胸部常见CT征象认读..ppt

胸部常见(chnjin)(chnjin)CT征象认读麻涌医院(yyun)(yyun)放射科卢劲松第一页，共一百八十七页。The Secondary Pulmonary Lobule肺小叶肺小叶(xioy)(xioy)（直径（直径1-2.5CM）第二页，共一百八十七页。小叶(xioy)(xioy)支气管、终末细支气管第三页，共一百八十七页。肺动脉pulmonaryartery第四页，共一百八十七页。小叶(xioy)(xioy)间隔interlobularsepta第五页，共一百八十七页。肺静脉pulmonaryvein第六页，共一百八十七页。腺泡pulmonaryacini第七页，共一百八十七页。正常(zhngchng)(zhngchng)HRCT.第八页，共一百八十七页。中央(zhngyng)(zhngyng)肺动脉。第九页，共一百八十七页。支气管与相邻肺动脉直径(zhjng)(zhjng)大致相等。第十页，共一百八十七页。肺动脉常分为两个直径相当(xingdng)(xingdng)的分支。第十一页，共一百八十七页。肺静脉常分成许多肺静脉常分成许多(xdu)(xdu)细小的分支细小的分支,这些分支与主支构成直角。这些分支与主支构成直角。第十二页，共一百八十七页。叶间裂（厚度小于1mm，边缘(binyun)(binyun)光滑，均一厚度）第十三页，共一百八十七页。常见(chnjin)(chnjin)伪影双侧下肺近心脏处，肺血管脉动伪影。低密度区，可以错当作(dnzu)(dnzu)扩大的支气管。第十四页，共一百八十七页。常见(chnjin)(chnjin)伪影主叶裂伪影。第十五页，共一百八十七页。常见(chnjin)(chnjin)伪影血管(xugun)(xugun)双重伪影。第十六页，共一百八十七页。正常小叶(xioy)(xioy)间隔normalsepta第十七页，共一百八十七页。正常小叶(xioy)(xioy)中心动脉第十八页，共一百八十七页。正常小叶中心(zhngxn)(zhngxn)动脉centrilobularartery2第十九页，共一百八十七页。肺静脉Pulmonaryveins第二十页，共一百八十七页。肺间质病变(bngbin)(bngbin)发生于：慢性间质性肺炎、弥漫性间质纤维化、结节病、癌性淋巴管炎、结缔组织病（红斑狼疮、类风湿性关节炎、硬皮病、皮肌炎）、尘肺（矽肺、煤矽肺、石棉肺）、组织细胞病、淋巴管平滑肌瘤病。：界面征、小叶间隔增厚、小叶中心(zhngxn)(zhngxn)结构增厚、胸膜下线、长疤痕线（扭曲肺结构）、蜂窝样改变、结节影、牵拉性支扩、磨玻璃样改变。第二十一页，共一百八十七页。Case1F/60y乳腺癌术后，现呼吸困难(hx(hxknnn)knnn)。第二十二页，共一百八十七页。分析：（1）小叶(xioy)(xioy)间隔增厚第二十三页，共一百八十七页。分析(fnx)(fnx)：（2）支气管血管周围间质增厚支气管袖口(xiku)(xiku)症：第二十四页，共一百八十七页。分析(fnx)(fnx)：(3)斜裂增厚第二十五页，共一百八十七页。分析(fnx)(fnx)：（4）大结节影第二十六页，共一百八十七页。网状阴影：病理上主要为小叶间隔增厚、小叶内间隔增厚、小叶核心增厚、胸膜下线影、蜂窝肺和支气管血管周围间质增厚等改变。可见(kjin)(kjin)于特发性间质性肺炎、结节病、癌性淋巴管炎、特发性含铁血黄素沉积、感染性疾病等。双肺网状阴影多见与特发性间质性肺炎、结缔组织病肺浸润、结节病等。单侧以癌性淋巴管炎和放射性肺炎为主。第二十七页，共一百八十七页。上病例(bngl)(bngl)为癌性淋巴管炎。第二十八页，共一百八十七页。Case279岁、淋巴瘤病史(bn(bnsh)sh)第二十九页，共一百八十七页。第三十页，共一百八十七页。小叶(xioy)(xioy)间隔增厚？(a)Yes(b)No第三十一页，共一百八十七页。双侧光滑(gunghu)(gunghu)增厚的小叶间隔第三十二页，共一百八十七页。支气管血管(xugun)(xugun)间质是否增厚？(a)Yes(b)No第三十三页，共一百八十七页。增厚的支气管血管(xugun)(xugun)间质第三十四页，共一百八十七页。胸膜(xingm)(xingm)下间质增厚？(a)Yes(b)No第三十五页，共一百八十七页。斜裂增厚第三十六页，共一百八十七页。Whatisthemostlikelydiagnosis?n n最可能(knng)(knng)的诊断？(a)Pulmonaryedema(肺水肿）(b)Interstitialfibrosis（间质纤维化）(c)Lymphangiticspreadoflymphoma（癌性淋巴管炎）第三十七页，共一百八十七页。Diagnosis:Lymphangiticspreadoflymphoma,withinterlobularseptalthickening。n n癌性淋巴管炎（小叶(xioy)(xioy)间隔增厚）第三十八页，共一百八十七页。