晕征与反晕征.ppt

1、晕征与反晕征 halo sign and reversed halo sign,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5 10mm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,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,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。,分类,一、

2、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）,晕征病因,Arch Bronconeumol. 2008;44(7):386-92,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,一晕征-感染性疾病-真菌,Kuhlman JE 1985,Invasive pulmonary aspergillosis. A: Computed to

3、mography (CT) scan of a patient with acute lymphoid leukemia and neutropenia showing a nodule surrounded by a halo in the right upper lobe, with adjacent acinar involvement (arrows). B: Macroscopic sagittal slice of another patients lung showing a round necrotic lesion (asterisk) surrounded by a hem

4、orrhagic halo (arrowheads), corresponding to invasive pulmonary aspergillosis. C: Microscopic image of the margin of the lesion described in B, with visible pulmonary necrosis and hemorrhage. The image also shows the hyphae of Aspergillus fumigatus (arrows), which are of regular caliber, septate, an

5、d branching at acute angles (hematoxylin-eosin, magnification 2).,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,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,slow-resolving bacterial pneumonia (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,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

6、养：流感嗜血杆菌,中国实用内科杂志 2009 7月 29卷 增刊1,一晕征-感染性疾病-细菌,立克次体 寄生虫,一晕征-感染性疾病-其他,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,Hemorrhagic metastasis in a patient with choriocarcinoma（绒毛膜癌） who presented with massive hemoptysis. A: Computed tomography scan of the chest shows multiple hemorrhagic pu

7、lmonary nodules with a halo sign that have coalesced in the posterior segments of the right lung. B: Macroscopic lung slice showing several round hemorrhagic lesions. C: Macroscopic image of nodules containing hemorrhagic areas, fibrin, and tumor cells (hematoxylin-eosin,magnification 10).,二晕征-肿瘤性疾病

8、-出血性瘤结节,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,Bronchioloalveolar carcinoma in a patient with chronic cough. A: Computed tomography scan of the chest shows nodules with a halo sign in the right lung, with some pseudocavitation (arrow). Also visible is a considerable area of consolidation in the left

9、 lung. B: Microscopic image showing thickened alveolar walls (asterisks) due to infiltration by tumor cells (arrows) ematoxylin-eosin ,magnification 10).,二晕征-肿瘤性疾病-瘤细胞浸润,Pulmonary lymphoma in a 73-year-old patient who visited the emergency service with dyspnea. A: An axial scan of the lower pulmonar

10、y lobes shows multiple pulmonary nodules with a halo sign and a tendency to coalesce in the posterior segments. There is also bilateral pleural effusion, somewhat greater on the right side. The patient died 3 weeks after admission. B: Low magnification image of pulmonary nodule showing mainly peribr

11、onchovascular tumor cell infiltration and marked necrosis (hematoxylin-eosin, magnification 4). C: A higher-magnification image of the periphery of the nodule shows the infiltration of tumor cells along the alveolar walls (arrows) (hematoxylineosin,magnification 10).,出血性结节 非出血性结节,三晕征-非感染性疾病,三晕征-非感染性

12、疾病-出血性结节,韦格纳肉芽肿 子宫内膜异位症 活检,Wegener granulomatosis. A: Computed tomography scan showing 2 pulmonary nodules surrounded by a halo (arrows) and an area of consolidation in the left lower lobe (asterisk), also with a halo sign. The patient, whose first symptom was hemoptysis, also had rapidly progressin

13、g glomerulonephritis肾小球肾炎B: Microscopic image showing inflammatory infiltration of the arterial wall with a multinucleated giant cell (arrow) and endothelial destruction (arrowheads)(hematoxylin-eosin, magnification 20).,三晕征-非感染性疾病 出血性结节,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,反晕征,是CT肺窗，中心

14、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。Voloudaki et al 1996 cop,反晕征病因,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,Invasive pulmonary aspergillosis in a 54-year-old female with multiple myeloma and secondary plasma cell leukaemia who had undergone chemotherapy

15、. (a) High-resolution CT image at the lung base shows a right lower-lobe pulmonary nodule (arrow) and the reversed halo sign (RHS) in the left lower lobe (curved arrow) with adjacent ground-glass opacities. (b) CT image with mediastinal window settings shows the peripheral consolidation of the RHS (

16、asterisks). Note a small right pleural effusion.,Pulmonary zygomycosis in a 22-year-old male with precursor B-cell acute lymphocytic leukaemia. (a) CT image shows the reversed halo sign (RHS) in the left upper lobe (arrows). (b) CT scan performed 2 months later shows interval development of cavitati

