肺部炎症新认识点滴.pptVIP

肺部炎症新认识点滴;肺部炎症;炎症、肿瘤 哪一个更难诊断？ 炎症、肿瘤、良性、恶性 你的诊断准确率是多少？ 细菌、病毒、支原体、真菌、结核 你诊断准确率又是多少？ 炎症诊断比肿瘤更难;目前多数医院;由于这样诊断;实际上;肺结核;肺结核;肺真菌感染;支原体肺炎;过敏性肺炎;支原体肺炎 常见，可治 有一定特征，部分能诊断 诊断有意义;支原体肺炎;组织病理学表现 ;MP影像学;典型表现的解释;M3;M21月;特征1;a reticulonodular pattern confined to the left lower lobe. ;M6;特征2;F8;M8，右下叶支气管壁增厚，下叶GGO;实变及GGO;M20月，;M4;M4，发热，咳嗽咳痰，呕吐腹泻;F6;M8;F7，GGO;M4，弥漫性GGO，伴网合结节;结节;间质性改变;2d后部分吸收，遗留条状网格影;M6，典型表现;M9，;肺不张常见，反映支气管病变 肺实质坏死 单侧肺门淋巴结增大7% -22%，与结核难以区分，没有特点。 5%–20%出现胸腔积液，多数一过性或无明显临床意义，少数在肺内病灶吸收后仍持续一段时间。(细菌性肺炎更容易出现胸水) 纵隔气肿;F8，舌段不全不张;M11，支原体肺炎;M2，支气管壁增厚，LN大，胸水;F2;M8;过敏性肺炎;常见，易治 想到，结合有关检查 大多能确诊 诊断有意义;多数病例吸入抗原后数年后发病;初始症状;影像表现;;急性、隐匿发作不伴纤维化;;;multifocal ground-glass opacitiesin the right lung. Spared lobules (arrow) probably represent air trapping, but expiratory high-resolution CT imageswere not available for confirmation. Inspiratory and expiratory patchy ground-glass opacities, normal regions, and air trapping. This combinationof findings, known as the headcheese sign, is indicative of hypersensitivity pneumonitis.;;;;Hypersensitivity pneumonitis in a workerin a salmon processing facility. (a–c) Axial high-resolutionCT images demonstrate patchy, vaguely centrilobularground-glass opacities with relative sparing of theextreme lung bases. (Case courtesy of Ingrid Peterson,MD, Virginia Mason Medical Center, Seattle, Wash.);;隐匿发作伴纤维化;Insidious hypersensitivity pneumonitis withfibrosis. (a) Axial high-resolution CT images of the upperpart of the lungs show predominant reticulation withhoneycombing, traction bronchiectasis, and architecturaldistortion. (b) Axial high-resolution CT images of thelower part of the lungs demonstrate ground-glass opacity,reticulation, and lobular air trapping. (c) Coronal reformattedCT image allows a better evaluation of the distributionof these abnormalities.;Hypersensitivity pneumonitis with imagingfeatures similar to those of NSIP. (a, b) Axial CTimages of the lower part of the lungs (a obtained duringinspiration; b, during