呼吸系统影像学 课件.pptVIP

Focal pleural effusion Interlobar effusion in the minor fissure Pleural thickening and calcification 思考题： 1 实变的定义与病变 2 空洞的分类 肿块mass 直径大于3cm 良恶性肿块的鉴别 良性 恶性 形状 圆形 不规则分叶 边缘 光滑锐利 不锐利 毛刺 无 有 密度 均匀 不均 包膜 有 无 Adenocarcinoma and Bronchioloalveolar carcinoma. HRCT image shows a spiculated right upper lobe nodule with bubble lucencies. 腺癌及支气管肺泡癌，HRCT影像显示右肺上叶结节，周围可见毛刺，可见“小泡征”。 bubble lucencies 结节内的小灶性透光区，直径约数毫米，肿瘤灶内部分肺泡未受累及，肿瘤细胞呈覆壁生长，使该部肺泡仍保持充气状态。 Adenocarcinoma. HRCT image shows a 3-cm diameter node in the right upper lobe. It has lobulated and spiculated margins and is associated with a moderate degree of pleural puckering. A low magnification photomicrograph shows a adenocarcinoma adjacent to the pleura. The spicules are the result of subsegmental atelectasis, interlobular septal thickening by fibrous tissue and peribronchiolar thickening by tumor infiltration. Tuberculoma in the left upper lobe, surrounded by satellite lesions 空 洞 空洞 —— cavity 肺内病变组织发生坏死后经引流支气管排出后形成 多见于结核、肺脓肿与肺癌 空 洞 薄壁空洞和厚壁空洞（3mm) 薄壁空洞：肺结核 厚壁空洞：肺脓肿、肺癌、肺结核 单发空洞和多发空洞 单发：结核空洞、肺脓肿和肺癌 多发：金黄色葡萄球菌肺炎、Wegener’s肉芽肿、转移瘤和结核。 虫蚀样空洞 Tuberculous cavity in the right upper lobe Cavitary tuberculosis. HRCT image shows a large, thin-walled cavity, a small cavity, linear opacities, and a few small nodules in right upper lobe. Magnified view of a sagittal slice of the excised specimen shows the cavity as well as several clacified an uncalcified granulomas. 实质：肺内支气管的各级分支及肺泡结构， 间质：肺泡间、终末气道上皮以外的支持组织。 肺间质病变interstitial abnormalities 肺泡上皮细胞及血管内皮细胞，间质为二者之间的所有组织，包括结缔组织、淋巴管、神经等 网、线和条形阴影 间质肺炎、结缔组织病、癌性淋巴管炎和慢性支气管炎 A 小气道扩张，形成蜂窝 ×40 B 间质正常结构消失 ×200 HRCT image shows extensive bilateral ground-glass opacities and poorly-defined Small nodules. Also note small right pleural effusion. 支气管扩张bronchiectasis 先天性支气管扩张 后天性支气管扩张的主要病因： 1 慢性感染 2 支气管内分泌物淤积及长期咳嗽 3 肺不张及肺纤维化 分型：柱状，囊状，静脉曲张型 支气管扩张常发生于支气管的3-6级分支 X-ray表现 早期轻度支扩在平片上可无发现 肺纹理改变 肺内炎症 肺不张 囊状或蜂窝状影 局限性胸膜增厚粘连 CT表现 双轨征，印戒征 正常时，肺动脉直径稍大于伴行的