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1、Imagingdiagnosisofrespirotarydiseasepart1AiPingChen 小儿胸腺 肺大泡 呼吸系统影像观察 分析和诊断 X线 投照条件是否正确投照位置是否正确两侧胸廓是否对称纵隔位置是否居中横膈高度是否正常 CT 上下层面结合分析肺窗与纵隔窗结合分析断面图像与三维重建图像结合分析平扫图像与增强扫描图像结合分析 观察 分析病灶 病变的部位 数目病变的形态与大小病变的密度与边缘病变对邻近结构的影响 不同成像技术的优选和综合应用 不同成像技术的价值和限度 X线 健康普查 胸部疾病的诊断和随访限度 结构重叠 小病灶漏诊 如心影后方病灶或后肋膈角病灶 密度分辨率低 对纵隔
2、病变的诊断有限 CT 发现病变 定位和定性诊断 限度 定性缺乏特异性 MRI 定位和定性均有一定优势 限度 肺组织信号弱 对微细结构的显示效果不好 成像技术的优选原则 疾病发病阶段 发病部位及病变性质不同 不同成像技术在胸部应用的优势不同 需要多种成像技术综合应用 经济优先 简便优先 实用优先 安全优先原则 支气管病变 气管 支气管异物foreignbodyinthebronchus先天性支气管囊肿congenitalbronchialcysts气管肿瘤支扩 Clinicalsymptom cough Purulentfoul smellingsputum emptysis orhaemopt
3、ysis 儿童 青年多见 多见于左下叶 右中叶及右下叶 咳嗽 咳痰 咯血 支气管扩张bronchiectasis Bronchiectasis支扩 Bronchiectasisisdefinedaslocalized irreversibledilatationofthebronchialtree congenitaloraquired Thereareseveralcausesofbronchiectasis postinfectiouscauses congenitaldefectsofastructurenature chronicgranulomatousinfectionsuchas
4、tuberculosis 无异常发现支气管及肺间质慢性炎症引起肺纹理增多 增厚 紊乱 可呈管状 杵状 囊状蜂窝状影 或卷发状 继发感染 呈小斑片状模糊影 常不易治愈 或于同一地方反复发作 X线表现 Bronchiectasis PathologyDamageofbronchuswallPressionofbronchusincreaseCircumferencetissuedraught支气管壁破坏支气管内压增加周围组织牵拉 疤痕 肺不张等 Bronchiectasis Bronchiectasiscanbedividedintothreemorphologictypes cylindrica
5、l saccular mixedtype 柱状 囊状或静脉曲张型 Cylindricalbronchiectasisreferstoageneralizedmoreorlessregularwideningofthelargebronchi Saccularbronchietasisshowsthatthebronchiterminateinsac likecavities Bronchiectasis X raymanifestation Theplainfilmmaybenormalifonlyasmallpartisinvolvedandthereisnosecondaryinfecti
6、on Themostcommonappearanceonplainfilmisincreasingoflungmarkings Thebronchialwallsmaybevisibleeitherassingleorparallellineopacities Therearepathsofopacitywheninfectionoccures Bronchiectasis lungmarkingsoftheleftlowlobeincrease andsmallsac sac likecavities Bronchiectasis lungmarkingsoftheleftlowlobein
7、crease andsmallsac sac likecavities Bronchiectasis Bronchographicinvestigationisimportantandnecessarytodelineatethetotalextentofthedisease Inthebronchogram thecylindricbronchiectasismaybeshowclub shapeddilatationofthebronchi whilethesaccularbronchiectasiswillshowsaccularorcysticdilationoftheaffected
8、bronchi Bronchogram saccularbronchictasisintheleftlung Bronchiectasis CTishelpfulespeciallyinthemoreadvancedformsofbronchiectasis cylindricalbronchiectasiscausessmoothdilatationofbronchi recognizableas tramline whenseeninthescanplaneandasthesignet ringsignincross section Thesignetringsignreferstothe