lymphocyticinterstitialpneumonitis(LIP)淋淋巴巴(l l n n b b)间间质质局局限限性性肺肺炎炎第三十九页，共一百八十七页。Case358-year-oldmanwithheartdisease第四十页，共一百八十七页。小叶(xioy)(xioy)间隔增厚？(a)Yes(b)No第四十一页，共一百八十七页。双侧小叶(xioy)(xioy)间隔增厚第四十二页，共一百八十七页。支气管血管(xugun)(xugun)间质增厚？(a)Yes(b)No第四十三页，共一百八十七页。支气管血管(xugun)(xugun)间质增厚第四十四页，共一百八十七页。Istherethickeningofthesubpleuralinterstitium?(胸膜(xingm)(xingm)下间质增厚？)(a)Yes(b)No第四十五页，共一百八十七页。NO!第四十六页，共一百八十七页。Whatisthemostlikelydiagnosis?(最可能(knng)(knng)的诊断？)(a)Pulmonaryedema肺水肿(b)Interstitialfibrosis间质纤维化(c)Lymphangiticspreadofcarcinoma癌性淋巴管炎第四十七页，共一百八十七页。(a)Pulmonaryedema肺水肿Correct.Becauseofthehistoryofheartdisease心脏病史,characteristicabnormalities典型的异常,ymmetry对称(duchn)(duchn),andthepredominanceofseptalthickeningindependentlung,thisdiagnosismustbeconsidered考虑mostlikely.第四十八页，共一百八十七页。文献(wnxin)(wnxin)：间质性肺水肿（1 1）肺血重新分布）肺血重新分布）肺血重新分布）肺血重新分布：左心衰左心衰-肺淤血。肺淤血。（2）支气管周围袖口症）支气管周围袖口症：正常厚度约正常厚度约1mm结缔组织内液体存积增厚。X-X-肺纹理及肺门血管增粗、模糊肺纹理及肺门血管增粗、模糊.（3）肺透过度下降）肺透过度下降）肺透过度下降）肺透过度下降：液体分布到支气管血管周围、小叶：液体分布到支气管血管周围、小叶间隔、小叶内支气管血管周围、肺泡间隔间隔、小叶内支气管血管周围、肺泡间隔透过度下降。透过度下降。（4 4）间隔线）间隔线）间隔线）间隔线：KerleyBKerleyB线xx上与肋膈角处与胸膜垂直。上与肋膈角处与胸膜垂直。（5）胸膜增厚）胸膜增厚：液体液体入脏层胸膜下薄层入脏层胸膜下薄层(bocn)(bocn)结缔组结缔组织织胸膜下结缔组织水肿-水肿位于脏层胸膜与结体组织水肿位于脏层胸膜与结体组织间，不随体位移动。间，不随体位移动。（）胸腔积液（）胸腔积液：胸膜腔内液体来自壁层胸膜。第四十九页，共一百八十七页。不同(btn)(btn)原因的肺水肿心源性肺水肿：左心衰（见于心梗、二尖瓣病变。肾性肺水肿：急慢性肾功能衰竭，可合并尿毒症水肾性肺水肿：急慢性肾功能衰竭，可合并尿毒症水钠潴留、左心衰肺水肿上腔静脉、奇静脉增宽。钠潴留、左心衰肺水肿上腔静脉、奇静脉增宽。肺微血管损伤性肺水肿：除肺水肿外，还可见出血及细肺微血管损伤性肺水肿：除肺水肿外，还可见出血及细胞渗出胞渗出肺血分布正常、无袖口症、间隔线。肺泡实变斑片状，肺野外为分布。毒性气体吸入、胃液吸入、药物(yow)(yow)、溺水、颅内压升高、高原性肺水肿、复张性肺水肿。第五十页，共一百八十七页。Case4a53-year-oldwomanwithandabnormalchestradiographandmildshortness（短缺(dunqu)(dunqu)）ofbreath（异常胸片，气短）第五十一页，共一百八十七页。第五十二页，共一百八十七页。Isseptalthickeningpresent?(a)Yes(b)No小叶(xioy)(xioy)间隔增厚吗？第五十三页，共一百八十七页。增厚的小叶(xioy)(xioy)间隔第五十四页，共一百八十七页。Aretheseptasmoothornodularinappearance?(a)Smooth(b)Nodular小叶间隔(jing)(jing)增厚是结节状还是光滑增厚？第五十五页，共一百八十七页。小叶间隔(jing)(jing)结节状增厚第五十六页，共一百八十七页。胸膜(xingm)(xingm)下间质结节影第五十七页，共一百八十七页。支气管袖口(xiku)(xiku)症第五十八页，共一百八十七页。Possiblediagnosesinclude:(a)pulmonaryedema肺水肿(b)interstitialfibrosis间质纤维化(c)sarcoidosis结节病最可能(knng)(knng)的诊断？第五十九页，共一百八十七页。sarcoidosis结节病Correct.Nodularthickeningofinterlobularseptaandfissurescanbeseeninthisdiseaseandlymphangiticspreadofcarcinoma.