呼吸系统放射学诊断演示专选课件

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,呼吸系统放射学诊断,（优选）呼吸系统放射学诊断,肺内病变组织发生坏死，坏死组织经引流支气管排出而形成,Cavity is formed as a result of tissue necrosis and communicated with the bronchus.,空洞cavity,虫蚀样空洞（无壁空洞）,薄壁空洞,Thin-walled cavity,厚壁空洞,thick-walled cavity,壁厚,3mm,以上，见于肺脓疡、肺结核、肺癌等,X线表现,薄壁空洞Thin-walled cavity,洞壁厚3mm以下内壁光滑境界清楚的园形透亮区，见于肺结核,结核性空洞常无或仅少量液体多为薄壁TB cavity with a little or not fluid level,虫蚀样空洞（无壁空洞）,实变肺野内多发小的透亮区，虫浊样，见于干酪性肺炎,癌性空洞内壁多呈结节状,Thick-walled cavity,Irregular inner ling,厚壁空洞,thick-walled cavity,壁厚,3mm,以上，见于肺脓疡、肺结核、肺癌等,肺脓疡空洞多有明显液片多为厚壁,Thick wall cavity with surround exudative lesions,associated with a fluid level,空腔,air,containing space,肺内腔隙的病理性扩大,肺大疱、肺气囊、肺气囊肿、囊状支扩,空 腔 性 病 变,右下肺囊肿,肺部基本病变,肺间质病变,interstitial lesion,:,发生在间质的弥漫性病变,:,即病变主要分布在支气管血管周围、,小叶间隔、肺泡间隔,.,X线表现,肺纹理增粗、网状,strip,纹理、蜂窝状,honeycomb,或伴广泛小结节影,netting-nodules,（间质结节）,弥漫性肺间质病变,(,diffuse interstitial disease),HRCT,：,小叶内间质增粗,小叶内细支气管血管周围,和肺泡间隔的间质增厚,弥漫性肺间质病变,(,diffuse interstitial disease),多发小结节及粟粒病变,(,multinodular and miliary diseases),弥漫性肺泡病变,diffuse alveolar disease,广泛分布，含气支气管征，毛玻璃密度,胸膜病变,pleural lesion,胸腔积液,（,pleural effusion,）,游离性胸腔积液,free pleural effusion,少量积液,中量积液,大量积液,局限性胸腔积液,localized pleural effusion,包裹性积液,叶间积液,肺底积液,少量胸腔积液,pleural effusion,X,线表现,先积聚于后肋膈角,液量,300ml,以上时侧肋膈角变平变钝,pleural effusion,中量胸腔积液,pleural effusion,X,线表现,下肺野均匀致密影,肋膈角消失、膈面影被掩盖而显示不清,上缘呈外高内低弧形液面，其形成机理,:,胸腔内负压状态,液体重力,肺组织弹性,液体表面张力作用,大量胸腔积液,pleural effusion,患侧肺野均匀致密，或仅肺尖透亮,纵隔向健侧移位,肋间隙增宽,大量积液,pleural effusion,纵隔？肋骨？横膈？,左全肺不张,胸腔心包积液CT表现,pleural effusion,包裹性积液,Loculated pleural effusion,包裹性积液,Loculated pleural effusion,叶间积液,interlobar fissure pleural effusion,斜裂或水平裂,梭形，两端与叶间裂相连,液量多时呈球形,叶间积液,interlobar fissure pleural effusion,叶间积液,interlobar fissure pleural effusion,气胸,pneumothorax,空气进入胸腔形成,air come into chest cavity.,Cause,:,壁层胸膜破裂,脏层胸膜破裂,Edge of the collapsed lungs,肺与胸壁之间透明含气区,increased radiolucent area,，其中不见肺纹理,液气胸,hydropneumothorax,胸腔内气体与液体并存,there is fluid with air above it ,either in the pleura space,pleural adhesions, thickening and calcification,轻度胸膜肥厚、粘连,多见于肋膈角处,costophrenic angle,肋膈角变浅变平,膈顶变平直而不呈园顶状,flatening of the dome of diaphragm,呼吸时膈运动受限,膈胸膜粘连有时表现幕状突起,胸膜钙化,pleural calcification,calcification along the chest wall on the surface of the pleura,Pleural calcification usually resulted from TB,hemorrhage,常见病,X,线诊断,X-ray demonstrations,In common diseases,支气管疾病,支气管扩张bronchiectasis,Etiology：following by chronic bronchitis, suppurative inflammation,pulmonic pneumonia, pulmonary atelectasis and fibrosis,Pathogenesis：慢性感染支气管壁组织破坏；,支气管内分泌物和长期咳嗽, 支气管内压增高；,肺不张和肺纤维化外在性牵拉,支气管疾病,支气管扩张bronchiectasis,continuous cough and purulent sputum,A history of recurrent haemoptysis,bronchiectasis,分型：柱状扩张Cylindrical bronchiectasis,囊状扩张Cystic bronchiectasis,混合型扩张Mixed bronchiectasis,bronchiectasis X-线表现,PLAIN FILM,正常,more than 50%,obscure recognition bronchi,Dilated bronchi, sometimes with fluid levels, are seen only in gross disease,bronchiectasis -CT：,轨道征dilatation of the bronchus, which usually is accompanied by bronchial wall thickening,印界征signet ring configuration :Dilated bronchus and concomitant pulmonary artery,囊柱状改变Large elliptical circular opacities,肺炎pneumonia,According to anatomic distributing,pneumonia can be as follows:,Lobar pneumonia,Bronchopneumonia,interstitial pneumonia,Lobar pneumonia临床,caused by pneumococcus,rapid development of high pyrexia,a