《医学影像学：肺炎、肺脓肿和肺结核》由会员分享，可在线阅读，更多相关《医学影像学：肺炎、肺脓肿和肺结核（67页珍藏版）》请在金锄头文库上搜索。
1、肺炎、肺脓肿和肺结核肺炎、肺脓肿和肺结核向本PPT原创者梁志莹师姐致谢支气管扩张支气管扩张lX线平片表现：肺纹理：增多紊乱、网状（支气管、间质慢性炎）支气管：l扩张含气：粗细不规则的管状透明影l扩张有分泌物：不规则杵状致密影l囊状扩张：薄壁空洞、有液平肺内炎症：斑片状模糊影肺不张：肺叶、段不张支气管扩张支气管扩张-支气管造影支气管造影76岁岁男性男性咳嗽咳嗽20余年余年近一周咯血两次近一周咯血两次Case 16大叶性肺炎大叶性肺炎l好发人群：青壮年l好发季节：气候变化剧烈的冬春季l病原体：肺炎双球菌l好发部位：右上、下叶、左下叶、右中叶l病情： 起病急，高热、寒战、咳嗽、胸痛、痰液粘稠、呼吸急
2、促、 咳铁锈色痰l体征：叩诊浊音、语颤增强、呼吸音减低、啰音l l F, 18y F, 18yl lCough, rusty sputumCough, rusty sputum锈色痰锈色痰锈色痰锈色痰, high fever, high fever9 days after treatmentCase 2l l M, 36y M, 36yl l high fever, Cough high fever, CoughCase 3l lAir-bronchogramsAir-bronchogramsCase 4l l M, 15y M, 15yl l Cough and high fever aft
3、er get wet in the rain Cough and high fever after get wet in the rainCase 5Lobar pneumoniaLobar pneumonial l M, 15y M, 15yl l Cough and high fever after get Cough and high fever after get wet in the rainwet in the rainCase 5Case 5 8 days after anti-inflammatory treatment8 days after anti-inflammator
4、y treatmentl l M, 28y M, 28yl l Cough, fever Cough, fever8 days after treatment27 days after treatmentCase 6Lobar pneumoniaLobar pneumonia中叶 or 下叶？支气管肺炎支气管肺炎 Bronchopneumonial好发人群l年老体弱患者l婴幼儿l其他疾病的并发症l好发部位：两肺下野内、中带，心膈角区l形态：斑点状、斑片状，边缘模糊l l M, 53y M, 53yl l Cough with sputum, fever Cough with sputum, f
5、everCase 81 week after treatment治疗前及治疗后对比密度变化l l M, 1y M, 1yl l Cough, gasping Cough, gasping喘息喘息喘息喘息 and fever and fever repeatedly for 10 daysrepeatedly for 10 daysCase 9双下肺野中内带肺纹理增粗、增多，周围可见少许斑点状、斑片状稍高密度影，边缘模糊。Case 10磨玻璃样密度影间质性肺炎间质性肺炎 （Interstitial Pneumonia)l临床特点：致病原：病毒、细菌、其他致病因子好发人群：l小儿：其他急性传染病之
6、后l成人：慢性支气管炎症状：发热、咳嗽、气急（儿童多见），痰少体征：轻微l病理特点：间质性炎症l累及部位：支气管、细支气管、小叶和肺泡间隔的结缔组织相通的部分肺泡亦常常受累局部淋巴管和淋巴结炎症可引起支气管阻塞l l F, 54y F, 54yl l Cough with sputum Cough with sputumCase 119 days after treatment间质性肺炎Case 12l l M, 57y M, 57yl l Breathlessness Breathlessness气短气短气短气短 with fever for 3 monthswith fever for 3
7、 monthsCase 126 days after treatmentl l M, 37y M, 37yl l Cough with sputum, fever and Cough with sputum, fever and bilateral cracklesbilateral crackles湿罗音湿罗音湿罗音湿罗音Case 13间质性肺炎Case 1427肺脓肿肺脓肿l相关病史误吸、上呼吸道感染灶、血源性l症状：寒战、高热；咳嗽咳痰；痰中带血；脓痰l部位：右肺多于左肺；上叶后段、下叶背段好发l特点合并空洞l鉴别：肺炎（无坏死）、癌性空洞（壁厚薄不均，有壁结节）、慢纤空（结核症状、壁厚