（小叶间隔结节状改变可见于结节病、癌性淋巴管炎、尘肺）。支气管血管(xugun)(xugun)间质、胸膜下间质结节状改变对结节病有特征性的诊断。第六十页，共一百八十七页。Case5a42-year-oldmanwithmildshortnessofbreathforanumberofyears（气促多年(dunin)(dunin)）第六十一页，共一百八十七页。Isseptalthickeningvisible?(a)Yes(b)NoNextPage小叶(xioy)(xioy)间隔增厚吗？第六十二页，共一百八十七页。增厚的小叶(xioy)(xioy)间隔第六十三页，共一百八十七页。扭曲(niq)(niq)的肺结构第六十四页，共一百八十七页。叶间裂的扭曲(niq)(niq)第六十五页，共一百八十七页。Diagnosis:n nEnd-stagesarcoidosiswithfibrosisandinterlobularseptalthickening.结节(jiji)(jiji)病伴随征象：肺结构扭曲、小叶间隔结节(jiji)(jiji)状增厚、牵拉性支扩、蜂窝肺等。第六十六页，共一百八十七页。文献(wnxin)(wnxin)：肺间质病变界面征：支气管血管间质增厚支气管血管间质增厚支气管血管束增粗、支气管袖口症；液体边缘光滑、肿瘤或肉芽组织结节结节(jiji)(jiji)状界面。状界面。胸膜下线：胸膜下线：近胸膜面1cm内弧线状影内弧线状影为肺纤维化征象。长疤痕线：长疤痕线：蜂窝肺：蜂窝肺：结节影：小结节2-5mm2-5mm，肉芽、肿瘤、纤维组织。，肉芽、肿瘤、纤维组织。肺结构扭曲变形及牵拉支扩：肺结构扭曲变形及牵拉支扩：磨玻璃样改变：第六十七页，共一百八十七页。Case6a68-year-oldwomanwithrheumatoidarthritisa68-year-oldwomanwithrheumatoidarthritis（风湿性关节炎）（风湿性关节炎）andprogressiveandprogressive累计累计(lij)(lij)shortnessshortness短缺短缺ofbreathovera2-yearperiodofbreathovera2-yearperiod第六十八页，共一百八十七页。第六十九页，共一百八十七页。Thepredominantabnormalfindingonthesescansis?(a)interlobularseptalthickening小叶间隔增厚。(b)honeycombing蜂窝肺主要的异常(ychng)(ychng)表现？第七十页，共一百八十七页。蜂窝(fngw)(fngw)肺第七十一页，共一百八十七页。部分(bfen)(bfen)层面小叶间隔增厚第七十二页，共一百八十七页。Whatdoeshoneycombingreflecthistologically?(a)Interstitialedema肺间质水肿(shuzhng)(shuzhng)(b)Interstitialinfiltration渗透bycells(c)Interstitialfibrosis蜂窝肺的组织学肺间质纤维化的后期表现。第七十三页，共一百八十七页。Diagnosis:Rheumatoidlungdisease,withfibrosisandhoneycombing.风湿性肺疾病(jbng)(jbng)，肺纤维化、蜂窝肺。壁厚0.8-1MM，胸膜下3-4cm范围内或近叶裂处；早期囊腔小而少；囊壁为折叠破坏的肺泡壁及气道壁。第七十四页，共一百八十七页。Case7a74-year-oldwomanwithprogressiveshortnessofbreathover6months第七十五页，共一百八十七页。Themostsignificantabnormalfindinginthisstudyis:(a)interlobularseptalthickening小叶间隔增厚(b)honeycombing蜂窝肺(c)subpleuralemphysema胸膜下肺气肿主要的异常(ychng)(ychng)表现？第七十六页，共一百八十七页。蜂窝(fngw)(fngw)肺第七十七页，共一百八十七页。Whatisthemostlikelydiagnosis?n n(a)Idiopathicpulmonaryfibrosis(IPF)特发性肺间质纤维化n n(b)Autoimmunedisease(e.g.,rheumatoidlungdisease)自身免疫性疾病n n(c)End-stagehypersensitivitypneumonitis过敏性肺炎n n(d)Asbestosis石棉肺n n(e)Drug-relatedlunginjury麻醉(mzu)(mzu)药物肺损害n n(f)Sarcoidosis结节病最可能的诊断？第七十八页，共一百八十七页。