characteristic rusty color sputum,The basic pathologic lesion is acute inflammatory exudation of the pulmonary parenchyma,大叶性肺炎 pathologic changings,充血期The congestive stage (it is about 24 hours after onset),红色肝变期The red consolidation stage,灰色肝变期The gray consolidation stage,消散期Resolution stage,Lobar pneumonia,充血期,It may be no X-ray changes,or with an increase of lung markings,or with a faint shadow in the inflammatory area,many of the alveoli are still aerated,Lobar pneumonia-肝变期,The X-ray feature is a large homogenous radiopaque shadow,there is no volume loss,air bronchogram is common,Borders of the shadow appear,as a sharply defined margin,Lobar pneumonia,Lobar pneumonia,Lobar pneumonia,Lobar pneumonia,Resolution stage,the alveolar exudates are absorbed,there are filled with air in the alveoli,the shadow of consolidation becomes scatter,resorption may be delayed up to one or two months,Lobular pneumonia (bronchopneumonia),caused lobular pneumonia are streptococcus, staphylococcus, pneumococcus,The common symptoms are fever, cough, purulent sputum and pleuritic pain etc,Small bronchus wall congest and swelling,interstitial inflammation involving,immersing,lobular,patchy opacities and consolidation,小支气管不同程度阻塞,-,Emphysema,or,lobular atelectasis,Bronchopneumonia,病理变化,Lobular pneumonia X-ray features,There is intensification of lung markings,Small patchy opaque shadows are seen in the middle and lower lung fields especially by the heart border,Emphysema of the both lungs is usually visible.,Confluence of these patchy opacities may produce segmental large area of consolidation.,Delayed or incomplete resolution may result in bronchiectasis and fibrosis,间质性肺炎interstitial pneumonia,Interstitial pneumonia involves mainly the interstitial tissue of lungs, including the bronchovascular bundles and intralobular septa,it may be caused by viral or bacterial infection,Clinic signs,：,shortness of breath, c,ough,cyanosis,pathology,：,interstitial inflammation,immersing,Lymphatitis,lymphadenitis,Small bronchus,inflammation,-,obstruct,emphysema and,atelectasis,肺泡也可轻度炎性浸润,多伴不同程度的间质纤维结缔组织增生,interstitial pneumonia,X-ray features of interstitial pneumonia,There are fine streak-like, net-like, nodular or nod-reticular shadows,Emphysema of both lungs in infant patients,Possibly there is enlargement and increase in density of the hilar shadow,CT, especially HRCT can depict the early sign of interstitial pneumonia. It may present as thickened septa,interstitial pneumonia,肺脓肿,pulmonary abscess,Purulence bacteria-inflammation focus-,Necrosis and fluidify-abscess,infect approach,：,inhale,hematogenous,direct spreed,stage,：,acute,subacute and chronic stage,病理,：,渗出与实变坏死液化空洞形成,: The lung abscess begins as an area of gangrenous bronchopneumonia,Radiological features,排脓之前：大片致密影,排脓以后：大片影内出现空洞与液平面,pulmonary abscess-,Acute stage,Lung abscess,急性期,高烧寒战、咳嗽、,咳脓臭痰,、胸痛等,symptoms include high pyrexia and pleuritic pain,pulmonary necrosis has occurred,The sputum is often foul smelling and blood-stained,pulmonary abscess-,Subacute stage,defined as the period between 6 weeks and 3 months after the onset of infection,fibrosis of the wall becomes established,appears as a cavity or multiple abscess cavities with fluid level as air enters these foci,the cavity with thick wall surrounded by exudative lesion,pulmonary abscess,Chronic stage,After 3 months