间质性肺病的关键征象解读.pptVIP

严重的肺气肿可以类似LCH的表现 当它超出小叶中心区域达次级肺小叶时，它可似有璧的囊肿。 LCH患者，病理学家可能会发现LCH ，但也有肺气肿，呼吸性细支气管炎，甚至纤维化 模仿郎格罕细胞组织细胞增生症的肺气肿 　　　　　　　　　　肺泡蛋白沉积症 肺泡蛋白沉积症是一种罕见的疾病，其特点是由表面活性剂的代谢异常引起肺泡内充填PAS阳性物质 诊断依据的是基于典型的HRCT征象（碎石路样改变）和特征BAL灌洗液（支气管肺泡灌洗液） 通常为30至50岁 干咳，发烧，及轻度呼吸困难 自从采用支气管肺泡灌洗进行 　治疗后，预后有所改善 肺泡蛋白沉积症与碎石路样征象 　　　　　肺泡蛋白沉积症的主要表现 碎石路样征象：网格状改变叠加在毛玻璃样改变上 致密影的程度从毛玻璃到实变 机理：由于巨噬细胞将肺泡的蛋白物质运输到间质组织，从而导致间隔增厚。 碎石路样征象是一非特异的表现。 许多其它疾病可有这种征象，并出现在鉴别诊断中。 肺泡蛋白沉积症的鉴别诊断 非心源性水肿： ARDS ，急性间质性肺炎。 肺炎： 感染（ PCP 和CMV ） OP (机化性肺炎) 慢性嗜酸性肺炎 出血 支气管肺泡癌 High resolution CT of interstitial lung disease: key findings in common disorders by Schaefer-Prokop, C, Prokop M, Fleischmann D, Herold CJ. European Radiology 2001;11: 373-392 High Resolution Lung CT, UCSF Interactive Radiology Series on CD-ROM This browser-based learning file is based on Dr. Webbs HRCT text.. It offers a wide variety of cases dealing with common HRCT patterns of disease, diffuse lung diseases and their significance, and clinical characteristics. It is one of the best educational CDs ever made. High resolution CT of diffuse lung disease: value and limitations by Hansell DM. Radiol Clin North Am 2001:39: 1115-35 HRCT of the lung (3rd edition) Lipincott 2001 by Webb, Mueller and Naidich. High Resolution CT in Diagnosis of Diffuse Infiltrative Lung Disease by Zampatori M, Sverzellati N, Poletti V et al. Semin Ultrasound CT MR 2005;20(3): 176-85 American Thoracic Society/European Respiratory Society International Multidisciplinary Consensus Classification of the Idiopathic Interstitial Pneumonias This Joint Statement of the American Thoracic Society (ATS), and the European Respiratory Society (ERS) was adopted by the ATS Board of Directors, June 2001 and by The ERS Executive Committee, June 2001 What Every Radiologist Should Know about Idiopathic Interstitial Pneumonias by Christina Mueller-Mang, MD, Claudia Grosse, MD, Katharina Schmid, MD, Leopold Stiebellehner, MD, and Alexander A. Bankier, MDRadioGraphics 2007;27:595-615 Respiratory bronchiolitis, r