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

支气管病变 气管、支气管异物foreign body in the bronchus 先天性支气管囊肿 congenital bronchial cysts 气管肿瘤 支扩 caseous pneumonia. 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