the abscess was considered to be chronic,持续性咳嗽咳痰等,X-ray features:,空洞周围纤维组织增生形成厚壁空洞,one or more irregular cavities and with multiloculation,some fibrotic lesions by the cavity or in the cavitary wall,Thickened pleura are usually seen,pulmonary abscess,血源性肺脓疡：,hematogenous pulmonary abscess,膈下脓肿或肝脓肿扩展到肺,形成肺脓肿：,pulmonary abscess,hematogenous pulmonary abscess,肺结核,Pulmonary tuberculosis,由结核杆菌引起的慢性传染病,basic pathological changes,：,渗出,exudation,增殖,proliferation,Pulmonary tuberculosis,愈合方式,：,吸收,absorb,纤维化,fibrosis,钙化,calcify,cavity purify or cavity scar over,Pulmonary tuberculosis,干酪样坏死,caseation,液化及空洞形成,necrotic,material be extruded -,formation of a cavity,播散,:,血行播散,hematogenous,dissemination,经淋巴管播散,支气管播散,局部扩展至邻近肺组织,Pulmonary tuberculosis,恶化表现,结核病临床分类（1998）,In 1998, the Chinese Antituberculous Association adapted a new classification of pulmonary tuberculosis. It has been divided into 5 types :,Primary tuberculosis (Type,),Hematogenous pulmonary tuberculosis (Type ),Secondary pulmonary tuberculosis (Type ),Tuberculous pleuritis (Type ),Extrapulmonary tuberculosis (Type ),原发性肺结核,primary tuberculosis,原发性肺结核,primary complex,The combination of the primary pulmonary tuberculous focus, lymphangitis and intrathoracic lymphadenitis,It occurs chiefly in children,临床表现：低热、盗汗、乏力、,食欲减退、轻咳,X线表现分为：原发综合征,胸内淋巴结结核,原发综合征,primary complex,an exudative lesion in the any,portion of the lung field,enlargement of hilar lymph nodes or,mediastinal lymph nodes,lymphangitis streaky shadows,原发综合征治疗前后,primary complex,The primary focus is usually absorbed,X,线表现,结节型（肿瘤型）：边界清楚,炎症型：边界模糊,增大淋巴结加淋巴结周围炎,intrathoracic tuberculous lymphadenitis,primary tuberculosis,Axial contrast-enhanced CT scan demonstrates multiple enlarged mediastinal lymph nodes,血行播散型肺结核hematogenous pulmonary tubculosis,（粟粒性肺结核）,急性acute,亚急性subacute,慢性chronic,急性血型播散型肺结核,acute hematogenous pulmonary tubculosis or acute miliary,TB,概念,The onset of the disease is sudden,大量结核杆菌一次或短期内数次进入血循环播散到肺引起者,临床 起病急、病情重，可有高热,febrile,寒战,气急、咳嗽等,cough and breathlessness,急性血型播散型肺结核,acute miliary TB,X线表现,No changes in the early stage,About 2 weeks after onset, it will begin to show,a lot of fine, pin-point mottling opacities,varying up to 1-2 mm in diameter,分布,distribution,均匀、大小,size,相同、密度相同,正常肺纹理不能显示,acute miliary,TB,High-resolution CT scan obtained with lung windowing demonstrates numerous fine, nodules bilaterally,acute miliary,TB,Subacute or chronic hematogenous pulmonary tuberculosis,亚急性或慢性血行播散型肺结核,概念,少量结核杆菌在较长时间内多次,进入血流播散至肺所致,临床,症状可不明显或轻度结核中毒症,状恶化者病灶融合形成空洞或转为慢纤空,Subacute or chronic hematogenous pulmonary tuberculosis,X-ray features,a lot of nodular shadows in both lung fields,The shadows are not uniform in size, in density and in distribution,infiltrative pulmonary tuberculosis,Symptoms,many patients diagnosed by X-ray,low pyrexia, lassitude, weight loss, night sweats, cough productive of mucoid sputum and haemoptysis,infiltrative pulmonary tuberculosis,X-ray features:,multiple basic X-ray features ： exudation, proliferation, fibrosis, calcification and cavitation,the lesion is at the apex and subclavicular region of the upper lobe and the superior segment of the lower lobe,干酪性肺炎,caseous pneumonia,The caseous pneumonia,occurs in poor health patient,The patient is usually with high,fever,病理,：,大叶性：大片渗出性结核性炎变,干酪样坏死而形成,小叶性：干酪空洞或干酪样化的,淋巴,结破溃经支气管播,散形成,caseous pneumonia,X-ray features,multiple