8、或薄、液少，一般无液平，周围见卫星病灶，播散灶）Case 152010-02-092010-02-12M 60yhigh fever, Cough with purulent sputum high fever, Cough with purulent sputum 脓痰脓痰脓痰脓痰 肺脓肿动态过程2010-02-252010-03-01脓肿腔在哪里？大家快来找一找l l M, 45y M, 45yl l High fever, cough, sputum High fever, cough, sputum productionproductionCase 16Case 16肺脓肿l l 16
9、 days after anti-inflammatory treatment 16 days after anti-inflammatory treatmentCase 16l l M, 19y M, 19yl l High fever, cough, sputum High fever, cough, sputum production and chest painproduction and chest painCase 17接着找脓肿腔Case 17Case 1740 days after treatment40 days after treatment还记得上节课的老朋友“空腔”吗？
10、此处回忆30秒结核的分型结核的分型l原发型肺结核原发综合症和胸内淋巴结结核l血行播散型肺结核l继发型肺结核多态性、多种病变共存 浸润性肺结核 空洞性肺结核 结核球 干酪性肺炎 纤维空洞性肺结核l结核性胸膜炎l其他肺外结核-骨结核、肾结核、肠结核肺结核的诊断程序肺结核的诊断程序l可疑症状患者的筛选l是否肺结核l有无活动性l是否排菌活动性结核在X线胸片上表现边缘模糊不清的斑片状影，可有中心溶解和空洞，或出现播散灶无活动性肺结核胸片上表现为钙化、结节或纤维化，痰检查不排菌，无任何症状l好发年龄l结核接触史lPPD实验l原发综合征？l胸内淋巴结结核？原发型肺结核原发型肺结核l l M, 9y M, 9
11、yl lCough and fever Cough and fever Case 18Case 18l l M, 8y M, 8yl l Cough for 5 days, fever for 3 Cough for 5 days, fever for 3 daysdaysCase 19胸内淋巴结核胸内淋巴结核原发性肺结核原发性肺结核-胸内淋巴结核胸内淋巴结核钙化钙化血行播散性肺结核血行播散性肺结核l急性l 婴幼儿和青少年，营养不良和传染性疾 病、运用免疫抑制剂者l 起病急、重，可合并脑膜炎l 三均匀l亚急性和慢性l 起病较缓，症状较轻l 大小不等、密度不同、分布不均l l F, 64y F,
12、 64yl l Cough, high fever,renal Cough, high fever,renal tuberculosis historytuberculosis historyCase 20急性血行播散性肺结核Case 21Case 22l l M, 31y M, 31yl lCough and low fever for 1 Cough and low fever for 1 monthmonth亚急性血行播散肺结核 三不均匀三不均匀l l 上重下上重下轻轻l l上旧下新上旧下新l l上密下淡上密下淡结核结节病癌性淋巴道转移血行转移继发性肺结核继发性肺结核l浸润性肺结核浸润渗
13、出、纤维、干酪l空洞性形态不一l结核球24cm，空洞、卫星病灶l干酪性肺炎免疫力低和体质弱，受大 量结核菌感染，大叶性、虫蚀样空洞、 播散灶，常为上叶大片实变l纤维空洞性肺结核慢性 厚壁 垂柳征l结核性胸膜炎可以没有肺内结核表现，胸水上叶尖、后段和下叶背段Case 23继发性肺结核（活动性）l l F, 29y F, 29yl lCough and low feverCough and low feverl l M, 52y M, 52yl lCoughCoughCase 24继发性肺结核l l M, 56y M, 56yl lCough with sputumCough with sputu
14、mCase 25继发性肺结核垂柳征l l M, M,l lCough with sputum, feverCough with sputum, feverCase 26干酪性肺炎l l M, 40y M, 40yCase 27结核球60l l M, 40y M, 40yCase 22结核球Tuberculosis pleurisyTuberculosis pleurisyl l F, 14y F, 14yl l Fever for 12 days Fever for 12 daysCase 28结核性胸膜炎l l F, 21y F, 21yl l High fever, cough with chest pain for 5 days High fever, cough with chest pain for 5 daysCase 29结核性胸膜炎Case 29结核性胸膜炎鉴别诊断鉴别诊断l肺炎抗炎治疗后好转，12周内吸收l肺癌分叶、毛刺，细胞学检查l肺脓肿高热、脓痰，胸片可见液气平 面的空洞，周围渗出多l纵膈和肺门疾病主要是定位谢谢！谢谢！bye