17、on (air crescent sign). The presence of RHS in an immunosuppressed patient is highly suggestive of pulmonary zygomycosis, especially if the patient is receiving prophylaxis for aspergillosis.,Paracoccidioidomycosis in a 49-year-old male, resident of a rural area in Brazil. CT image shows reversed ha

18、lo sign (RHS) lesions (arrows) and bilateral small poorly marginated pulmonary nodules. The presence of RHS in a patient from an endemic region for fungal infection should raise concern for that specific fungal infection.,一反晕征-感染性疾病-结核,Tuberculosis in a 59-year-old female. High-resolution CT image s

19、hows bilateral small centrilobular nodules, tree-in-bud opacities and areas of reversed halo sign (RHS). Note the nodular appearance of the ring of consolidation of the RHS lesions (arrows), which may be helpful in the differentiation between active granulomatous disease and cryptogenic organising p

20、neumonia. The presence of associated centrilobular nodules and tree-in-bud opacities should raise suspicion of tuberculosis.,二反晕征-机化性肺炎（19%）,Organising pneumonia in a 53-year-old male with graft-vs-host disease after stem cell transplantion for treatment of acute myelogenous leukaemia. CT scan shows

21、 bilateral peripheral and peribronchovascular consolidative opacities with the reversed halo sign (arrows). Open-lung biopsy showed organising pneumonia. The patient was treated with steroids with resolution of the lesions.,二反晕征-机化性肺炎,47-yr-old female was referred to a tertiary centre (St Michaels H

22、ospital,Toronto, Canada) for further evaluation of chronic cough, fever, progressive exertional dyspnoea and fatigue. Coronal chest computed tomography scan showing multiple areas of central ground-glass opacity, surrounded by ring or crescentic-shape, dense airspace consolidation, mainly in the lef

23、t lower lobe and the right upper lobe. Transbronchial biopsy showing organising pneumonia,三反晕征-非特异性间质性肺炎,The British Journal of Radiology, May 2011,A 52-year-old female presented with a cough and New York Heart Association (NYHA) class 2 dyspnoea of 4 months duration，CT images show a central ground-

24、glass opacity surrounded by crescent or ring-shaped areas of consolidation, showing the reversed halo sign. (e) 6 days and (f) 6 months of steroid therapy, both showed improvement.,四反晕征-结节病,Sarcoidosis in a 44-year-old female. High-resolution CT image shows bilateral nodular opacities with the rever

25、sed halo sign (RHS) (arrows) and small pulmonary nodules with predominant perilymphatic distribution. The presence of the RHS associated with nodules in perilymphatic distribution and mediastinal and hilar lymphadenopathy (not shown) should raise suspicion of sarcoidosis.,五反晕征-肺栓塞,Acute pulmonary em

26、bolism with pulmonary infarction in a 64-year-old female. (a) CT image shows the reversed halo sign in the superior segment of the right lower lobe. (b) CT image (mediastinal window settings) shows a clot in the distal right main pulmonary artery extending to the superior segmental branch of the rig

27、ht lower lobe pulmonary artery. (c) 2 month follow-up CT scan shows cavitation of the infarcted pulmonary parenchyma.,Multifocal pulmonary adenocarcinoma in a 70- year-old female. CT image shows bilateral ulmonary nodules with the reversed halo sign (black arrows) and ground-glass pulmonary nodules

28、(white arrows).,六反晕征-肿瘤,Metastatic renal cell carcinoma in a 73-year-old male. The CT scan shows multiple bilateral lesions with reversed halo sign (RHS), biopsy proven to represent metastatic renal cell carcinoma in a background of fibrosis and necrosis. In patients with a known primary malignancy,

29、 RHS lesions may represent atypical presentation of metastatic disease. The main differential diagnosis is organising pneumonia, which can be related to drug toxicity if the patient is receiving chemotherapy.,六反晕征-肿瘤,Reversed halo sign (RHS) following radiofrequency ablation (RFA) of a pulmonary ade

30、nocarcinoma in a 64-year-old female. (a) CT image shows the adenocarcinoma in the left lower lobe. (b) CT scan performed 1 month after RFA of the tumour shows development of the RHS. When present shortly after RFA, the RHS should not be confused with recurrence of disease.,七反晕征-射频消融术后改变,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,八反晕征-放疗后改变,Reversed halo sign (RHS) following proton radiation therapy for a poorly differentiated squamous（鳞癌） cell carcinoma in a 71-yearold male. (a) CT image shows the p