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1、呼吸系统放射学诊疗空洞与空腔cavityandaircontainingspace 肺内病变组织发生坏死 坏死组织经引流支气管排出而形成Cavityisformedasaresultoftissuenecrosisandcommunicatedwiththebronchus 空洞cavity 虫蚀样空洞 无壁空洞 薄壁空洞Thin walledcavity厚壁空洞thick walledcavity壁厚3mm以上 见于肺脓疡 肺结核 肺癌等 X线表现 薄壁空洞Thin walledcavity洞壁厚3mm以下内壁光滑境界清楚的园形透亮区 见于肺结核 结核性空洞常无或仅少量液体多为薄壁TBcav
2、itywithalittleornotfluidlevel 虫蚀样空洞 无壁空洞 实变肺野内多发小的透亮区 虫浊样 见于干酪性肺炎 癌性空洞内壁多呈结节状Thick walledcavityIrregularinnerling 厚壁空洞thick walledcavity壁厚3mm以上 见于肺脓疡 肺结核 肺癌等 肺脓疡空洞多有明显液片多为厚壁Thickwallcavitywithsurroundexudativelesionsassociatedwithafluidlevel 空腔aircontainingspace肺内腔隙的病理性扩大肺大疱 肺气囊 肺气囊肿 囊状支扩 空腔性病变 右下肺囊
3、肿 肺部基本病变 肺间质病变interstitiallesion 发生在间质的弥漫性病变 即病变主要分布在支气管血管周围 小叶间隔 肺泡间隔 X线表现肺纹理增粗 网状strip纹理 蜂窝状honeycomb或伴广泛小结节影netting nodules 间质结节 弥漫性肺间质病变 diffuseinterstitialdisease HRCT 小叶内间质增粗 小叶内细支气管血管周围和肺泡间隔的间质增厚 弥漫性肺间质病变 diffuseinterstitialdisease 多发小结节及粟粒病变 multinodularandmiliarydiseases 弥漫性肺泡病变diffusealveo
4、lardisease 广泛分布 含气支气管征 毛玻璃密度 胸膜病变pleurallesion 胸腔积液 pleuraleffusion 游离性胸腔积液freepleuraleffusion少量积液中量积液大量积液局限性胸腔积液localizedpleuraleffusion包裹性积液叶间积液肺底积液 少量胸腔积液pleuraleffusionX线表现先积聚于后肋膈角液量300ml以上时侧肋膈角变平变钝 pleuraleffusion 中量胸腔积液pleuraleffusionX线表现下肺野均匀致密影肋膈角消失 膈面影被掩盖而显示不清上缘呈外高内低弧形液面 其形成机理 胸腔内负压状态液体重力肺组
5、织弹性液体表面张力作用 大量胸腔积液pleuraleffusion患侧肺野均匀致密 或仅肺尖透亮纵隔向健侧移位肋间隙增宽 大量积液pleuraleffusion纵隔 肋骨 横膈 左全肺不张 胸腔心包积液CT表现 pleuraleffusion 包裹性积液Loculatedpleuraleffusion 包裹性积液Loculatedpleuraleffusion 叶间积液interlobarfissurepleuraleffusion斜裂或水平裂梭形 两端与叶间裂相连液量多时呈球形 叶间积液interlobarfissurepleuraleffusion 叶间积液interlobarfissur
6、epleuraleffusion 气胸pneumothorax空气进入胸腔形成aircomeintochestcavity Cause 壁层胸膜破裂脏层胸膜破裂Edgeofthecollapsedlungs肺与胸壁之间透明含气区increasedradiolucentarea 其中不见肺纹理 液气胸hydropneumothorax胸腔内气体与液体并存thereisfluidwithairaboveit eitherinthepleuraspace pleuraladhesions thickeningandcalcification轻度胸膜肥厚 粘连多见于肋膈角处costophrenican
7、gle肋膈角变浅变平膈顶变平直而不呈园顶状flateningofthedomeofdiaphragm呼吸时膈运动受限膈胸膜粘连有时表现幕状突起 胸膜钙化pleuralcalcificationcalcificationalongthechestwallonthesurfaceofthepleuraPleuralcalcificationusuallyresultedfromTB hemorrhage 常见病X线诊断X raydemonstrationsIncommondiseases 支气管疾病 支气管扩张bronchiectasis Etiology followingbychronicbr
8、onchitis suppurativeinflammation pulmonicpneumonia pulmonaryatelectasisandfibrosisPathogenesis 慢性感染 支气管壁组织破坏 支气管内分泌物和长期咳嗽 支气管内压增高 肺不张和肺纤维化 外在性牵拉 支气管疾病 支气管扩张bronchiectasis continuouscoughandpurulentsputumAhistoryofrecurrenthaemoptysis bronchiectasis 分型 柱状扩张Cylindricalbronchiectasis囊状扩张Cysticbronchiec
