肺真菌病的影像诊断课件.pptVIP

肺真菌病的影像诊断Imaging Diagnosis of Pulmonary Mycoses 彭文鸿 解放军第306医院呼吸内科 小叶中心性结节Centrilobular nodule 小叶中心性结节分布广泛，酷似随机分布的表现，但不累及胸膜面和小叶间隔。 Centrilobular nodules are usually of similar size and spaced at regular distances from each other. If the nodules are each at the center of a lobule, the internodular distance will be approximately 1-2.5 cm. At the periphery they occur 5-10 mm from the pleural surface (1/2 the diameter of a lobule). They usually represent linear peribronchiolar or bronchiolar densities cut in cross-section. 淋巴管周围性结节（Perilymphatic nodules） 淋巴管周围结节主要在肺门旁的支气管血管周围区、小叶中心区和与小叶间隔和胸膜面有关。 Ground glass ,consolidation 磨玻璃影Ground glass opacity 肺密度模糊增加，但不掩盖其内部的肺血管。提示为活动性或急性病变。 马赛克衰减（Mosaic attenuation） The term ‘mosaic attenuation’ is used to describe density differences between affected and non-affected lung areas.There are patchy areas of black and white lung. 马赛克灌注，肺灌注的区域性差异，导致吸气时HRCT上可见肺衰减的差异。反映了血管阻塞或通气异常，多见于气道疾病透亮区的血管特征性地表现为较致密肺内的血管细小。呼气HRCT 在由气道疾病中导致的马赛克灌注诊断上的价值。 马赛克衰减（Mosaic attenuation） Mosaic attenuation 实变影 Consolidation 肺衰减增加并掩盖了该区域内的肺血管，可见支气管空气征。 complete opacification of this area. When the bronchi remain aerated, they are seen as branching lucencies called air-bronchograms, which are present in this image. This image represents infectious pneumonia, which is limited by the major fissure, resulting in a sharp border. The advancing anteromedial margin shows ground-glass opacity (see later). 实变影 Consolidation 树芽征（Tree in Bud） 树芽征（Tree in Bud） 扩大的小叶中心细支气管，管腔内为黏液、液体或脓液所嵌塞，常伴细支气管炎症。 Hypodense sign(在实变及结节出现中心性低密度区) Reversed Halo Reversed Halo 空洞Cavitation  指肺组织坏死、液化，坏死物质经支气管排除后形成的病变。 1 曲霉菌病(aspergillosis) 曲霉菌病(aspergillosis) 1.1 Aspergilloma（曲霉菌球） 为寄生型，霉菌球由菌丝和坏死白细胞 通常发生在已经存在的肺空腔病变内，如结核空洞、肺囊肿、癌性空洞等； 典型的曲霉菌球CT表现：为肺空洞或空腔性病变内球形内容物，空洞或空腔壁与内容物之间可见新月形或环形透亮影。改变体位，内容物位置可发生变化，球形表面光滑，密度均匀，可有钙化。 Aspergilloma（曲霉菌球） Aspergilloma（曲霉菌球） * PCP Airway invasive aspergillosis PCP in AIDS 支气管肺活检证实为曲霉性支气管炎和肺炎 Halo---Hypodense----Air crescent 纵隔窗示中心密度低，有组织梗死 Halo Hypod