暈征與反暈征PPT課件

1、 暈征與反暈征暈征與反暈征 halo sign and reversed halo sign一般將小于等一般將小于等3cm3cm者稱為結(jié)節(jié)，者稱為結(jié)節(jié)，大于大于3cm3cm者稱為者稱為腫塊。腫塊?；靖拍罨靖拍钍侵阜尾渴侵阜尾緾TCT或薄層或薄層CTCT上，肺密度輕度增加，支氣管上，肺密度輕度增加，支氣管和血管輪廓可見，形似磨玻璃，稱磨玻璃密度影。和血管輪廓可見，形似磨玻璃，稱磨玻璃密度影。意義意義非特異，任何使肺實(shí)變、遠(yuǎn)端氣腔內(nèi)空氣含量減非特異，任何使肺實(shí)變、遠(yuǎn)端氣腔內(nèi)空氣含量減少而又不使肺泡全部閉塞的因素都可產(chǎn)生磨玻璃影。少而又不使肺泡全部閉塞的因素都可產(chǎn)生磨玻璃影。 磨玻璃密度影（磨玻

2、璃密度影（GGOGGO）基本概念基本概念暈征暈征 CTCT表現(xiàn)表現(xiàn)在在CTCT上肺內(nèi)結(jié)節(jié)或腫塊周圍的暈狀上肺內(nèi)結(jié)節(jié)或腫塊周圍的暈狀磨玻璃密度影，低于中央結(jié)節(jié)，但高于正常肺磨玻璃密度影，低于中央結(jié)節(jié)，但高于正常肺組織，形似日暈。組織，形似日暈。分類分類 一、出血性肺結(jié)節(jié)一、出血性肺結(jié)節(jié) ( (一一) )感染性疾病中的出血性結(jié)節(jié)感染性疾病中的出血性結(jié)節(jié) ( (毛霉菌病、念珠菌病、結(jié)核病、病毒毛霉菌病、念珠菌病、結(jié)核病、病毒性肺炎、侵襲性曲菌病性肺炎、侵襲性曲菌病) ) ( (二二) )非感染性疾病中的出血性結(jié)節(jié)（韋格納肉非感染性疾病中的出血性結(jié)節(jié)（韋格納肉芽腫病，芽腫病，KabosiKabosi肉

3、瘤，）肉瘤，） 二、腫瘤細(xì)胞浸潤(rùn)性結(jié)節(jié)（細(xì)支氣管肺泡癌，淋二、腫瘤細(xì)胞浸潤(rùn)性結(jié)節(jié)（細(xì)支氣管肺泡癌，淋巴瘤、肺泡內(nèi)腫瘤生長(zhǎng)）巴瘤、肺泡內(nèi)腫瘤生長(zhǎng)） 三、非出血性結(jié)節(jié)（肉狀瘤病，機(jī)化性肺炎）三、非出血性結(jié)節(jié)（肉狀瘤病，機(jī)化性肺炎）暈征病因暈征病因Arch Bronconeumol. 2008;44(7):386-92 免疫功能不全免疫功能不全 侵襲性曲霉菌、毛霉菌、念珠菌及隱球菌侵襲性曲霉菌、毛霉菌、念珠菌及隱球菌一暈征一暈征-感染性疾病感染性疾病-真菌真菌一暈征一暈征-感染性疾病感染性疾病-真菌真菌Kuhlman JE 1985 Invasive pulmonary aspergillosis.

4、 A: Computed tomography (CT) scan of a patient with acute lymphoid leukemia and neutropenia showing a nodule surrounded by a halo in the right upper lobe, with adjacent acinar involvement (arrows). B: Macroscopic sagittal slice of another patients lung showing a round necrotic lesion (asterisk) surr

5、ounded by a hemorrhagic halo (arrowheads), corresponding to invasive pulmonary aspergillosis. C: Microscopic image of the margin of the lesion described in B, with visible pulmonary necrosis and hemorrhage. The image also shows the hyphae of Aspergillus fumigatus (arrows), which are of regular calib

6、er, septate, and branching at acute angles (hematoxylin-eosin, magnification 2).中國CT和磁共振雜志 2014年6月 12卷 3期一暈征一暈征-感染性疾病感染性疾病-真菌真菌 免疫功能不全免疫功能不全 常見單純皰疹病毒、巨細(xì)胞病毒、常見單純皰疹病毒、巨細(xì)胞病毒、 水痘帶狀皰疹病毒及粘病毒水痘帶狀皰疹病毒及粘病毒一暈征一暈征-感染性疾病感染性疾病-病毒病毒 slow-resolving bacterial pneumonia slow-resolving bacterial pneumonia ( (吸收延遲性肺炎吸

