2018年No.6 2014.3.7 学习指导 七年制影像chest -呼吸常见病1支气管病变+肺炎+肺结核- 陈爱萍-文档资料.ppt
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1、小儿胸腺,肺大泡,呼吸系统影像 观察、分析和诊断,X线,投照条件是否正确 投照位置是否正确 两侧胸廓是否对称 纵隔位置是否居中 横膈高度是否正常,CT,上下层面结合分析 肺窗与纵隔窗结合分析 断面图像与三维重建图像结合分析 平扫图像与增强扫描图像结合分析,观察、分析病灶,病变的部位,数目 病变的形态与大小 病变的密度与边缘 病变对邻近结构的影响,不同成像技术的优选 和综合应用,不同成像技术的价值和限度,X线:健康普查、胸部疾病的诊断和随访 限度:结构重叠,小病灶漏诊,如心影后方病灶或后肋膈角病灶;密度分辨率低,对纵隔病变的诊断有限。 CT:发现病变、定位和定性诊断。 限度:定性缺乏特异性。 M
2、RI:定位和定性均有一定优势。 限度:肺组织信号弱,对微细结构的显示效果不好,成像技术的优选原则,疾病发病阶段、发病部位及病变性质不同,不同成像技术在胸部应用的优势不同,需要多种成像技术综合应用。 经济优先,简便优先,实用优先,安全优先原则,支气管病变,气管、支气管异物 foreign body in the bronchus 先天性支气管囊肿 congenital bronchial cysts 气管肿瘤 支扩,Clinical symptom: cough, Purulent foul-smelling sputum , emptysis, or haemoptysis. 儿童,青年多见,
3、多见于左下叶、右中叶及右下叶。 咳嗽、咳痰、咯血,支气管扩张bronchiectasis,Bronchiectasis支扩,Bronchiectasis is defined as localized, irreversible dilatation of the bronchial tree. congenital or aquired - There are several causes of bronchiectasis, postinfectious causes; congenital defects of a structure nature; chronic granulomat
4、ous infection such as tuberculosis.,无异常发现 支气管及肺间质慢性炎症引起肺纹理增多,增厚,紊乱。可呈管状、杵状、囊状蜂窝状影,或卷发状。 继发感染:呈小斑片状模糊影,常不易治愈,或于同一地方反复发作。,X线表现,Bronchiectasis,Pathology Damage of bronchus wall Pression of bronchus increase Circumference tissue draught 支气管壁破坏 支气管内压增加 周围组织牵拉(疤痕、肺不张等),Bronchiectasis,Bronchiectasis can be
5、 divided into three morphologic types: cylindrical,saccular, mixed type.柱状、囊状或静脉曲张型。 Cylindrical bronchiectasis refers to a generalized more or less regular widening of the large bronchi. Saccular bronchietasis shows that the bronchi terminate in sac-like cavities.,Bronchiectasis,X-ray manifestation
6、: The plain film may be normal if only a small part is involved and there is no secondary infection. The most common appearance on plain film is increasing of lung markings. The bronchial walls may be visible either as single or parallel line opacities. There are paths of opacity when infection occu
7、res.,Bronchiectasis:lung markings of the left low lobe increase,and small sac( sac-like cavities),Bronchiectasis: lung markings of the left low lobe increase,and small sac( sac-like cavities),Bronchiectasis,Bronchographic investigation is important and necessary to delineate the total extent of the
8、disease. In the bronchogram, the cylindric bronchiectasis may be show club-shaped dilatation of the bronchi, while the saccular bronchiectasis will show saccular or cystic dilation of the affected bronchi.,Bronchogram: saccular bronchictasis in the left lung,Bronchiectasis,CT is helpful especially i
9、n the more advanced forms of bronchiectasis, cylindrical bronchiectasis causes smooth dilatation of bronchi, recognizable as “tram line” when seen in the scan plane and as the signet-ring sign in cross-section. The signet ring sign refers to the thickened and dilated bronchus, saccular bronchiectasi
10、s can be diagnosed most reliably by CT, sometime we can see air-fluid level in the dilated bronchus.,HRCT:支气管壁增厚,管腔增宽。 呈“轨道征”或“印戒征”。 柱状、囊状或静脉曲张型。,bronchictasis tram line 轨道征 signet-ring sign 印戒征,air-fluid level in the sac.,支扩伴黏液栓形成,bronchictasis tram line and the signet-ring sign in cross-section.,Q
11、uestion:where is the bronchiectasis?,肺先天性疾病,肺发育异常 肺隔离症 (bronchopulmonary sequestration) intralobar extralobar 肺动静脉瘘,肺AVM,Pneumonia,The causative organisms are variable:病原体多样 感染:细菌、病毒、真菌、支原体、衣原体、立克次体、寄生虫 理化性:类脂性、毒气、药物、放射线等 免疫和变态反应,Pneumonia,Pneumonia can cause a wide variety of abnormal findings on t
12、he chest radiograph. Commonly, it presents as alveolar consolidation, which can be segmental or lobar, or may be patchy, fluffy, alveolar infiltrates-without any segmental distribution(bronchopneumonia pattern) Pneumonia also may present as diffuse alveolar disease or as diffuse interstitial disease