cavities usually seen,usually with bronchogenic disseminated focus in both low fields,infiltrative pulmonary,tuberculosis,The tuberculoma is formed by fibrous tissue encysted caseous lesion,The size is larger than 1.5cm in diameter,多见于上叶尖、后段、下叶背段,Infiltrative pulmonary tuberculosis,结核瘤,结核瘤,X-ray features,a round or oval opaque shadow,with well-defined margin and high density,typically in the upper lobes,There may be calcific lesion,“Satellite” lesions,These lesions are stable for long periods of time,Cavitation is extremely rare with tuberculoma,infiltrative pulmonary tuberculosis,infiltrative pulmonary tuberculosis,infiltrative,pulmonary,tuberculosis,慢性纤维空洞型肺结核,chronic fibro-cavitative pulmonary TB,属继发性肺结核，晚期类型,由于好坏交替，多种病理改变并存,Symptoms : repeated low pyrexia, cough productive of mucoid sputum and haemoptysis,Some patients may be without marked symptoms,chronic fibro-cavitative pulmonary TB,Image features:,With Fibrotic cavity (纤维厚壁空洞),With many Fibrotic lesions(广泛纤维化),Usually with bronchogenic dissemination to the lower lung fields支气管播散病灶,结核性胸膜炎,tuberculosis pleuritis,pleural effusion,Pleural thickening,CT can demonstrate pleural effusion and thickened pleura clearly,Axial contrast-enhanced CT scan demonstrates a large, right-sided pleural effusion,原发性支气管肺癌,primary bronchogenic carcinoma,primary bronchogenic carcinoma,Primary bronchogenic carcinoma arises from,the bronchial epithelium,bronchial glands,epithelium of the alveolus,The incidence of the carcinoma is now steadily increasing,primary bronchogenic carcinoma,Bronchogenic carcinoma is usually classified histologically into,squamous cell carcinoma,adenocarcinoma (including alveolar cell carcinoma),undifferentiated carcinomas,small cell (oat cell),various large cell types,Clinical features,Cough, haemoptysis, sputum, breathlessness,Obstruction of the bronchus,Spread to the pleura,Tumor invasion of mediastinum,(1) left recurrent laryngeal nerve palsy,(2) superior vena caval obstruction,(3) Dysphagia,(4) phrenic nerve paralysis,(5) apical tumors involving brachial plexus and sympathetic ganglia (Pancoast tumors) cause Horners syndrome.,primary lung carcinoma,central type,peripheral type,diffuse type,The central type,Carcinoma originated from main bronchi, lobar bronchi or segmental bronchi,The direct signs,A hilar mass,an irregular narrowing,The central type,The indirect signs,Obstructive atelectasis,“Transverse s” sign,obstructive pneumonia,obstructive emphysema,气管癌,周围型肺癌peripheral carcinoma,the mass is to be located in the peripheral lung field,周围型肺癌peripheral carcinoma,Spherical shape of the mass,infiltrating edge,Clear, shaggy or cloudy border,Pleural tail sign in adenocarcinoma.,Cavity with the irregular inner wall,肿块特征：分叶征 毛刺征 癌性空洞,squamous cell carcinoma,A left lower lobe cavity with irregular thick wall,细支气管肺泡癌,孤立结节型,弥漫结节型,大片实变型,The diffuse type,some opaque mottled shadows,The sizes of the shadows are various,The individual shadows varying from barely visible to lobar consolidation, and may contain air bronchograms,细支气管肺泡癌,孤立结节型,弥漫型,肺癌转移,Spread of tumor,Hilar and mediastinal,lymph node,Mediastinal invasion,Pleural involvement,Chest wall invasion,肺转移瘤,secondary(metastatic) lung cancer,Lymphangitic spread of breast cancer. CT reveals interstitial linear opacities and tiny nodules in both lungs,纵隔肿瘤,mediastinal tumor,淋巴瘤治疗前后,甲状腺瘤胸内延伸,胸腺瘤,谢谢观看！,