9、thickenedanddilatedbronchus saccularbronchiectasiscanbediagnosedmostreliablybyCT sometimewecanseeair fluidlevelinthedilatedbronchus HRCT 支气管壁增厚 管腔增宽 呈 轨道征 或 印戒征 柱状 囊状或静脉曲张型 bronchictasistramline轨道征signet ringsign印戒征 air fluidlevelinthesac 支扩伴黏液栓形成 bronchictasistramlineandthesignet ringsignincross se
10、ction Question whereisthebronchiectasis 肺先天性疾病 肺发育异常 肺隔离症 bronchopulmonarysequestration intralobarextralobar 肺动静脉瘘 肺AVM Pneumonia Thecausativeorganismsarevariable 病原体多样感染 细菌 病毒 真菌 支原体 衣原体 立克次体 寄生虫理化性 类脂性 毒气 药物 放射线等免疫和变态反应 Pneumonia Pneumoniacancauseawidevarietyofabnormalfindingsonthechestradiograph
11、Commonly itpresentsasalveolarconsolidation whichcanbesegmentalorlobar ormaybepatchy fluffy alveolarinfiltrates withoutanysegmentaldistribution bronchopneumoniapattern Pneumoniaalsomaypresentasdiffusealveolardiseaseorasdiffuseinterstitialdisease Italsocanpresentassingleormultiplenodules Thepresenceof
12、pneumoniasometimesmaybemaskedbyanassociatedpleuraleffusion congestivefailure oradultrespiratorydistresssyndrome ARDS Pneumonia Accordingtotheradiologicappearance pneumoniacanbecommonlydividedintolobarpneumoniabronchopneumoniainterstitialpneumonia Lobarpneumonia LobarpneumoniamostcommonlyiscausedbyS
13、pneumoniae肺炎链球菌 butitcanalsooccurwithotherorganisms Lobarpneumoniarepresentsatypeofinflammationofthelungcharacterizedbyout pouringofexudatesintothealveoliwithlittlechangeinthebronchiorinterstitialtissue Theout pouringoffluidisgenerallyconsideredtoresultfromalocalsensitivityreactiontothepolysaccharid
14、esinthecapsuleofthepneumococcus Thebacteriaarerapidlycarriedbytheedemafluidfromalveolustoalveolus Lobarpneumonia Earlystage InflammatoryedemaConsolidationstageResolutionstage Lobarpneumonia Earlystage InflammatoryedemaTheinfectionandedemahaveusuallyspreadthroughoutasegmentofthelung X rayfindings The
15、lungmarkingsincrease Itdoesnotcompletelyobscurethepulmonaryvesselsintheareabecausemanyofthealveoliarestillaerated Lobarpneumonia ConsolidationstageThelungischaracterizedbyaratherdenseshadowofuniformopacity Ifthebronchiremainpatent theaircolumnwithinthemstandsoutasdark Thepresenceofanairbronchogramwi
16、thinashadowinthepulmonaryfieldindicatesthatthedensityisduetoconsolidationoflung Ifadequateantibiotictreatmentisgiven nofurtherspreadtakesplace 1 大叶性肺炎 病理过程 充血期 12 24hr 毛细血管充血 少量浆液渗出 肺泡部分仍含气 实变期 2 5d 分红色和灰色肝硬变期 肺泡内充满炎性渗出物 消散期 1w后开始 2 3w消散 线表现可无异常或肺纹理增粗 均匀实变影 与肺叶 段一致的高密度影 随各肺叶形态不同而不同 不均匀斑片状 逐渐吸收 胸膜侧最晚 可有胸膜增厚 纤维条索 lobarpneumonia consolidationofrightupperlungand airbronchogram consolidationofrightmiddlelober consolidationofrightupperlober Lobarpneumonia ResolutionstageThehomogenicityiftheshadowofcon
