肺部HRCT诊断基础 （肿瘤医院ICU）.ppt

a very important finding in practice fibrosis is present UIP is likely the histologic pattern in the absence of a known disease, IPF very likely lung biopsy is uncommonly performed if significant honeycombing is visible fibrosis is very likely present useful in diagnosis when a reticular abnormalityis unassociated with honeycombing UIP and IPF are common causes other causes of fibrosis (i.e. sarcoidosis, HP, NSIP) are more likely than when honeycombing present biopsy often indicated unless the patient hasa C-V disease sarcoidosis or lymphangitic carcinoma very likely clinical history may be sufficient for diagnosis bronchoscopy will likely provide diagnostic material 鉴别诊断 bronchiolitis, e.g. infectious, inflammatory endobronchial spread of TB, MAC bronchopneumonia (any cause) hypersensitivity pneumonitis endobronchial spread of tumor (BAC) pneumoconiosis (e.g. silicosis) organizing pneumonia, i.e. BOOP (rare) histiocytosis (rare) edema or vasculitis (uncommon) small airways disease (e.g. bronchiolitis) most likely consider infection with appropriate history, may be diagnostic of hypersensitivity pneumonitis remember BAC because of relation of nodules to airways, transbronchoscopic biopsy often diagnostic in patients with infection or tumor Dilatation and impaction of centrilobular airways resembles a budding tree centered 5 - 10 mm from the pleural surface more conspicuous than normal branching vessels often associated with centrilobular nodules endobronchial spread of TB, MAC bronchopneumonia (any cause) bronchiectasis or bronchitis cystic fibrosis panbronchiolitis (rare) aspiration (rare) ABPA or asthma (rare) BAC (rare) 多表明有小气道病变如：细支气管炎症、弥漫泛发性细支气管炎及肺结核播散病灶，其他肺部感染性病变 ； 陈伟，第三军医大学西南医院放射科 诊断基础：结节分布 病毒性肺炎 陈伟，第三军医大学西南医院放射科 诊断基础：结节分布 支气管肺炎 陈伟，第三军医大学西南医院放射科 诊断基础：结节分布 吸入性肺炎 陈伟，第三军医大学西南医院放射科 小叶中心结节：意义 陈伟，第三军医大学西南医院放射科 tree-in-bud Gosset N, et al.Tree-in-bud pattern. AJR American journal of roentgenology 2009;193 (6):W472-477 陈伟，第三军医大学西南医院放射科 “树芽征”（ tree-in-bud ） 部