13、. It also can present as single or multiple nodules. The presence of pneumonia sometimes may be masked by an associated pleural effusion, congestive failure, or adult respiratory distress syndrome(ARDS).,Pneumonia,According to the radiologic appearance, pneumonia can be commonly divided into lobar p
14、neumonia bronchopneumonia interstitial pneumonia,Lobar pneumonia,Lobar pneumonia most commonly is caused by S.pneumoniae肺炎链球菌, but it can also occur with other organisms. Lobar pneumonia represents a type of inflammation of the lung characterized by out-pouring of exudates into the alveoli with litt
15、le change in the bronchi or interstitial tissue. The out-pouring of fluid is generally considered to result from a local sensitivity reaction to the polysaccharides in the capsule of the pneumococcus. The bacteria are rapidly carried by the edema fluid from alveolus to alveolus,Lobar pneumonia,Early
16、 stage: Inflammatory edema Consolidation stage Resolution stage,Lobar pneumonia,Early stage: Inflammatory edema The infection and edema have usually spread throughout a segment of the lung. X-ray findings: The lung markings increase. It does not completely obscure the pulmonary vessels in the area b
17、ecause many of the alveoli are still aerated.,Lobar pneumonia,Consolidation stage The lung is characterized by a rather dense shadow of uniform opacity. If the bronchi remain patent, the air column within them stands out as dark. The presence of an air bronchogram within a shadow in the pulmonary fi
18、eld indicates that the density is due to consolidation of lung. If adequate antibiotic treatment is given, no further spread takes place.,1.大叶性肺炎,病理过程 充血期:12-24hr。毛细血管充血,少量浆液渗出,肺泡部分仍含气; 实变期:2-5d,分红色和灰色肝硬变期,肺泡内充满炎性渗出物。 消散期:1w后开始,2-3w消散。,线表现 可无异常或肺纹理增粗。 均匀实变影,与肺叶、段一致的高密度影,随各肺叶形态不同而不同。 不均匀斑片状,逐渐吸收,胸膜侧最
19、晚,可有胸膜增厚、纤维条索,lobar pneumonia,consolidation of right upper lung and “air bronchogram “,consolidation of right middle lober,consolidation of right upper lober,Lobar pneumonia,Resolution stage The homogenicity if the shadow of consolidation is lost and it becomes mottled as the exudate in various port
20、ions of the affected lung is absorbed and alveoli here and there are filled with air. The pathologic consists of intermingled areas of consolidation of varying degree, aeration of the alveoli and areas of atelectasis. The latter are often represented on the film by streak-like shadow. These shadows
21、disappear as the lung re-expands and resolution is completed.,Resolution stage in the right upper lober,Streak like shadow,Resolution stage in the left lower lober,consolidation of left upper lober,双上叶见大片状致密影,可见支气管充气征,consolidation of right and left upper lober (air bronchogram),Bronchopneumonia (lo
22、bular pneumonia),It is commonly seen in infants and elderly patients by infection by Staphylococcus aureus, most gram-negative bacteria and some fungi. It begins as a bronchial infection and has a tendency to involve separate parts of the lung. The infection spreads along the bronchial walls and res
23、ults in infiltration of the interstitial tissues with little involvement of the alveolar air space. In most cases, both consolidations of the alveolar air spaces and interstitial infiltration are present.,Bronchopneumonia (lobular pneumonia),The radiologic manifestations of bronchopneumonia depend o
24、n the severity of the disease. Mild bronchopneumonia results in peribronchial thickening and poorly defined air-space opacities. More severe disease results in inhomogeneous, patchy areas of consolidation that usually involve several lobes.,Bronchopneumonia (lobular pneumonia),Consolidation involvin
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