晕征与反晕征ppt课件

晕征与反晕征halosignandreversedhalosign 1 结节与肿块 CT表现 致密影 直径 5mm称微结节 2 3mm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 2 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 3 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 4 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 5 晕征病因 ArchBronconeumol 2008 44 7 386 92 6 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 7 一晕征 感染性疾病 真菌 KuhlmanJE1985 Invasivepulmonaryaspergillosis A Computedtomography CT scanofapatientwithacutelymphoidleukemiaandneutropeniashowinganodulesurroundedbyahalointherightupperlobe withadjacentacinarinvolvement arrows B Macroscopicsagittalsliceofanotherpatient slungshowingaroundnecroticlesion asterisk surroundedbyahemorrhagichalo arrowheads correspondingtoinvasivepulmonaryaspergillosis C MicroscopicimageofthemarginofthelesiondescribedinB withvisiblepulmonarynecrosisandhemorrhage TheimagealsoshowsthehyphaeofAspergillusfumigatus arrows whichareofregularcaliber septate andbranchingatacuteangles hematoxylin eosin magnification 2 8 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 9 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 10 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 11 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 12 立克次体寄生虫 一晕征 感染性疾病 其他 13 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 14 Hemorrhagicmetastasisinapatientwithchoriocarcinoma 绒毛膜癌 whopresentedwithmassivehemoptysis A Computedtomographyscanofthechestshowsmultiplehemorrhagicpulmonarynoduleswithahalosignthathavecoalescedintheposteriorsegmentsoftherightlung B Macroscopiclungsliceshowingseveralroundhemorrhagiclesions C Macroscopicimageofnodulescontaininghemorrhagicareas fibrin andtumorcells hematoxylin eosin magnification 10 二晕征 肿瘤性疾病 出血性瘤结节 15 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 16 Bronchioloalveolarcarcinomainapatientwithchroniccough A Computedtomographyscanofthechestshowsnoduleswithahalosignintherightlung withsomepseudocavitation arrow Alsovisibleisaconsiderableareaofconsolidationintheleftlung B Microscopicimageshowingthickenedalveolarwalls asterisks duetoinfiltrationbytumorcells arrows ematoxylin eosin magnification 10 二晕征 肿瘤性疾病 瘤细胞浸润 17 Pulmonarylymphomaina73 year oldpatientwhovisitedtheemergencyservicewithdyspnea A Anaxialscanofthelowerpulmonarylobesshowsmultiplepulmonarynoduleswithahalosignandatendencytocoalesceintheposteriorsegments Thereisalsobilateralpleuraleffusion somewhatgreaterontherightside Thepatientdied3weeksafteradmission B Lowmagnificationimageofpulmonarynoduleshowingmainlyperibronchovasculartumorcellinfiltrationandmarkednecrosis hematoxylin eosin magnification 4 C Ahigher magnificationimageoftheperipheryofthenoduleshowstheinfiltrationoftumorcellsalongthealveolarwalls arrows hematoxylineosin magnification 10 18 出血性结节非出血性结节 三晕征 非感染性疾病 19 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 20 Wegenergranulomatosis A Computedtomographyscanshowing2pulmonarynodulessurroundedbyahalo arrows andanareaofconsolidationintheleftlowerlobe asterisk alsowithahalosign Thepatient whosefirstsymptomwashemoptysis alsohadrapidlyprogressingglomerulonephritis肾小球肾炎B Microscopicimageshowinginflammatoryinfiltrationofthearterialwallwithamultinucleatedgiantcell arrow andendothelialdestruction arrowheads hematoxylin eosin magnification 20 三晕征 非感染性疾病出血性结节 21 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 22 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 23 反晕征病因 24 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 25 Invasivepulmonaryaspergillosisina54 year oldfemalewithmultiplemyelomaandsecondaryplasmacellleukaemiawhohadundergonechemotherapy a High resolutionCTimageatthelungbaseshowsarightlower lobepulmonarynodule arrow andthereversedhalosign RHS intheleftlowerlobe curvedarrow withadjacentground glassopacities b CTimagewithmediastinalwindowsettingsshowstheperipheralconsolidationoftheRHS asterisks Noteasmallrightpleuraleffusion 26 Pulmonaryzygomycosisina22 year oldmalewithprecursorB cellacutelymphocyticleukaemia a CTimageshowsthereversedhalosign RHS intheleftupperlobe arrows b