弥漫性细支气管炎课件.pptVIP

Diffusepanbronchiolitis;In1969,thediseasewasnamedDPBtodistinguishitfromchronicbronchitis

Diffusereferstothedistributionofthelesionsthroughoutbothlungs

pan-referstotheinvolvementofinflammationinalllayersoftherespiratorybronchioles;EPIDEMIOLOGY;associatedwithsinusitisin75%ofpatients

etiologyisnotclear

Asianimmigrantsalsosuffers.

researchhasshownanassociationwithHLABw54,foundpredominantlyamongEastAsians;Atautopsy,lungsinDPBappearhyperinflatedandoftenshowbronchiectasis

Cutsectionsshowyellownodules,2–3mmindiameter,centringonsmallairways;PATHOLOGY;弥漫性细支气管炎;临床表现;影像学表现;Chestradiograph：bilateral,diffuse,smallnodularshadowswithpulmonaryhyperinflation;弥漫性细支气管炎;弥漫性细支气管炎;弥漫性细支气管炎;弥漫性细支气管炎;影像学鉴别诊断;肺结核支气管播散可有“树芽征”出现,也是这一CT征象最早被描述的疾病,但肺结核病灶有多态性的背景特点,其肺内病变除“树芽征”外,还伴有斑片影、空洞等多种形态。而急性粟粒性肺结核则表现为细粟粒样结节影,其密度更淡,分布更密集,有大小、密度、分布三均匀的特点,但无“树芽征”。因此在与DPB的鉴别诊断时胸部CT检查十分必要,尤其使用高分辨率CT(HRCT)更有利于病变的显示和鉴别。

尘肺的早期影像学表现是双肺弥漫性分布的粟粒样小结节影,但不呈小叶中心性分布。只有当气道损伤延伸至小气道时,CT上可出现细支气管扩张及小叶中心结节影(即TIB)。尘肺早期一般不伴发支气管扩张,亦无树芽征和支气管壁增厚。但纵隔、肺门淋巴结增大伴钙化是其特征,且有生产性粉尘接触史。而DPB患者无粉尘相关职业史,常无纵隔、肺门淋巴结肿大、钙化。;1.Persistentcough,sputumandexertionaldyspnoea

2.Historyofchronicparanasalsinusitis

3.BilateraldiffusesmallnodularshadowsonplainchestfilmorcentrilobularmicronodulesonchestCT

4.Coarsecrackles

5.FEV1/FVC70%andPaO280mmHg

6.Titreofcoldhaemagglutinin≥64;PROGNOSIS;TREATMENT;THANKYOUFORYOURATTENTION;谢谢聆听！