IPF:特发性肺间质纤维化磨玻璃密度：肺野周围磨玻璃密度：肺野周围活动性肺泡炎症。网状改变：小叶网状改变：小叶(xioy)(xioy)间隔、小叶间隔、小叶(xioy)(xioy)中心结构增厚中心结构增厚蜂窝蜂窝状改变的前期。状改变的前期。蜂窝状改变：胸膜下间质纤维化：胸膜下弧线状影、脏层胸膜及叶间胸膜胸膜下间质纤维化：胸膜下弧线状影、脏层胸膜及叶间胸膜增厚。增厚。肺气肿：小叶中心型肺气肿。肺气肿：小叶中心型肺气肿。肺实变：肺实变：支扩：支扩：第七十九页，共一百八十七页。蜂窝(fngw)(fngw)肺第八十页，共一百八十七页。牵拉(qinl)(qinl)性支扩第八十一页，共一百八十七页。小叶(xioy)(xioy)间隔增厚第八十二页，共一百八十七页。Case886-year-oldmanwithchronicmyelogenousleukemia86-year-oldmanwithchronicmyelogenousleukemia骨髓性的白血病骨髓性的白血病,treated,treatedusingmethotrexateusingmethotrexate化疗化疗(hulio)(hulio),nowcomplainsofshortnessofbreath,nowcomplainsofshortnessofbreath 气短气短.第八十三页，共一百八十七页。第八十四页，共一百八十七页。DoesthismanshowevidenceoffibrosisandUIP?(a)Yes(b)Non n显示(xinsh)(xinsh)明显的纤维化和普通间质性肺炎？n n屑性间质性肺炎（DIP）、普通性间质性肺炎（UIP）。第八十五页，共一百八十七页。(a)YesCorrect.Findingsindicativeofusualinterstitialpneumonitis(UIP)visibleinthispatientinclude:n nhoneycombing;蜂窝肺n nirregularfissures;叶裂扭曲n nirregularinterlobularseptalthickening;小叶(xioy)(xioy)间隔不规则增厚。n ntractionbronchiectasis.牵拉性支扩第八十六页，共一百八十七页。蜂窝(fngw)(fngw)肺第八十七页，共一百八十七页。叶裂扭曲(niq)(niq)第八十八页，共一百八十七页。不规则小叶(xioy)(xioy)间隔增厚第八十九页，共一百八十七页。牵拉(qinl)(qinl)性支扩第九十页，共一百八十七页。Themostlikelydiagnosisis:可能的诊断？(a)idiopathicpulmonaryfibrosis(IPF)(b)lunginvolvementbyleukemia白血病肺浸润。(c)drug-relatedlunginjury化疗药物(yow)(yow)肺损害。第九十一页，共一百八十七页。(c)drug-relatedlunginjuryCorrect.Thepatternoffibrosisseeninthispatientisnonspecific,andCorrect.Thepatternoffibrosisseeninthispatientisnonspecific,andcouldbecausedbyIPF.TherecenthistoryoftreatmentwithcouldbecausedbyIPF.Therecenthistoryoftreatmentwithmethotrexatemakesdrug-relatedfibrosismostlikely.Lunginvolvementmethotrexatemakesdrug-relatedfibrosismostlikely.Lunginvolvementbyleukemiawouldlikelyresultinanappearancesimilartothatofbyleukemiawouldlikelyresultinanappearancesimilartothatoflymphangiticspreadofcarcinomawithseptalthickeningbeingthelymphangiticspreadofcarcinomawithseptalthickeningbeingthepredominantfinding.predominantfinding.IPFIPF一可有同种表现，但患者有最近化疗史，白血病肺浸润小叶间隔一可有同种表现，但患者有最近化疗史，白血病肺浸润小叶间隔(jin(jing)g)增厚明显。增厚明显。第九十二页，共一百八十七页。Case9ina63-year-oldmanwithahistoryofsclerodermaina63-year-oldmanwithahistoryofscleroderma硬皮病硬皮病andprogressiveandprogressiveshortnessofbreathshortnessofbreath进行性喘憋进行性喘憋第九十三页，共一百八十七页。