颈部结核3.ppt

颈部结核颈部结核3 3Key Wordstuberculosis tj,bkjlss n.肺结核；结核病larynx lrks n.解剖 喉；喉头thyroid ard n.甲状腺；甲状软骨；adj.甲状腺的；盾状的pathogenesis ,pdnss n.发病机理；发病原Key Wordshaematogenous hi:mtdins 血源性的，造血的granulomas n.肉芽肿mucosa mjkos n.解剖 粘膜antiseptic ntseptk adj.防腐的，抗菌的；n.防腐剂，抗菌剂IntroductionThe purpose of this study is to describe the imaging features of tuberculous involvment in the following neck regions:larynx;thyroid gland;neck spaces.The pathogenesis and imaging findings of tuberculous involvement in the neck region will be discussed.简介 本研究主要描述颈区域（喉、甲状腺、颈间间隙）结核病变的影像特征。讨论颈部区域结核的发病机制和影像学表现。LarynxPathogenesisPrimary involvement is rare and occurs by direct infection of the mucosa via aerosolized particles.Secondary involvement occurs via expectoration of highly infectious sputum from the tracheo-bronchial tree,via haematogenous spread from sites other than lungs,or via lymphatic spread,which is rare.喉发病机制 原发性喉结核较为罕见，主要是通过雾化微粒直接感染粘膜所致。继发性喉结核是由来自气管支气管树具有高度传染性的痰、来源于肺组织以外其他部位结核的血源性播散、或是淋巴扩散所引起,而淋巴播散较为罕见。Imaging findingsCT and MRI findings in the acute stage include diffuse bilateral glottic thickening,with or without an associated mass。The commonest finding in the chronic stage is a localized lesion granuloma mimicking a mass.影像表现 CT和MRI发现在急性期双侧声襞弥漫性增厚，伴或不伴有肿块形成。在慢性期最常见的表现是类似肿块的局部肉芽肿性病变。Fig 1 Axial CECT of the larynx shows a large,enhancing,tumour like granulomatous mass in pre-epiglottic space(black arrow)with caseating right cervical lymph node(white arrow).图1、喉部轴位CT图像显示，会厌前间隙可见体积较大、明显强化、类似肿瘤的肉芽肿肿块(黑色箭头)和右颈部干酪样坏死淋巴结(白色箭头)。ThyroidPathogenesisTuberculous involvement of the thyroid is rare and is due to secondary involvement either by haematogenous spread,or by contiguous spread from adjacent infected larynx and lymph nodes.Tubercular thyroid involvement is rare because the thyroid gland is enveloped by a tough capsule protecting it from contiguous spread of infection and the high iodine concentration within the gland which acts as a natural antiseptic.甲状腺发病机制 甲状腺的结核比较罕见,甲状腺结核主要是通过血源性播散或通过临近感染的喉及淋巴结的直接蔓延所引起的继发感染。原发性甲状腺结核罕见是因为甲状腺体有被膜包绕使它免于临近感染的播散，腺体内的高浓度碘成为天然的抗菌剂。Imaging findingsCT demonstrate multiple,small,focal lesions in the entire gland resembling miliary TB(Fig.7).Caseating granulomas can cause enlargement of the gland with cold abscess formation with or without sinus formation.影像表现 CT显示在整个腺体中表现为类似粟粒状肺结核的多发小而局灶的病变(图7)。干酪样肉芽肿能增大已形成冷脓肿（伴有或不伴有窦道的形成）的腺体。Figure.2 Axial image of the thyroid gland.Miliary low density nodules(open arrows)in the entire thyroid gland.图2、甲状腺轴位图像显示在整个甲状腺中多发粟粒状的低密度结节影(空心箭头)。Neck abscessPathogenesisSecondary lymphatic involvement is common due to acute tubercular pharyngitis/mastoiditis or chronic tuberculous infection of cervical spine or cervical lymph nodes.It commonly occurs in the retropharyngeal space mostly due to infection in the retropharyngeal nodes.颈部脓肿发病机制 继发性淋巴感染主要是由于急性结核性咽炎/乳突炎或慢性颈椎或颈部淋巴结结核性感染引起。它通常发生在咽后间隙，主要是由咽后淋巴结感染引起。Imaging findingsCT and MRI show variable-sized,ill-defined,thick-walled masses with central necrosis and rim enhancement following contrast medium injection(Fig.4).影像表现 CT和MRI显示为形态多样、边界不清、伴有中央坏死和注射对比剂后边缘强化的厚壁肿块。（图4）Figure 3、Coronal CT image of the neck showing a large,peripherally enhancing,centrally liquefied,multiseptate,transpatial cold abscess(white arrows)with airway(white arrowheads)and vascular mass effect.图3、颈部冠位CT示：体积较大、周边强化、中心液化坏死、跨间隙生长的冷脓肿，伴气道(白色箭头)和血管(白色箭头)的占位效应。ConclusionTuberculous infection affects many sites in the neck,and has a variety of imaging appearances,mimicking benign and malignant lesions.The diagnosis of TB can be suggested based on specific imaging features.Early commencement of treatment prevents debilitating complications and morbidity from disseminated disease.结论 结核性感染能侵犯颈部的多个部位,拥有类似良性和恶性病变的多种影像学表现。结核病的诊断可以基于典型的影像特征。早期治疗可以预防严重并发症并降低疾病的发病率。thank you