1、呼吸系统影像诊断学 Imaging diagnostics of the respiratory system 郑州大学第一附属医院 the first affiliated hospital radiology department of Zhengzhou University 张焱 Zhang Yan,呼吸系统疾病 diseases of respiratory system,第一节 肺部疾病 pulmonary disease,(一）支气管扩张症 Bronchiectasis1.病因及病理 pathogeny and pathology ：支气管、肺慢性炎症使管壁破坏管外牵拉chron
2、ic inflammation of bronchi and pulmonary destroy the wall 内压增高而形成支气管扩张extratubal dragging cause increasment of intrapressure and formation of bronchiectasia subsequently,2.临床 clinical characters ： 咳嗽 cough 咳脓痰或血丝 purulence sputum or blood streak 反复发烧 recurrent ferver 杵状指（趾）等 achropachy,3.X线表现：（1）轻者无
3、异常 the slighter is normal （2）重者 the severity ：病灶好发于左肺下叶predilection is inferior lobe of left lung病变区肺纹理增多，粗糙，紊乱呈网状incresement of lung marking in diseased region 可见双轨征、杵状征和含气液的囊状影double track sign and drumstick and cystic image contain air and liquid 继发感染则出现斑片模糊影patchy fuzzy image follow Secondary in
4、fection,常伴发肺不张pulmonary atelectasis associated 晚期可并发肺心病pneumocardial disease coincidence at advanced stage,造影和SCT是确诊方法contrast examination opacification and SCT are final diagnosis way 可见扩张支气管边缘不规则呈柱状、囊状或混合型扩张表现margin of ectasia bronchi is irregular and columar,cystic or mixed pattern ectasy,支气管扩张症（
5、囊状型） 平 片 造影片,支气管扩张症（柱状型、右位心） 平 片 造 影 片,（二）肺炎 Pneumonia,按解剖分布 anatomy ：1.大叶性肺炎 lobar pneumonia 2.支气管肺炎 bronchial pneumonia3.间质性肺炎 interstitial pneumonia,1.大叶性肺炎 Lobar pneumonia,Lung infection caused by gram positive organism Staphylococcus, usually S. aureous General featuresBest diagnostic clueRapid
6、 onset patchy or lobar consolidation, marked by widespread, rapid, severe lung destruction with abscess formation Abscess can occur with a variety of different bacterial pneumoniasImaging shows thick-wall cavity, 30-40%Abscess can heal with pneumatocele formation (thin walled air-cyst in 2%), and ca
7、n last for yearsParapneumonic pleural effusion is very common, up to 2/3 of patientsEmpyema due to methicillin-resistant organisms becoming more common, especially in childrenLocation: Patchy bronchopneumonia with a multisegmental distribution, frequently bilateral,PATHOLOGY,General FeatureGenetics:
8、 Staphylococcus aureus strains carrying the gene for the Panton-Valentine leukocidin (PVL) cause rapidly progressive, hemorrhagic, necrotizing pneumonia, typically in otherwise healthy children and young adultsEpidemioloyMost common bronchopneumoniaVast majority are hospital acquiredCommon cause of
9、death during outbreaks of influenza,（1）病理及临床 pathological and clinical characters ：多由肺炎双球菌引起 pneumoniae diplococcus 病理分充血、红色肝样变、灰色肝样变和消散期congestive stage 、red hepatize 、gray hepatize 、dissipated stage 好发于冬春季，青壮年predilection season is winter and spring,the age is young adult,症状： 高热、咳嗽、咳铁锈色痰、胸痛ardent
10、fever, cough, rusty expectoration and chest pain 化验白细胞高，中性明显高WBC increase and neutrophil increase obviously,（2）X线、CT表现 X-ray and CT findings :充血期:congestion stage 肺纹理增多，肺透过度稍低lung marking increase and low radiotransparency 实变期（红灰肝变期）:consolidate stage 大片均匀致密影占据肺段或肺叶，近叶间胸膜处、边界清楚，余部模糊mass uniform high
11、 density lesion occupy the segment or lobes of lung.border near interlober pleurisy is clear and the other is obscure 有时实变区内可见支气管气像 visual air bronchogram in consolregion sometimes,空气支气管征：由于实变的肺组织与含气的支气管相衬托，在实变区中可见透明的支气管影because the consolidated lung tissue and the bronchi contain air foil each othe
