呼吸常见病专题培训专家讲座.pptx

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,*,*,Imaging diagnosis of respirotary common disease,AiPing Chen,1,呼吸常见病专题培训,第1页,Clinical symptom:,cough,Purulent foul-smelling sputum,emptysis,or haemoptysis.,儿童，青年多见，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,2,呼吸常见病专题培训,第2页,Bronchiectasis,支扩,Bronchiectasis is defined as localized,irreversible dilatation of the bronchial tree.It may be congenital or aquired.,The formerextremely rare.,causes of bronchiectasis：postinfectious causes;congenital defects of a structure nature;chronic granulomatous infection such as tuberculosis.,3,呼吸常见病专题培训,第3页,无异常发觉,支气管及肺间质慢性炎症引发肺纹理增多，增厚，紊乱。可呈管状、杵状、囊状蜂窝状影，或卷发状。,继发感染：呈小斑片状含糊影，常不易治愈，或于同一地方重复发作。,X线表现,4,呼吸常见病专题培训,第4页,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）,5,呼吸常见病专题培训,第5页,Bronchiectasis,three morphologic types:,cylindrical,saccular,mixed type,柱状、囊状或混合型。,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.,6,呼吸常见病专题培训,第6页,Bronchiectasis,X-ray manifestation:,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 occures.,7,呼吸常见病专题培训,第7页,Bronchiectasislung markings of the left low lobe increase,and small sac(sac-like cavities),8,呼吸常见病专题培训,第8页,Bronchiectasis:lung markings of the left low lobe increase,and small sac(sac-like cavities),9,呼吸常见病专题培训,第9页,Bronchiectasis,Bronchographic investigation is important and necessary to delineate the total extent of the disease.,In the bronchogram,the cylindric bronchiectasis may be show club-shaped dilatation of the bronchi,while the saccular bronchictasis will show saccular or cystic dilation of the affected bronchi.,10,呼吸常见病专题培训,第10页,Bronchogram:saccular bronchictasis in the left lung,11,呼吸常见病专题培训,第11页Bronchiectasis,CT is helpful especially in 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 bronchiectasis can be diagnosed most reliably by CT,sometime we can see air-fluid level in the dilated bronchus.,12,呼吸常见病专题培训,第12页,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。,13,呼吸常见病专题培训,第13页,bronchictasis,tram line,轨道征,signet-ring sign 印戒征,14,呼吸常见病专题培训,第14页,air-fluid level in the sac.,15,呼吸常见病专题培训,第15页,bronchictasis,tram line”and the signet-ring sign in cross-section.,16,呼吸常见病专题培训,第16页,bronchictasis,tram line”and the signet-ring sign in cross-section.,17,呼吸常见病专题培训,第17页,Question:where is the bronchiectasis?,18,呼吸常见病专题培训,第18页,19,呼吸常见病专题培训,第19页,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、药品、放射线等,免疫和变态反应,20,呼吸常见病专题培训,第20页,Pneumonia,Pneumonia can cause a wide variety of abnormal findings on the 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.,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).,21,呼吸常见病专题培训,第21页,Pneumonia,According to the radiologic appearance,pneumonia can be commonly divided into,lobar pneumonia,bronchopneumonia,interstitial pneumonia.,22,呼吸常见病专题培训,第22页,Lobar pneumonia,Lobar pneumonia most commonly is caused by S.pneumoniae,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 little 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,23,呼吸常见病专题培训,第23页,Lobar pneumonia,Early stage:Inflammatory edema,Consolidation stage,Resolution stage,24,呼吸常见病专题培训,第24页,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 because many of the alveoli are still aerated.,25,呼吸常见病专题培训,第25页,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 field indicates that the density is due to consolidation of lung.,If adequate antibiotic treatment is given,no further spread takes place.,26,呼吸常见病专题培训,第26页,1.大叶性肺炎,病理过程,充血期：,12-24hr。毛细血管充血，少许浆液渗出，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、段一致高密度影，随各肺叶形态不一样而不一样。