9、tasis混合型扩张Mixedbronchiectasis bronchiectasisX 线表现 PLAINFILM正常morethan50 obscurerecognitionbronchiDilatedbronchi sometimeswithfluidlevels areseenonlyingrossdisease bronchiectasis CT 轨道征dilatationofthebronchus whichusuallyisaccompaniedbybronchialwallthickening印界征signetringconfiguration Dilatedbronchus
10、andconcomitantpulmonaryartery囊柱状改变Largeellipticalcircularopacities 肺炎pneumonia Accordingtoanatomicdistributing pneumoniacanbeasfollows LobarpneumoniaBronchopneumoniainterstitialpneumonia Lobarpneumonia 临床 causedbypneumococcusrapiddevelopmentofhighpyrexiaacharacteristicrustycolorsputumThebasicpatholo
11、giclesionisacuteinflammatoryexudationofthepulmonaryparenchyma 大叶性肺炎pathologicchangings 充血期Thecongestivestage itisabout24hoursafteronset 红色肝变期Theredconsolidationstage灰色肝变期Thegrayconsolidationstage消散期Resolutionstage Lobarpneumonia充血期 ItmaybenoX raychangesorwithanincreaseoflungmarkingsorwithafaintshado
12、wintheinflammatoryareamanyofthealveoliarestillaerated Lobarpneumonia 肝变期 TheX rayfeatureisalargehomogenousradiopaqueshadowthereisnovolumelossairbronchogramiscommonBordersoftheshadowappearasasharplydefinedmargin Lobarpneumonia Lobarpneumonia Lobarpneumonia LobarpneumoniaResolutionstage thealveolarexu
13、datesareabsorbedtherearefilledwithairinthealveolitheshadowofconsolidationbecomesscatterresorptionmaybedelayeduptooneortwomonths Lobularpneumonia bronchopneumonia causedlobularpneumoniaarestreptococcus staphylococcus pneumococcusThecommonsymptomsarefever cough purulentsputumandpleuriticpainetc Smallb
14、ronchuswallcongestandswelling interstitialinflammationinvolvingimmersinglobularpatchyopacitiesandconsolidation小支气管不同程度阻塞 Emphysemaorlobularatelectasis Bronchopneumonia病理变化 LobularpneumoniaX rayfeatures ThereisintensificationoflungmarkingsSmallpatchyopaqueshadowsareseeninthemiddleandlowerlungfieldses
15、peciallybytheheartborderEmphysemaofthebothlungsisusuallyvisible Confluenceofthesepatchyopacitiesmayproducesegmentallargeareaofconsolidation Delayedorincompleteresolutionmayresultinbronchiectasisandfibrosis 间质性肺炎interstitialpneumonia Interstitialpneumoniainvolvesmainlytheinterstitialtissueoflungs inc
16、ludingthebronchovascularbundlesandintralobularseptaitmaybecausedbyviralorbacterialinfectionClinicsigns shortnessofbreath cough cyanosis pathology interstitialinflammationimmersingLymphatitis lymphadenitisSmallbronchusinflammation obstructemphysemaandatelectasis肺泡也可轻度炎性浸润多伴不同程度的间质纤维结缔组织增生 interstitialpneumonia X rayfeaturesofinterstitialpneumonia Therearefinestreak like net like nodularornod reticularshadowsEmphysemaofbothlungsininfantpatientsPossiblythereisenlargementandincreaseindensityofthehil
