no.6 2014.3.7 学习指导 七年制影像chest -呼吸常见病1支气管病变+肺炎+肺结核- 陈爱萍.ppt

Postprimary tuberculosis (Adult tuberculosis) Productive tuberculosis is characterized by well-defined solid nodules, 1-2mm in diameter and rich in epithelioid cells; Productive tuberculosis produces sharply defined, irregular, polygonal opacities admixed with calcified granulomata. Productive tuberculosis Postprimary tuberculosis (Adult tuberculosis) Tuberculomas measure 1-3cm in diameter and comprise a caseous core surrounded by a mantle of granulation tissue. They have smooth margins and predilection for the upper zones. In 80% of cases, conventional or computed tomography will show small satellite lesions and calcifications. Tuberculomas Tuberculomas Tuberculomas Postprimary tuberculosis (Adult tuberculosis) Cavitating tuberculosis is active tuberculosis, the wall of the cavity contains infectious caseous material. Eventually, the cavity becomes fibrosed and may even acquire an epithelial lining. Postprimary tuberculosis (Adult tuberculosis) The tuberculous process heals by fibrosis, is associated with fibrous contraction and distortion of the lung architecture leading to emphysema, bronchiectasis, and bronchovascular distortion. Radiologic manifestations of fibrotic tuberculosis include apical pleural thickening, parenchymal scarring, calcification, and fibrotic bands radiating from the hilum to the apex. Cranial shift of hilar structures indicates fibrous contraction. Cavitating tuberculosis Tuberculous pleurisy (type Ⅳ) Bacilli invade the pleura where they form tubercles, this is associated with development of a pleural effusion rich in lymphocytes. Exudative tuberculous pleuritis resembles other effusions radiographically. The effusion obliterates the costophrenic sulcus and layers in the lateral decubitus position. 上叶 上叶空洞型肺结核伴下叶支气管播散 胸壁结核 胸壁结核 病理： 渗出：结核性肺泡炎 增殖：结核性肉芽肿 进展：干酪样坏死、液化空洞、支气管和血行播散 愈合：吸收、纤维化、钙化，空洞愈合或净化 肺结核  肺结核分类 原发型肺结核(Ⅰ型) 血行播散型肺结核(Ⅱ型) 继发性肺结核(Ⅲ型) 结核性胸膜炎 (IⅤ型) 其他肺外结核(Ⅴ型) 原发型肺结核 原发综合征 原发灶：近胸膜处渗出性病灶，病变可大可小 结核性淋巴管炎：条索状，从原发灶向肺门引流