,不均匀斑片状，逐步吸收，胸膜侧最晚，可有胸膜增厚、纤维条索,lobar pneumonia,27,呼吸常见病专题培训,第27页,consolidation of right upper lung and“air bronchogram“,28,呼吸常见病专题培训,第28页,consolidation of right middle lober,29,呼吸常见病专题培训,第29页,consolidation of right upper lober,30,呼吸常见病专题培训,第30页,Lobar pneumonia,Resolution stage,The homogenicity if the shadow of consolidation is lost and it becomes mottled as the exudate in various portions 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 streaklike shadow.These shadows disappear as the lung re-expands and resolution is completed.,31,呼吸常见病专题培训,第31页,Resolution stage in the right upper lober,Streak like shadow,32,呼吸常见病专题培训,第32页,Resolution stage in the left lower lober,33,呼吸常见病专题培训,第33页,consolidation of left upper lober,34,呼吸常见病专题培训,第34页,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,),35,呼吸常见病专题培训,第35页,36,呼吸常见病专题培训,第36页,37,呼吸常见病专题培训,第37页,38,呼吸常见病专题培训,第38页,Bronchopneumonia(lobular 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 results 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.,39,呼吸常见病专题培训,第39页,Bronchopneumonia(lobular pneumonia),The radiologic manifestations of bronchopneumonia depend on 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.,40,呼吸常见病专题培训,第40页,Bronchopneumonia(lobular pneumonia),Consolidation involving the terminal and respiratory bronchioles and adjacent alveoli results in poorly defined centrilobular nodular opacities measuring 4 to 10 mm in diameter(air-space nodules);extension to involve the entire secondary lobule(lobular consolidation)may be seen.,Bronchopneumonia frequently results in loss of volume of the affected segments or lobes.When confluent,bronchopneumonia may resemble lobar pneumonia.,41,呼吸常见病专题培训,第41页,小叶性肺炎影像学表现,病变部位：两肺中下野内中带,肺纹改变：增多、增粗、含糊,X-ray:两肺中下野内中带沿支气管分布，肺纹理增多、增粗、含糊，小叶渗出与实变表现为斑片状含糊致密影，有融合倾向,CT表现：两中下肺支气管血管束增粗，有大小不一样结节和片状阴影，12cm大小，边缘含糊。病变之间除正常含气肺组织外，还有12cm类圆型透亮阴影，代表小叶性过分充气,42,呼吸常见病专题培训,第42页,patchy areas of consolidation,43,呼吸常见病专题培训,第43页,Lung markings increase and patchy in the right lower lobe,44,呼吸常见病专题培训,第44页,Lung markings increase and patchy in the right and left lung,45,呼吸常见病专题培训,第45页,Patchy shadow in both of the lung,46,呼吸常见病专题培训,第46页,Patchy shadow in both of the lung,47,呼吸常见病专题培训,第47页,48,呼吸常见病专题培训,第48页,49,呼吸常见病专题培训,第49页,HIV infection,immune deficiency accompany with infection or tuberculosis and so on,免疫缺点者伴随感染或结核等,50,呼吸常见病专题培训,第50页,HIV female 23 years olds,51,呼吸常见病专题培训,第51页,HIV,Patchy shadow in both of the lung,52,呼吸常见病专题培训,第52页,53,呼吸常见病专题培训,第53页,54,呼吸常见病专题培训,第54页,Lung abscess,Hematogenous abscess血源性脓肿 is rather rare now.Abscesses occur most often as a complication of aspiration of food,vomitus,or foreign body;of bacterial pneumonia;or bronchial obstruction.Anaerobic bacteria厌氧菌are often the cause.,Other relatively Common agents are S.aureus金黄色葡萄球菌and Pseudomonas aeruginosa假单胞菌.,Abscesses may also be secondary to septicemia败血病,and they occasionally develop in an infected pulmonary infarct.,55,呼吸常见病专题培训,第55页,Lung abscess,Symptomatology resembles that of acute pnenmonia with fever,cough productive of purulent sputum脓痰,and leucocytosis白细胞增多.,Diabetics,alcoholics,and immunocompromised,免疫受损individuals are at increased risk of developing lung abscess.,56,呼吸常见病专题培训,第56页,Lung abscess,The abscess resulting from aspiration most frequently occurs in the dependent segments of the lung-the posterior segments of the upper lobe and the superior segments of the lower lobe.,The abscess first appears as a round but poorly defined area of segmental consolidation usually near the periphery of the lung.No fluid level is seen until bronchial communication is established.,57,呼吸常见病专题培训,第57页,Lung abscess,As the abscess ruptures into the bronchus a translucent ring with a fluid level is seen in the middle of the opaque segment.,The inner walls of the cavity are smooth.Adjacent parenchymal consolidation is also present.,Multiple cavities may develop within consolidated lung(necrotizing pneumonia).,Conventional tomography may show gas bubbles within an abscess indicating either a bronchial communication or possible infection with gas-forming organisms.There is frequently an associated pleural effusion.,58,呼吸常见病专题培训,第58页,Lung abscess,CT allows earlier detection of abscess formation,CT is also superior in defining the relationship of the process to the pleural cavity,.,Empyemas tend to be lenticular in shape,and their angle of interface with the chest wall is usually obtuse.,A lung abscess is usually spherical and produces an acute angle with the chest wall.,59,呼吸常见病专题培训,第59页,Lung abscess,After antibiotic treatment in favorable cases both the cavity and the surrounding consolidation gradually shrinks and disappears.The abscess heals completely and leaves no visible scar or sometimes a small area