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1、几种特殊 X 线影像学征象,Contents,Signs in chest imaging Tree-in-bud Pattern Crazy-paving pattern Halo sign Air crescent sign Finger-in-glove sign ,Tree-In-Bud Pattern,树芽征 tree-in-bud pattern,HRCT 上细支气管周围炎，小叶中央支气管及其远端气道扩张、粘液嵌塞，在不同的截面组合一起，形似“春天发芽”的征象 树芽征最初用于描述肺结核并支气管播散，但也见于其他疾病 最经典的是弥漫性泛细支气管炎（DPB） 满肺的树芽征作为诊断依据之
2、一,树芽征常见原因 感染 细菌、真菌、病毒 先天性疾病 囊性纤维化、Kartagener 综合征 特发性疾病 闭塞性细支气管炎、弥漫性泛细支气管炎 误吸或异物吸入 免疫性疾病 ABPA 结缔组织疾病 类风湿性关节炎、干燥综合征 外周肺血管性疾病,High-resolution CT scan (far left) and drawings of the lung (middle left), a budding tree (middle right),and tree buds (far right) show the tree-in-bud pattern. Note the similar
3、ity of the obstructed bronchioles to the objects used in the game of jacks.,Thin-section CT scan obtained in a 29-year-old man with acute myeloid leukemia after bone marrow transplantation. The patient had a history of fever and cough. Image shows multiple, small,centrilobular nodules of soft-tissue
4、 attenuation connected to linear branching opacities (arrows). Note the morphologic similarities to the photograph of the tree in bud. At serologic examination,an infection with Mycoplasma pneumoniae was confirmed.,18-year-old man with active tuberculosis. High-resolution CT scan shows severe change
5、s of bronchiolar dilatation and impaction. Tree-in-bud pattern is seen in right lower lobe (arrow) and represents endobronchial spread of tuberculosis. Direct signs of bronchiolar involvement are also seen in left upper and lower lobes.,弥漫性泛细支气管炎（DPB）,东亚的地区病，影像学上特征明显 临床诊断标准 症状：咳嗽、咳较多脓痰、活动后胸闷、气短 体征：中
6、细湿性罗音，可有哮鸣音 影像学：弥漫性树芽征 肺功能：阻塞性通气功能障碍，通常无弥散功能下降；低氧血症 冷凝集试验效价升高，64 倍以上升高 慢性鼻窦炎,DPB 确诊标准,确诊有赖于组织病理学检查 (3 条中 2 条以上) 淋巴组织增生，表现为淋巴滤泡肥大增生，淋巴细胞和浆细胞浸润 泡沫细胞 细支气管周围纤维化 诊断中的困惑 冷凝集试验医院不做 如此小的细支气管中心性病变，经皮肺穿的阳性率低,DPB、支气管扩张和树芽征,Crazy-paving pattern,Photograph of a colonial-era pavement street in Buenos Aires, Argen
7、tina (left), drawings of the lungs (center) and lung tissue (top right), and close-up high-resolution CT scan (bottom right) show the crazy-paving pattern.,Causes of the crazy-paving pattern,Adult respiratory distress syndrome in a 27-year-old man who developed barotrauma and pulmonary interstitial
8、emphysema. High-resolution CT scan shows scattered ground-glass attenuation and thickening of the intra- and interlobular septa (crazy paving pattern). Note the air within the areas of interlobular thickening, a finding indicative of pulmonary emphysema.,Hematopoietic stem cell transplantation (HSCT
9、) 38-year-old man with adenovirus pneumonia HRCT scan at level of upper lobes shows bilateral areas of ground-glass attenuation with superimposed interlobular septal thickening (“crazy-paving” pattern),Halo sign,Invasive pulmonary aspergillosis in a 39-year-old man with acute myelogenous leukaemia a
10、nd neutropenia. Thin-section CT at the level of the lung apex shows multiple nodules surrounded by a halo of ground glass opacity in both upper lobes.,Cytomegalovirus pneumonia in a 45-year-old woman with rapidly progressive glomerulonephritis. Thin-section CT of the right lung base demonstrates mul
11、tiple tiny nodules (arrows) with the CT halo sign in the right lower lobe,Kaposi sarcoma in a 29-year-old woman with a history of renal transplantation. Thin-section CT at the level of the carina shows multiple nodules with a surrounding halo of ground glass opacity in both lungs, which are dissimil
12、ar to flame-shaped lesions, the classic findings of Kaposi sarcoma,a The most common condition showing the CT halo sign in immunocompromised patients. b The most common condition showing the CT halo sign in immunocompetent patients.,Air crescent sign,Aspergilloma (round mass in the left upper lobe)
13、visualized by computed tomography in a young man. The etiology of the underlying cavity was unknown in this case.,CT halo sign. This first thoracic CT scan (day 0) was performed in a patient with febrile neutropenic leukemia. The ground glass attenuation surrounding the nodule was considered a typic
14、al halo sign. The diagnosis of IPA was considered highly likely, and antifungal treatment was started.,Caillot et al. J Clin Oncol 2001; 19:253-9.,Invasive aspergillosis in a febrile neutropenic patient. Sequential cone-down views of the left upper lobe show progression from rounded consolidation to
15、 development of the classic air crescent sign (arrows).,The air crescent sign A clue to the etiology of chronic necrotizing pneumonia,The most common cause is the fungus ball of angioinvasive aspergillosis The ball can be large or small, solitary or multiple It may move when the patients position ch
16、anges or remain fixed Additional causes Pulmonary hydatid cyst 肺包囊虫囊肿 Other fungi,blood clot or Rasmussen aneurysm in a tuberculous cavity拉斯穆森瘤 Lung abscess with inspissated pus 浓缩了的粘稠脓液 Staphylococcal pneumonia 金葡菌肺炎 Nocardial infection Carcinoma of the lung Pulmonary gangrene or hematoma 肺坏疽或血肿,Fi
17、nger-in-glove sign,(A) Postoanterior radiograph showing a branching opacity in the left upper lung (finger-in-glove sign) (B) Axial CT image with tubular opacity and adjacent hyperlucency in the left upper lobe (C) 3D-reconstruction of the bronchial tree. There is no division of corresponding bronchi, indicating atresia (see arrows).,