7、收延遲性肺炎) ) 放線菌放線菌 結(jié)核分枝桿菌結(jié)核分枝桿菌一暈征一暈征-感染性疾病感染性疾病-細(xì)菌細(xì)菌1.641.64歲男，退休，咳嗽、間斷咯血?dú)q男，退休，咳嗽、間斷咯血2 2月來診。吸煙，既往健月來診。吸煙，既往健康，痰涂片革蘭陰性菌，培養(yǎng)：卡他布蘭漢菌；康，痰涂片革蘭陰性菌，培養(yǎng)：卡他布蘭漢菌；2.452.45歲，歲，既往心梗，吸煙，咳嗽既往心梗，吸煙，咳嗽1 1月間斷咯血月間斷咯血1010天，痰培養(yǎng)：流感嗜天，痰培養(yǎng)：流感嗜血桿菌血桿菌中國實(shí)用內(nèi)科雜志 2009 7月 29卷 增刊1一暈征一暈征-感染性疾病感染性疾病-細(xì)菌細(xì)菌 立克次體立克次體 寄生蟲寄生蟲一暈征一暈征-感染性疾病感染性

8、疾病-其他其他 腎上腺嗜鉻細(xì)胞瘤腎上腺嗜鉻細(xì)胞瘤 血管肉瘤轉(zhuǎn)移瘤血管肉瘤轉(zhuǎn)移瘤 腎細(xì)胞癌腎細(xì)胞癌 絨毛膜癌絨毛膜癌 肺血管肉瘤肺血管肉瘤 KaposiKaposi肉瘤肉瘤二暈征二暈征-腫瘤性疾病腫瘤性疾病-出血性瘤結(jié)節(jié)出血性瘤結(jié)節(jié)Hemorrhagic metastasis in a patient with choriocarcinoma（絨毛膜癌）（絨毛膜癌） who presented with massive hemoptysis. A: Computed tomography scan of the chest shows multiple hemorrhagic pulmonary

9、 nodules with a halo sign that have coalesced in the posterior segments of the right lung. B: Macroscopic lung slice showing several round hemorrhagic lesions. C: Macroscopic image of nodules containing hemorrhagic areas, fibrin, and tumor cells (hematoxylin-eosin,magnification 10).二暈征二暈征-腫瘤性疾病腫瘤性疾病

10、-出血性瘤結(jié)節(jié)出血性瘤結(jié)節(jié) 細(xì)支氣管肺泡癌細(xì)支氣管肺泡癌 消化系、胰腺、肺腺癌消化系、胰腺、肺腺癌 淋巴瘤淋巴瘤二暈征二暈征-腫瘤性疾病腫瘤性疾病-瘤細(xì)胞浸潤(rùn)瘤細(xì)胞浸潤(rùn)Bronchioloalveolar carcinoma in a patient with chronic cough. A:Computed tomography scan of the chest shows nodules with a halo sign in the right lung, with some pseudocavitation (arrow). Also visible is a considerab

11、le area of consolidation in the left lung. B: Microscopic image showing thickened alveolar walls (asterisks) due to infiltration by tumor cells (arrows) ematoxylin-eosin ,magnification 10).二暈征二暈征-腫瘤性疾病腫瘤性疾病-瘤細(xì)胞浸潤(rùn)瘤細(xì)胞浸潤(rùn)Pulmonary lymphoma in a 73-year-old patient who visited the emergency service with

12、dyspnea. A: An axial scan of the lower pulmonary lobes shows multiple pulmonary nodules with a halo sign and a tendency to coalesce in the posterior segments. There is also bilateral pleural effusion, somewhat greater on the right side. The patient died 3 weeks after admission. B: Low magnification

13、image of pulmonary nodule showing mainly peribronchovascular tumor cell infiltration and marked necrosis (hematoxylin-eosin, magnification 4). C: A higher-magnification image of the periphery of the nodule shows the infiltration of tumor cells along the alveolar walls (arrows) (hematoxylineosin,magn

14、ification 10). 出血性結(jié)節(jié)出血性結(jié)節(jié) 非出血性結(jié)節(jié)非出血性結(jié)節(jié)三暈征三暈征-非感染性疾病非感染性疾病三暈征三暈征-非感染性疾病非感染性疾病-出血性結(jié)節(jié)出血性結(jié)節(jié) 韋格納肉芽腫韋格納肉芽腫 子宮內(nèi)膜異位癥子宮內(nèi)膜異位癥 活檢活檢Wegener granulomatosis. A: Computed tomography scan showing 2 pulmonary nodules surrounded by a halo (arrows) and an area of consolidationin the left lower lobe (asterisk), also wi