Findingsinclude:interlobularseptalthickening;小叶(xioy)(xioy)间隔增厚。n ntractionbronchiectasis;牵拉性支扩n nsubpleuralhoneycombing;胸膜下蜂窝肺n nirregularfissures.叶裂扭曲第九十四页，共一百八十七页。小叶(xioy)(xioy)间隔增厚第九十五页，共一百八十七页。牵拉(qinl)(qinl)性支扩第九十六页，共一百八十七页。胸膜(xingm)(xingm)下蜂窝肺第九十七页，共一百八十七页。斜裂扭曲(niq)(niq)第九十八页，共一百八十七页。Canyoubeconfidentthatlungfibrosisispresent?(a)Yes(b)No你能确定(qudng)(qudng)肺纤维化存在？第九十九页，共一百八十七页。YesCorrect.Thepresenceofhoneycombingisdiagnosticoffibrosis.Tractionbronchiectasisisalsostronglysuggestiveoffibrosis.Interlobularseptalthickeningandirregularfissuresarenonspecific,andcannotbereliedupontodiagnosefibrosis.蜂窝肺、牵拉(qinl)(qinl)性支扩肺纤维化存在。小叶间隔增厚、斜裂扭曲对肺纤维化的诊断意义不大。第一百页，共一百八十七页。Diagnosis:Scleroderma,withlungfibrosis,honeycombing,andtractionbronchiectasisn n硬皮病硬皮病肺纤维化：蜂窝肺、牵拉性支扩。肺纤维化：蜂窝肺、牵拉性支扩。n n结缔组织病及肺血管炎结缔组织病及肺血管炎主要为肺间质病变。主要为肺间质病变。肺内实变肺泡内渗出、肉芽肿形成、肺泡内出血、肺泡内渗出、肉芽肿形成、肺泡内出血、水肿水肿(shuzhng)(shuzhng)。肺内多发结节肺内多发结节肺内血管炎、肉芽肿、肺栓塞所形成。常见于：wengnerwengner类风湿性关节炎。肺间质病变肺间质性肺炎、肺泡炎肺间质性肺炎、肺泡炎间质纤维化、蜂窝肺。第一百零一页，共一百八十七页。Case10ina61-year-oldwomanwithprogressiveshortnessina61-year-oldwomanwithprogressiveshortnessofbreathofbreath进行性喘憋进行性喘憋.第一百零二页，共一百八十七页。Whichofthefollowingfindingsareshownonthisscan?n n上图包含症像:(a)Honeycombing蜂窝肺(b)Asubpleuralline胸膜下线(c)Aperipheralandsubpleuraldistribution外围(wiwi)(wiwi)胸膜下分布(d)Alloftheabove以上全包括第一百零三页，共一百八十七页。AlloftheaboveCorrect.Smallsubpleuralcystsarepresenttypicalofmildhoneycombing.轻度的蜂窝(fngw)(fngw)肺Anirregularlineparallelsthepleuralsurface,termedasubpleuralline.胸膜下线第一百零四页，共一百八十七页。Whichofthefollowingismostlikelyinthiscase?Whichofthefollowingismostlikelyinthiscase?n n最符合最符合(fh)(fh)的诊断？的诊断？(a)Idiopathicpulmonaryfibrosis(IPF)(a)Idiopathicpulmonaryfibrosis(IPF)n n特发性间质纤维化特发性间质纤维化(b)Autoimmunedisease(e.g.,rheumatoidlungdisease)n n自身免疫性疾病自身免疫性疾病(c)End-stagehypersensitivityPneumonitisn n过敏性肺炎过敏性肺炎(d)Asbestosis石棉肺石棉肺(e)Drug-relatedlunginjury(e)Drug-relatedlunginjury药物肺损害药物肺损害(f)Sarcoidosis(f)Sarcoidosis结节病第一百零五页，共一百八十七页。Idiopathicpulmonaryfibrosis(IPF)Correct.Idiopathicpulmonaryfibrosis(IPF).Intheabsenceahistorytosuggestoneofthespecificdiagnosesonthislist,IPFismostlikely.Itaccountsfor60%ofcaseshavingthisappearance.IPF在该病例(bngl)(bngl)无特异性，60%有该表现。