of fibrosis indicates the site.In some cases healing is slow and there is often a residual bronchiectasis of fusiform type.,60,呼吸常见病专题培训,第60页,Acute abscess:the cavity(fluid in cavity)and the surrounding consolidation,61,呼吸常见病专题培训,第61页,Acute abscess:the cavity(fluid in cavity)and the surrounding consolidation,62,呼吸常见病专题培训,第62页,Acute abscess:the cavity(fluid in cavity)and the surrounding consolidation,63,呼吸常见病专题培训,第63页,Chronic abscess:the cavity and the surrounding consolidation,64,呼吸常见病专题培训,第64页,Chronic abscess:the cavity and the surrounding consolidation,65,呼吸常见病专题培训,第65页,Chronic abscess:the cavity and the surrounding consolidation,66,呼吸常见病专题培训,第66页,67,呼吸常见病专题培训,第67页,Tuberculosis of the lung,Tuberculosis is an infectious disease that may affect any organ but shows a marked predilection for the lungs.Nowadays better standards of living and hygiene have sharply reduced the incidence of tuberculosis.Despite recent advances in therapy and careful public health measures,TB remains a problem in the large reservoir of elderly patients who have previously been infected with tubercle bacilli and in the urban poor who continue to be exposed to tubercle bacilli.,68,呼吸常见病专题培训,第68页,Tuberculosis of the lung,The main factor determining whether tuberculosis infection progresses to disease is the immune competence of the individual.The disease is most commonly found in persons whose immune status is compromised by old age,alcohol abuse,diabetes,steroid therapy,or AIDS.,69,呼吸常见病专题培训,第69页,Tuberculosis of the lung,Tuberculosis is classically divided into,()primary tuberculosis.,()hematogenous tuberculosis.,()postprimary tuberculosis.,()tuberculous pleurisy.,()extraplumonary tuberculosis.,70,呼吸常见病专题培训,第70页,primary tuberculosis,Most cases of primary tuberculosis due to inhale the tubercle bacilli.It is commonly seen in children or adolescents.The infection spreads from the initial focus in the lung to the regional and mediastinal lymph nodes by way of the lymphatic channels.Inhaled tubercle bacilli initially evoke a focal,nonspecific subpleural alveolitis that converts to a tuberculosis-specific inflammatory focus(Ghon focus)in about 10 days.Spread of tubercle via the lumphatics leads to a specific hilar lymphadenitis.The combination of the primary pulmonary focus,lymphangitis and lymphadenitis is known as the primary complex.,71,呼吸常见病专题培训,第71页,primary tuberculosis,The Ghon focus is a circumscribed,small,peripheral consolidation.Hilar and mediastinal lymphadenitis presents as hilar enlargement and mediastinal widening.Occasionally,lymphangitic stranding connecting the primary focus with the hilar lymphadenitis,forms a dumbbell-shaped,opacity.Segmental opacity may be due to segmental atelectasis distal to bronchial compression by enlarged lymph nodes.,72,呼吸常见病专题培训,第72页,Right hilar enlargement and mediastinal widening,73,呼吸常见病专题培训,第73页,Left hilar enlargement,74,呼吸常见病专题培训,第74页,Left hilar enlargement and mediastinal widening,75,呼吸常见病专题培训,第75页,Right hilar enlargement and mediastinal widening,76,呼吸常见病专题培训,第76页,Lymph node enlargement in mediastinum,77,呼吸常见病专题培训,第77页,After treatment enlargement lymph node disappear,78,呼吸常见病专题培训,第78页,Hematogenous tuberculosis(Type),Mycobacteria entering the blood from the primary complex may become disseminated to numerous extrapulmonary sites.It may be classified as acute,subacute or chronic hematogenous dissemination tuberculosis.,79,呼吸常见病专题培训,第79页,Miliary tuberculosis,Acute miliary tuberculosis,Military tuberculosis exhibits a finely mottled nodular pattern resulting from summation of individual nodules.These may range in size from 1-4mm in diameter.,They completely obscure the normal lung markings in acute hematogenous dissemination tuberculosis.,Three homogeneous:distribute,size,density,80,呼吸常见病专题培训,第80页,Three homogeneous:distribute,size,density,Acute miliary tuberculosis,81,呼吸常见病专题培训,第81页,Three homogeneous:distribute,size,density,Acute miliary tuberculosis,82,呼吸常见病专题培训,第82页,Acute miliary tuberculosis,83,呼吸常见病专题培训,第83页,Acute miliary tuberculosis,84,呼吸常见病专题培训,第84页,Miliary tuberculosis,Subacute or chronic miliary tuberculosis,tiny opacities are chiefly dis