12、r so hyaline bronchi image could be seen in consolidated region.,消散期:dissipate stage 原实变区出现分布不规则、大小不一、分散之斑片影 maldistribution,abnormal size and dispersed patchy image 一般二周内完全吸收entire absorption in two weeks 若吸收延迟可形成机化性肺炎absorption delay may induce organized pneumonia,右肺中叶大叶性肺炎,2.支气管肺炎 Bronchopneumoni
13、a （1）病理及临床特点： 多由链球菌、金黄色葡萄球菌和肺炎双球菌等引起caused by chain coccus,SA(staphylococcus aureus)and pneumoniae diplococcus,病理：pathology 小支气管、肺小叶实质和间质充血、水肿炎性渗出和实变parenchyma and interstitium of bronchia,lobules of lung congestion,hydrops inflammantorius excudation and consolidation,好发于婴幼儿、老年、手术后predilection is in
14、fant,elderly and postoperative people 症状：symptom 高热、咳嗽、咳脓痰和气喘等ardent fever、cough、purulent sputum and breathlessness,（2）X线表现：好发于两肺中下野内中带 predilection is inner-middle region of middle and lower field of both lung患区肺纹理增多、粗糙、模糊 lung marking increase ,coarsen,blur of affected part,沿肺纹理分布斑片状、边界不清的致密影 patc
15、hy and obscure border high density lesion distribute along the lung marking密度不均，有时可融合成大片 asymmetry density and amalgamate together sometimes多数病灶23周消散mostly dissipate in 2-3 weeks 小儿患病常有肺门增大模糊和局限性肺气肿 hilum pulmonis increment and illegibility and local emphysema,两侧中下肺支气管肺炎,3.肺炎支原体肺炎（Mycoplasmal pneumo
16、nia）（1）病理及临床特点：pathology and clinical character病原为肺炎支原体pathogen is Mycoplasma pneumonia病理：小支气管及肺间质充血、水肿及炎性细胞浸润，继而发生肺泡的渗出与实变Bronchia and pulmonary interstitial congest,edema and inflammatory cell infiltrate and follow exudation and consolidation of alveolus,好发于冬春及夏秋之交，一般为散发predilection season is inte
17、rsection of winter-spring and summer-autumn.it is sporadic currently.症状轻微可有疲乏、胸闷、轻咳和低热 fatigue, chest distress, tussicula and low-grade fever血清冷凝集试验多数阳性serum cold agglutination test is positive mostly,（2）X线表现：早期为肺纹理增多、模糊，也可呈网状改变 lung marking increase, blur or reticulum change 病情发展则在上述背景上出现炎性实变progre
18、ssion of disease is inflammatory consolidation on above background多出现在肺门及其下方，密度稍高，边界模糊，一般不超过肺叶 present to hilus of lung or inferior of it,slightly high density,obscure border and it is not exceeding lobi pulmonis,本病多在12周内吸收 absorb in 1-2weeks 若发生在肺上叶应注意与肺结核鉴别 differential diagnosis with pulmonary tu
19、berclosis if the lesion in lobi superior of the lung,两侧肺炎支原体肺炎（吸收前、后）,支原体肺炎（血冷凝集试验阳性）Mycoplasmal pneumonia (serum cold agglutination test is positive)是使用红霉素治疗5天后的平片和治疗9天后的CTX-Ray of 5 days post-treatment and CT of 9 days by erythromyci,4.间质性肺炎（Interstitial pneumonia）（1）病因病理：pathogeny and pathology细菌
20、或病毒引起小支气管壁和肺间质炎性病变pulmonary interstitial inflammatory disease of bronchia by bacterium or virus,（2）临床：常见于小儿 infant is common往往继发于急性传染病如麻疹、百日咳或流感等secondary to acute infectious disease as measles, pertussis or influenza症状有原发病症状加上气急、紫绀、咳嗽、鼻翼搧动和呼吸急促等 Primary symptom and breath lessness, cyanosis，cough，
21、flaring of alaenasi and ecphysesis,X线、CT：好发于两肺门区和中下肺野 predilection region is hilus and middle-lower field of both lung肺门轻度大、模糊、浓密Enlargement ,blurring and high density of Hilum,肺纹理模糊，粗而乱 blurring and coarse lung marking in disorder可见网点状阴影 shadow like lattice point常伴发弥漫性肺气肿或肺不张 diffuse emphysema or p
22、ulmonary atelectasis病灶消散较慢 slowly dissipate,间 质 性 肺 炎 麻疹后肺炎 间质性肺炎,Acute Interstitial PneumoniaAge/Sex: 66/M Brief History & Lab. findings: dry cough & progressive dyspnea for one month with rapid progression during last several dayspreviously healthy, no history of tuberculosis, no fever, no sign of