第一百零六页，共一百八十七页。Case11a34-year-oldmanwithprogressiveshortnessofbreath喘憋第一百零七页，共一百八十七页。第一百零八页，共一百八十七页。Thepredominantabnormalityinthiscaseis:n n明显(mngxin)(mngxin)的异常表现(a)honeycombingn n蜂窝肺(b)intralobularinterstitialthickeningn n小叶间质增厚第一百零九页，共一百八十七页。intralobularinterstitialthickeningCorrect.Honeycombingisnotvisibleinthispatient.Afineirregularreticular不规则的网状改变patternispresentinthelungperiphery,representingintralobularinterstitialthickening.小叶(xioy)(xioy)间质增厚Insomepatientswithpulmonaryfibrosis,thisfindingwillpredominate.Otherfindingsoffibrosisinthispatientincludetractionbronchiectasis.牵拉性支扩Thedifferentialdiagnosisofthisappearanceisidenticalasthatforhoneycombing.第一百一十页，共一百八十七页。小叶(xioy)(xioy)间质增厚第一百一十一页，共一百八十七页。牵拉(qinl)(qinl)性支扩第一百一十二页，共一百八十七页。Diagnosis:Idiopathicpulmonaryfibrosis特发性间质纤维化,withintralobularinterstitialthickening.第一百一十三页，共一百八十七页。Case12a71-year-oldmanwithprogressiveshortnessofbreath第一百一十四页，共一百八十七页。第一百一十五页，共一百八十七页。Thepredominantabnormalityinthiscaseis:n n突出(tch)(tch)的表现(a)honeycombingn n蜂窝肺(b)intralobularinterstitialthickeningn n小叶间质增厚第一百一十六页，共一百八十七页。intralobularinterstitialthickeningCorrect.Honeycombingisnotclearlyseeninthispatient.Afinebutirregularreticularpattern不规则的网状改变ispresentinthelungperiphery外围,representingintralobularinterstitialthickening小叶间质增厚.Insomepatientswithpulmonaryfibrosis,thisfindingwillpredominate.Otherfindings其他(qt)(qt)征象offibrosisinthispatientincludetractiontractionbronchiectasisbronchiectasis牵拉性支扩牵拉性支扩,andirregularinterlobularseptalthickening不规则小叶间隔增厚不规则小叶间隔增厚.Thedifferential.Thedifferentialdiagnosisofthisappearanceisidenticaltothatfordiagnosisofthisappearanceisidenticaltothatforhoneycombing.honeycombing.第一百一十七页，共一百八十七页。小叶(xioy)(xioy)间质增厚第一百一十八页，共一百八十七页。牵拉(qinl)(qinl)性支扩第一百一十九页，共一百八十七页。不规则小叶(xioy)(xioy)间隔增厚第一百二十页，共一百八十七页。Diagnosis:Idiopathicpulmonaryfibrosis特发性间质纤维化,withintralobularinterstitialthickening.第一百二十一页，共一百八十七页。Case1334-year-oldwomanwithlupuserytematosus狼疮(lngchung)(lngchung)红斑第一百二十二页，共一百八十七页。第一百二十三页，共一百八十七页。Canyoudiagnosefibrosis?n n能诊断(zhndun)(zhndun)纤维化？(a)Yes(b)No第一百二十四页，共一百八十七页。