamationfordegenerationandcavitypresent19精选ppt20精选ppt21精选ppt②亚急性或慢性血行播散型肺结核:（又称慢性播散型肺结核，chronicdisseminatedpulmonarytuberculosis）：结核菌少量，多次进入肺循环fewBacillustuberculosiscomeintopulmonarycirculationtimeaftertime症状较轻slightsymptom22精选ppt典型表现:classicalcharacters为结节状病灶nodositaslesion主要分布在两肺上、中部mediansuperiorlung（少数可单侧）大小不一，分布不均，密度不一致，呈多种性质病灶abnormalsize,densityandasymmetryofdistributionandmultinature23精选ppt急性粟粒型肺结核亚急性、慢性血行播散型

肺结核24精选ppt（3）浸润型肺结核（infiltrativepulmonarytuberculosis）:为继发性肺结核，最常见

secondpulmonarytuberculosisandbestcommonX线表现有三种形式：25精选ppt①常见表现：好发于两肺或一侧肺的锁骨上、下区regionesofsupraclavicularorinfraclavicula

可以呈多种性质multinature，多种形态multianatomy，多个小叶性病灶multilesionofsublobe病灶边界模糊obscureborder病灶可融合成大片或出现空洞lesionmergeortogethercavitypresent26精选ppt②结核瘤（球）tuberculoma：系干酪样结核病变被纤维组织包绕而成caseastionoftuberculosiscircumfusedbyfibroustissue一般为圆或椭圆形致密影rotateorellipsehighdensitylesion大小2~3cm多数轮廓光滑outlineissmooth病灶内可有钙化或小空洞calcificationorsmallcavityinthelesion病灶周围常有卫星病灶satellitearoundthelesion

27精选ppt③干酪性肺炎caseouspneumonia

：机体抵抗力差，对结核菌高度过敏而形成，分大叶性和小叶性Lowresistanceandhypersensitivetotuberculosis.Divideintolobarandlobularpneumonia.大叶性呈肺段或大叶实变阴影，内有无壁空洞，其余部位可有播散病灶Lobarpneumoniaishighdensitylesionofsegmentorlobarandcavitywithoutwallinit.Disseminatuslesionsinotherregions.小叶性病灶呈小片状阴影，常与大叶性病灶同时存在Lobularlesionislobularshadowandcoexistwithlobarlesion28精选ppt

浸润型肺结核

常见表现结核球29精选ppt浸润型肺结核（干酪性肺炎）

平片断层片30精选ppt31精选ppt32精选ppt（4）慢性纤维空洞型肺结核（Ⅳ型）

Chronic

fibrocavitarypulmonarytuberculosis①为各型结核恶化、好转与稳定交替发展而来的晚期肺结核Latepulmonarytuberculosisbydegeneration,improvementandstabilizationofalltuberculosis

33精选ppt②X线、CT