1、Pulmonary Sarcoidosis: Typical Manifestations at High- Resolution CT with Pathologic Correlation,Recent Advances in Sarcoidosis,结节病CT典型表现结节病进展,Sarcoidosis is a multisystem disorder that is characterized by noncaseous epithelioid cell granulomas, which may affect almost any organ. 结节病是一种以非干酪样坏死的上皮细胞肉
2、芽肿为特点的多系统疾病，几乎可以累及所有器官。,Sarcoidosis may be asymptomatic or chronic. It commonly improves or clears up spontaneously（自愈或好转）. More than 2/3 of people with lung sarcoidosis have no symptoms after 9 years. About 50% have relapses. About 10% develop serious disability.,Sarcoidosis of the lung is primaril
3、y an interstitial lung disease in which the inflammatory process involves the alveoli, small bronchi, and small blood vessels.,Typical and Atypical Features of Pulmonary Sarcoidosis at High-Resolution CT Typical features 1 Lymphadenopathy: hilar, mediastinal (right paratracheal), bilateral, symmetri
4、c, and well defined 2 Nodules: micronodules (24 mm in diameter; well defined, bilateral); macronodules (5 mm in diameter, coalescing) 3 Lymphangitic spread: peribronchovascular, subpleural, interlobular septal 4 Fibrotic changes: reticular opacities, architectural distortion, traction bronchiectasis
5、, bronchiolectasis, volume loss Bilateral perihilar opacities 5 Predominant upper- and middle-zone locations of parenchymal abnormalities,结节病原本是肺间质性病变，累及肺泡，支气管和小血管,淋巴结增大，两侧对称，境界清楚,大小结节,淋巴管播散，支气管血管鞘，胸膜下，小叶间隔,纤维化改变，网状阴影，肺结构扭曲，牵拉性支扩，肺容积缩小，两肺门旁致密影,中上肺为主,典型特征,Pathologic Correlation 相关病理 Granulomas in the
6、 lung parenchyma have a characteristic distribution in relation to lymphatics in the peribronchovascular interstitial space, subpleural interstitial space, and, to a lesser extent, the interlobular septa (ie, a lymphangitic distribution)肺实质肉芽肿分布与支气管血管鞘，胸膜下结缔组织，小叶间隔中淋巴管相关Thickened bronchovascular bun
7、dles and small perivascular nodules seen at CT corresponded to granulomas within the connective tissue sheath surrounding pulmonary airways and vessels. Pleural or subpleural nodules were correlated with granulomas adjacent to the visceral pleuraCT上支气管血管鞘增厚和小结节是与包绕气道血管结缔组织鞘中肉芽肿，胸膜和胸膜下结节与脏层胸膜旁肉芽肿相关。,
8、Ground-glass opacities represented an accumulation of many granulomatous lesions, with or without fibrosis, in the alveolar septa and around the small vessels. No alveolitis was seen 肺泡间隔小血管周围大量肉芽肿是毛玻璃阴影主要原因，可伴纤维化，但没有肺泡炎。Large parenchymal nodules (1 cm in diameter) represented coalescent granulomas
9、大结节是肉芽肿病变的融合 Air bronchiolograms within regions of dense consolidation on CT images corresponded to bronchiolar dilatation with surrounding fibrosis 支气管充气症是纤维化旁的支扩honeycomb-like pattern of microscopic cysts seen at pathologic analysis. 蜂窝样改变在显微镜下就是很多的小囊,pulmonary sarcoidosis shows the typical perily
10、mphatic distribution of micronodules (arrow). （外周淋巴分布的微结节） Photomicrograph of a lung biopsy specimen demonstrates numerous epithelioid granulomas (arrow) surrounding the bronchial walls and immediately beneath the normal bronchial epithelium (arrowheads).,CT scan shows multiple micronodules with a p
11、eribronchovascular distribution in both lungs, predominantly in the upper and middle lobes. One cluster of nodules in the periphery of the left upper lobe (arrow) has coalesced to form a conglomerate lesion (macronodule). Coronal reformatted image from high-resolution CT clearly shows upper-lobe pre
12、dominance of the micronodules. Low-magnification photomicrograph,slice from the lower part of the right upper lobe shows multiple confluent granulomas infiltrating the peribronchovascular (arrows) and subpleural (arrowheads) interstitium.,CT scan shows mediastinal lymph node enlargement and a reticu
13、lar pattern produced by nodularity and thickening of interlobular septa, pleural surfaces, and fissures, CT扫描显示纵隔淋巴结肿大和形成网状图案的小叶间隔增厚，及胸膜表面，及产生的裂缝。 (b) Photomicrograph of a specimen from fine-needle aspiration biopsy of an enlarged right paratracheal lymph node shows a group of histiocytes against a
14、lymphocytic background, a cytologic structure characteristic of sarcoid granuloma. (c) Photomicrograph of a lung biopsy specimen from another patient shows progressive thickening of the interlobular septum (*) because of the accumulation of numerous sarcoid granulomas (arrowheads), an appearance tha
15、t correlates well with the CT features seen in a. 从扩大的右气管旁淋巴结细针穿刺活检标本显微镜下显示一组以淋巴细胞的背景的组织细胞，具有结节病肉芽肿细胞的结构特征。（C）从另一个病人的肺活检标本的显微照片显示小叶间隔增厚（*），大量积累的肉芽肿结节（箭头）。,. (11a) CT scan shows a diffuse ground-glass pattern produced by multiple confluent micronodules, with associated bronchiectasis. CT扫描显示弥漫性磨玻璃影，由
16、多个融合的结节产生，伴支气管扩张 (11b) Magnified axial high-resolution CT scan of the right lung clearly depicts separate nodules in a subpleural (black arrow) and fissural (white arrow) distribution and along the bronchovascular bundles (arrowheads) 放大的轴位高分辨率CT扫描清楚显示右肺胸膜下区分胸膜下的结节（黑色箭头）和沿支气管血管束分布的“裂”（白色箭头）. (11c) H
17、igh-power photomicrograph shows an accumulation of interstitial granulomas (white *), which causes a thickened appearance of the interalveolar septa, and acinar granulomas (black *), which form in the interstitium of the alveolar wall and protrude into the alveoli (arrowheads). 高倍镜下涂片显示间质肉芽肿集聚（白*），使
18、肺小泡壁的增厚，和腺泡肉芽肿（黑色），形成在肺泡壁的间质和伸入肺泡（箭头）。,Typical (a, b) and atypical (c, d) radiologic findings of lymphadenopathy in four patients with sarcoidosis四例结节病淋巴结病变的影像学表现. (a) Axial contrast materialenhanced CT scan (mediastinal window) shows typical bilateral and symmetric hilar (ar- rows) and subcarinal (
19、*) lymphadenopathy.CT增强扫描（纵隔窗）显示了典型的双侧对称性肺门（箭头）及隆突下淋巴结肿大（*） (b) Axial unenhanced CT scan (mediastinal window) obtained at the level of the left pulmonary artery shows enlargement of right paratracheal and left hilar lymph nodes (arrows) 右气管旁和左肺门淋巴结肿大. Although the right hilum is not shown, it too wa
20、s affected. (c) Axial unenhanced CT scan (mediastinal window) shows punctate cal- cifications of hilar lymph nodes (arrows), a pattern that also occurs in other chronic granulomatous diseases. (d) Axial contrast-enhanced CT scan shows bilateral eggshell-like calcifications of hilar and mediastinal lymph nodes双侧纵隔、肺门淋巴结蛋壳样钙化 (arrows), findings that warrant the inclusion of silicosis 矽肺in the differential diagnosis in this case.,END,