CTscanperformed2monthslatershowsintervaldevelopmentofcavitation aircrescentsign ThepresenceofRHSinanimmunosuppressedpatientishighlysuggestiveofpulmonaryzygomycosis especiallyifthepatientisreceivingprophylaxisforaspergillosis 27 Paracoccidioidomycosisina49 year oldmale residentofaruralareainBrazil CTimageshowsreversedhalosign RHS lesions arrows andbilateralsmallpoorlymarginatedpulmonarynodules ThepresenceofRHSinapatientfromanendemicregionforfungalinfectionshouldraiseconcernforthatspecificfungalinfection 28 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 29 二反晕征 机化性肺炎 19 Organisingpneumoniaina53 year oldmalewithgraft vs hostdiseaseafterstemcelltransplantionfortreatmentofacutemyelogenousleukaemia CTscanshowsbilateralperipheralandperibronchovascularconsolidativeopacitieswiththereversedhalosign arrows Open lungbiopsyshowedorganisingpneumonia Thepatientwastreatedwithsteroidswithresolutionofthelesions 30 二反晕征 机化性肺炎 47 yr oldfemalewasreferredtoatertiarycentre StMichael sHospital Toronto Canada forfurtherevaluationofchroniccough fever progressiveexertionaldyspnoeaandfatigue Coronalchestcomputedtomographyscanshowingmultipleareasofcentralground glassopacity surroundedbyringorcrescentic shape denseairspaceconsolidation mainlyintheleftlowerlobeandtherightupperlobe Transbronchialbiopsyshowingorganisingpneumonia 31 三反晕征 非特异性间质性肺炎 TheBritishJournalofRadiology May2011 A52 year oldfemalepresentedwithacoughandNewYorkHeartAssociation NYHA class2dyspnoeaof4monthsduration CTimagesshowacentralground glassopacitysurroundedbycrescentorring shapedareasofconsolidation showingthe reversedhalosign e 6daysand f 6monthsofsteroidtherapy bothshowedimprovement 32 四反晕征 结节病 Sarcoidosisina44 year oldfemale High resolutionCTimageshowsbilateralnodularopacitieswiththereversedhalosign RHS arrows andsmallpulmonarynoduleswithpredominantperilymphaticdistribution ThepresenceoftheRHSassociatedwithnodulesinperilymphaticdistributionandmediastinalandhilarlymphadenopathy notshown shouldraisesuspicionofsarcoidosis 33 五反晕征 肺栓塞 Acutepulmonaryembolismwithpulmonaryinfarctionina64 year oldfemale a CTimageshowsthereversedhalosigninthesuperiorsegmentoftherightlowerlobe b CTimage mediastinalwindowsettings showsaclotinthedistalrightmainpulmonaryarteryextendingtothesuperiorsegmentalbranchoftherightlowerlobepulmonaryartery c 2monthfollow upCTscanshowscavitationoftheinfarctedpulmonaryparenchyma 34 Multifocalpulmonaryadenocarcinomaina70 year oldfemale CTimageshowsbilateralulmonarynoduleswiththereversedhalosign blackarrows andground glasspulmonarynodules whitearrows 六反晕征 肿瘤 35 Metastaticrenalcellcarcinomaina73 year oldmale TheCTscanshowsmultiplebilaterallesionswithreversedhalosign RHS biopsyproventorepresentmetastaticrenalcellcarcinomainabackgroundoffibrosisandnecrosis Inpatientswithaknownprimarymalignancy RHSlesionsmayrepresentatypicalpresentationofmetastaticdisease Themaindifferentialdiagnosisisorganisingpneumonia whichcanberelatedtodrugtoxicityifthepatientisreceivingchemotherapy 六反晕征 肿瘤 36 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 37 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 38 八反晕征 放疗后改变 Reversedhalosign RHS followingprotonradiationtherapyforapoorlydifferentiatedsquamous 鳞癌 cellcarcinomaina71 yearoldmale a CTimageshowstheprimarytumourintheleftperi hilarregion b CTscanperformed4monthsafterradiationtherapyshowsdevelopmentoftheRHSintheregionofthetumourconsistentwithnecrosis 39 Reversedhalosign RHS followingradiationtherapyforametastaticnon smallcelllungcancerina59 year oldfemale a CTimageshowstheprimarytumourintheleftupperlobe b PositronemissiontomographyCTaxialfusionimageshowsfludeoxyglucose FDG avidmetastasisintheleftscapula arrow c CTscan1monthafterchemotherapyandpalliativeradiationtherapytotheleftscapulashowsdevelopmentoftheRHSintheleftlungapex arrow adjacenttotheprimarytumour consistentwithradiationpneumonitis d Afollow upCTscanperformed4monthsafter c showsdevelopmentofcavitationintheregionoftheRHS Whenpresentwithintheradiationfieldshortlyafterradiationtherapy theRHSshouldnotbeconfusedwithinfectionorrecurrenceordisease 40 同影异病 同病异影 41 42 43 44 45 46 Addyourcompanyslogan ThankYou 47