YesCorrect.HRCTobtainedinthesupineandpronepositions仰卧和俯卧位仰卧和俯卧位showsanumberoffindingsindicatingfibrosis指示指示,including:,including:honeycombingwhichismildindegree;轻度蜂窝轻度蜂窝(fngw)(fngw)肺肺tractionbronchiectasistractionbronchiectasis;牵拉性支扩intralobularinterstitialthickeningintralobularinterstitialthickening;小叶间质增厚interlobularseptalthickeninginterlobularseptalthickening小叶间隔增厚小叶间隔增厚;andasubpleuraldistribution.胸膜下分布第一百二十五页，共一百八十七页。轻度(qnd)(qnd)蜂窝肺第一百二十六页，共一百八十七页。牵拉(qinl)(qinl)性支扩第一百二十七页，共一百八十七页。小叶(xioy)(xioy)间质增厚第一百二十八页，共一百八十七页。小叶(xioy)(xioy)间隔增厚第一百二十九页，共一百八十七页。Diagnosis:Systemiclupuserythematosus（SLE系统性红斑狼疮(hnbnlnchun)(hnbnlnchun)肺部表现肺结缔组织病,withfibrosisandhoneycombing.第一百三十页，共一百八十七页。Case14a65-year-oldwomanwithrheumatoidarthritisa65-year-oldwomanwithrheumatoidarthritis风湿性关节风湿性关节炎炎andmilddyspneaandmilddyspnea轻度轻度(qnd)(qnd)呼吸困难呼吸困难第一百三十一页，共一百八十七页。Canyoudiagnosefibrosis?n n能诊断(zhndun)(zhndun)纤维化？(a)Yes(b)No第一百三十二页，共一百八十七页。Correctn nincluding:tractionbronchiectasis;牵拉性支扩intralobularinterstitialthickening;小叶(xioy)(xioy)间质增厚asubpleuralline.胸膜下线第一百三十三页，共一百八十七页。牵拉(qinl)(qinl)性支扩第一百三十四页，共一百八十七页。小叶(xioy)(xioy)间质增厚第一百三十五页，共一百八十七页。胸膜(xingm)(xingm)下线第一百三十六页，共一百八十七页。Diagnosis:Rheumatoidlungdisease肺结缔组织(jid-(jid-zzh)zzh)病,withmildpulmonaryfibrosis轻度肺纤维化andintralobularinterstitialthickening小叶间质增厚.第一百三十七页，共一百八十七页。Case15a26-year-oldwomanwithmixedconnectivetissuea26-year-oldwomanwithmixedconnectivetissuediseasedisease混合结缔组织混合结缔组织(jid-zzh)(jid-zzh)病病,basilarcracklesonphysicalexamination,basilarcracklesonphysicalexamination双双肺底水泡音肺底水泡音,andrestrictivediseaseonpulmonaryfunctiontests,andrestrictivediseaseonpulmonaryfunctiontests肺功能受肺功能受限限第一百三十八页，共一百八十七页。第一百三十九页，共一百八十七页。Canyoudiagnosefibrosis?n n能诊断(zhndun)(zhndun)纤维化？(a)Yes(b)No第一百四十页，共一百八十七页。YesCorrect.Including:tractionbronchiectasis;牵拉性支扩intralobularinterstitialthickening小叶间质增厚;asubpleuraldistribution胸膜(xingm)(xingm)下分布第一百四十一页，共一百八十七页。牵拉(qinl)(qinl)性支扩第一百四十二页，共一百八十七页。小叶(xioy)(xioy)间质增厚第一百四十三页，共一百八十七页。Diagnosis:Mixedconnectivetissuedisease混合(hnh)(hnh)结缔组织病,withpulmonaryfibrosis,andintralobularinterstitialthickening第一百四十四页，共一百八十七页。Case16a81-year-oldmanwithsignificantoccupationalexposuretoasbestos石棉(shmin)(shmin)职业史第一百四十五页，共一百八十七页。第一百四十六页，共一百八十七页