23、 edema WBC 9600,5.化脓性肺炎（Suppurative pnenmonia）（1）病因病理： 金黄色葡萄球菌从外界吸入或经血液到达肺部引起急性炎症SA(staphylococcus aureus) arrive in the lung from outside absorption and blood cause acute inflammation （2）临床： 多见于小儿或老年 infant or elderly is common 症状：高热，咳嗽，咳脓血痰，气急和胸痛等ardent fever,cough,vomica,breath lessness and chest
24、pain,（3）X线表现： 吸入性化脓性肺炎：aspirated surppurative pneumonia ：表现为小叶、肺段或大叶高密度云絮状阴影high density patchy shadow of lobuli,segment or lobar 有时一日内扩展为两肺广泛浸润阴影expandto wide infiltration shadow of both lung in one day sometimes此种炎症看不见支气管气像 bronchoscope is invisible发展则成肺脓肿 progression of disease is pulmonary absce
25、ss有时可见肺气囊 lung air bladder,血源性化脓性肺炎：hematogenic surppurative pneumonia表现为两肺多发大小不一的球形阴影，边界模糊或清楚 abnormal roundness shadow multiple of both lung.the border is obscure or clear其中可见空洞及液面 visual cavity and liquid-flat inside亦可见肺气囊 lung air badder,化 脓 性 肺 炎 左下肺大片状阴影， 十天后出现多个小囊状透明区,6.过敏性肺炎（Allergic pneumon
26、ia）（1）临床特点：clinical character 机体对某种物质过敏所致 又称吕弗勒综合征（Lofflers syndrome） organism hypersensitiveness to some matter,病理：pathology肺内嗜酸粒细胞浸润及局限性神经血管性水肿acidocyte in the lung infiltrate and local periodic edema 症状：symotom轻微 可有全身不适、轻咳、低热和哮喘等general malaise,tussicula,low-gradefever and asthma 化验：外周血嗜酸细胞增高peri
27、phery acidocyte increase,肺内任何部位均可出现斑片状、边界模糊、密度浅淡的云雾状影patchy,obscure border,low density ,cloudiness image at anywhere of the lung 阴影中有的可见肺纹理visual lung marking in some shadow 病灶此起彼伏，具有“游走特征”transmigration sign 一般数日内消散disipate in several days,两 侧 过 敏 性 肺 炎 阴影有游走性：左中、右下阴影，三天后消散，右上新出现阴影,Loefflers Syndro
28、me (simple pulmonary eosinophilia)：39 / maleIncidental solitary pulmonary nodule detected on chest CT.The second CT image obtained 1 month later shows complete disappearance of the nodule,（三）肺脓肿 （Lung abscess) 1、病因及病理：etiological factor and pathology化脓菌通过血液，外界吸入或邻近化脓灶直接蔓延到达肺部 pyogenic bacterium arri
29、ve in the lung by blood,outside obsorption or direct spread of adjacent suppuration 引起急性化脓炎症进而坏死、液化 cause acute supprative inflammation and necrosis,colliquation following咳出液化物形成空洞则成肺脓肿expectorate the colliquation cause cavity and lung abscess,2.临床：（1）高热、咳嗽 ardent fever,cough 咳大量臭脓痰或血，胸痛expectorate
30、mass purulent sputum or blood ,chest pain （2）慢性者呈消耗体质,反复发烧the chronic sufferer is wasting state咳脓痰和杵状指（趾）等 vomica and achropachy,3.X线、CT表现:（1）吸入性：aspiration急性肺脓肿 :acute lung abscess 肺内出现大片状阴影，占据一叶或一段，边界模糊great lamellar shadow in the lung and occupy lobi or segment of lung with obscure border早期密度较均匀
31、uniform density at early stage,病变进展：progression阴影中心出现透明空洞影 洞壁厚而不规整、边界模糊 the cavity wall is thick and irregular and obscure of the border洞内有液平面 liquid flat in the cavity如引流支气管活瓣阻塞、空洞迅速增大The cavity augment rapidly if the drainage bronchi valve obstructed,慢性肺脓肿 : chronic lung abscess 空洞壁厚而内外较光整，呈圆、椭圆或不
32、规则形，有或无液平面The cavity wall is thick and smooth of inside and outside.it is rotate ,ellipse or irregular shape .it has liquid flat or not洞周可有条索或斑片状影 streak or patchy shadow around the cavity空洞有时呈多房状，造影可显示支扩the cavity is multilocular sometimes and visualization may show bronchiectasis常伴发胸膜肥厚，积液或肋骨增生 pl
33、eural thickening and effusion or costa proliferation,（2）血源性：hematogenous似化脓性肺炎apostematosa pneumonia两肺出现大小不等、边界模糊或清楚的斑片状阴影 patchy shadow of abnormal size ,obscure or clear border in both lung常伴有空洞 simultaneous cavity,（3）直接蔓延：direct spread 可见膈下或肝脓肿表现 subdiaphragmatic or hepatic abscess膈面附近肺内大片致密影，空洞及胸膜增厚、粘连、钙化Mass high density lesion in the lung near facies diaphragmatica,cavity and pleural thickening, adhesion ,calcification,吸入性肺脓肿（急性） 平 片 断 层 片,吸入性肺脓肿（慢性）,
