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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MRI室 the first affiliated hospital radiology department of the Zhengzhou University 张焱 Zhang YanL,三、胸部基本病变的影像 Basic imaging findings in disease of respiratory system,气管支气管病变disease of the tracheobronchus： （一）支气管阻塞及其后果 bronchi obstruct
2、ion and the results：病因 ： etiopathogenisis 管内 : intralumen 异物、分泌物和血块等 foreign body, excretion and blood clot 管壁 ： tubal wall 肿瘤、痉挛、先天性和炎症等 tumor, spasm,congenital and inflammation 管外：extralumen 有肿瘤、增大淋巴结压迫等 tumor and enlargement of the lymph nodes,病理 pathologically： 部分阻塞引起肺气肿 obstructive emphysema (i
3、ncomplete obstruction) 完全阻塞引起肺不张 atelectasis (complete obstruction),1.阻塞性肺气肿 obstruction emphysema： 部分阻塞致肺内气体不能完全排出，肺泡过度膨胀形成肺气肿 incomplete obstruction cause to emphysema 终未细支气管以远的含气腔隙过度充气、异常扩大，可伴有不可逆性肺泡壁的破坏 enlargement of alveoli ,accompanied by destruction of alveolar walls 若多个肺泡膨胀破裂，融合则成肺大泡 bulla
4、is formed due to rupture of alveolar wall and communicated with each other, pneumatocele,（1）弥漫性肺气肿diffuse obstruction emphysema ： 两肺纹理变细、少、分散及肺透过度增大 lung markings appear thinner than normal, increase lucency of both lungs 膈肌低、动度弱 depression and flattening of the diaphragm 肋间隙增宽；心影狭长 intercostal spac
5、e widen, heart shadow appears long and narrow,（2）局限性肺气肿localized emphysema ： 局部透过度高 increase lucency of the affected 肺纹理细、少、分散 lung markings appear as thinner of the involved area 肺门、叶间胸膜、纵隔及膈肌移位 displacement of hilum, pleura, mediastinum and diaphragm to the unaffected side 有时可见纵隔摆动 pendular moveme
6、nt of the mediastinum,CT findings： 小叶中央型肺气肿 病变累及肺小叶中央部分，上叶多见 全小叶型肺气肿 病变累及全部肺小叶，下叶多见 间隔旁型肺气肿 病变累及肺小叶边缘，多见于胸膜下或小叶间隔周围,弥 漫 性 肺 气 肿 diffuse obstruction emphysema,右上慢性纤维空洞肺结核伴左侧代偿性肺气肿 局 限 性 肺 气 肿,小叶中心性肺气肿 正常肺HRCT,小叶中心性肺气肿 正常肺HRCT,小叶中心性肺气肿 正常肺HRCT,小叶中心型 全小叶型,间隔旁型 肺大泡,2.阻塞性肺不张（obstructive atelectasis）： 支气管
7、完全阻塞 complete obstruction of the bronchus 有时并发肺炎或支气管扩张 concomitant conditions such as pneumonia or bronchiectasis,（1）一侧性肺不张atelectasis of an entire lung： 患侧肺密度高 increase density of the affected 肋间隙狭窄 narrowing of the intercostals spaces on the affected side 膈肌升高 the affected side presents elevation
8、of diaphragm 纵隔移向患侧 displacement of mediastinum to the affected side 健侧代偿性肺气肿 compensatory emphysema on the opposite side lung,（2）肺叶不张 lobar atelectasis ： 肺叶体积小，密度高 the affected lobe appears as a high density lesion, loss of lung volume 邻近肺组织代偿性肺气肿 compensatory emphysema on the adjacent lobe 叶间胸膜及肺门
9、移位 displacement of pleura and hilum to the affected area 患侧膈肌升高 the affected side presents elevation of diaphragm 患区肋间隙狭窄 narrowing of the intercostals spaces on the affected side,（3）肺段不张： 不张肺段一般呈三角形致密影，体积缩小，尖向肺门 the affected segment appears as a dense triangular shadow, loss of lung volume, the ape
10、x of the triangular shadow at the hilum and its base at the outside （4）肺小叶不张： 不张肺小叶呈多数小斑片状致密影，周围可有透明的气肿带 multiple patchy dense shadow and lucent bands surround the affected lobules,各 叶 肺 不 张 示 意 图,右肺上叶不张,（二）肺部病变 disease of the lung1.渗出与实变 exudation and consolidation （1）病理 pathologically： 部分肺泡内被病理性液体
11、代替称渗出 the air within the acinus is incompletely replaced by pathological exudates or fluid 全部肺泡内被病理液体或组织代替称实变the air within the acinus is completely replaced by pathological exudates or tissue,（2）X线表现 X-ray findings： 渗出病灶： exudative lesion： 均匀云絮状影 floccular homogeneous shadow 边缘模糊 ill-defined,实变病灶 c
12、onsolidation： 片状均匀致密影 homogeneous patchy dense shadow 边界不清 ill-defined 近叶间胸膜处则边缘清楚 the border near the pleura is clearly 实变区内有时可见支气管气像 air bronchograms may be seen in consolidation opacity,（3）临床意义clinic significance： 见于： 肺炎 pneumonia 渗出性肺结核 exudative pulmonary tuberculosis 肺出血 pneumorrhagia 肺水肿等 pne
13、umochysis,2.增殖 Proliferation（1）病理 pathologically： 肺组织内充满肉芽组织（细胞和纤维） 代表慢性炎症filled with granulation tissue ,it is chronic inflammation,（2）X线表现 X-ray findings ： 呈腺泡结节状 nodular 密度较高 high density 边界较清楚的致密影 well-defined 有时多数病灶融合一起，呈块状 tend to coalesce （3）临床意义： 慢性肺炎，肺结核等 chronic pneumonia and pulmonary tub
14、erculosis,渗出性病变 增殖性病变 支气管肺炎 粟粒性肺结核,3.纤维化（Fibrosis）： （1）病理 pathologically： 肺组织内局限或弥漫被纤维组织代替称纤维化 the lung tissue is locally or diffuse replaced by fibrous tissue 是急、慢性炎症愈合形式之一 end result of acute or chronic inflammation,（2）X线表现 X-ray findings： A.弥漫性 diffuse： 常累及肺间质 involved pulmonary interstitium 呈索条状
15、、网点状、块状致密影 dense linear or reticular or nodular shadow 边缘清楚 well-defined 密度高 high density,B.局限性local： 呈索条、网点状或块状 dense linear or reticular or nodular shadow 边缘清楚 well-defined 高密度致密影 high density shadow 常伴有纵隔、肺门、膈肌向患区移位 displacement of mediastinum, hilum and diaphragm to the affected area 患区肋间变窄等 nar
16、rowing of the intercostals spaces on the affected area,（3）临床意义： 弥漫性常见于肺间质纤维化、放射性肺炎、结缔组织病等 diffuse fibrous usually is the result of pulmonary interstitial fibrosis, radiation pneumonia and connective tissue disease 局限性常见于肺结核、尘肺和支气管扩张等 local fibrous usually is the result of pulmonary tuberculosis, pneumonoconiosis and bronchiectasis,