15、th a halo sign. The patient, whose first symptom was hemoptysis, also had rapidly progressing glomerulonephritis腎腎小球腎炎小球腎炎B: Microscopic image showing inflammatory infiltration of the arterial wall with a multinucleated giant cell (arrow) and endothelial destruction (arrowheads)(hematoxylin-eosin, m

16、agnification 20).三暈征三暈征-非感染性疾病非感染性疾病 出血性結(jié)節(jié)出血性結(jié)節(jié) 結(jié)節(jié)病結(jié)節(jié)病 機(jī)化性肺炎機(jī)化性肺炎 閉塞性細(xì)支氣管炎閉塞性細(xì)支氣管炎 嗜酸細(xì)胞肺炎嗜酸細(xì)胞肺炎 肺淀粉樣變肺淀粉樣變?nèi)龝炚魅龝炚?非感染性疾病非感染性疾病 非出血性結(jié)節(jié)非出血性結(jié)節(jié)反暈征反暈征 是是CT肺窗，中心為磨玻璃樣密度影，周圍肺窗，中心為磨玻璃樣密度影，周圍是高密度新月形或環(huán)形條帶，與暈征的周是高密度新月形或環(huán)形條帶，與暈征的周圍稍低密密度磨玻璃影相反，稱反暈征。圍稍低密密度磨玻璃影相反，稱反暈征。Voloudaki et al 1996 cop反暈征病因反暈征病因一反暈征一反暈征-感染性疾

17、病感染性疾病-真菌真菌 肺曲菌肺曲菌 接合菌屬（接合菌屬（Zygomycetes Zygomycetes 包括根霉和毛霉）包括根霉和毛霉） 地方性真菌感染（南美芽生菌病地方性真菌感染（南美芽生菌病- -拉丁美洲拉丁美洲- -巴西）巴西） 隱球菌隱球菌 早期征象早期征象Invasive pulmonary aspergillosis in a 54-year-old female with multiple myeloma and secondary plasma cell leukaemia who had undergone chemotherapy. (a) High-resolution

18、 CT image at the lung base shows a right lower-lobe pulmonary nodule (arrow) and the reversed halo sign (RHS) in the left lower lobe (curved arrow) with adjacent ground-glass opacities. (b) CT image with mediastinal window settings shows the peripheral consolidation of the RHS (asterisks). Note a sm

19、all right pleural effusion.Pulmonary zygomycosis in a 22-year-old male with precursor B-cell acute lymphocytic leukaemia. (a) CT image shows the reversed halo sign (RHS) in the left upper lobe (arrows). (b) CT scan performed 2 months later shows interval development of cavitation (air crescent sign)

20、. The presence of RHS in an immunosuppressed patient is highly suggestive of pulmonary zygomycosis, especially if the patient is receiving prophylaxis for aspergillosis.Paracoccidioidomycosis in a 49-year-old male,resident of a rural area in Brazil. CT image shows reversed halo sign (RHS) lesions (a

21、rrows) and bilateral small poorlymarginated pulmonary nodules. The presence of RHS in a patient from an endemic region for fungal infection should raise concern for that specific fungal infection.一反暈征一反暈征-感染性疾病感染性疾病-結(jié)核結(jié)核Tuberculosis in a 59-year-old female. High-resolution CT image shows bilateral s

22、mall centrilobular nodules, tree-in-bud opacities and areas of reversed halo sign (RHS). Note the nodular appearance of the ring of consolidation of the RHS lesions (arrows), which may be helpful in the differentiation between active granulomatous disease and cryptogenic organising pneumonia. The pr

23、esence of associated centrilobular nodules and tree-in-bud opacities should raise suspicion of tuberculosis.二反暈征二反暈征-機(jī)化性肺炎（機(jī)化性肺炎（19%）Organising pneumonia in a 53-year-old male with graft-vs-host disease after stem cell transplantion for treatment of acute myelogenous leukaemia. CT scan shows bilater

24、al peripheral and peribronchovascular consolidative opacities with the reversed halo sign (arrows). Open-lung biopsy showed organising pneumonia. The patient was treated with steroids with resolution of the lesions.二反暈征二反暈征-機(jī)化性肺炎機(jī)化性肺炎47-yr-old female was referred to a tertiary centre (St Michaels Ho

25、spital,Toronto, Canada) for further evaluation of chronic cough, fever, progressive exertional dyspnoea and fatigue. Coronal chest computed tomography scan showing multiple areas of central ground-glass opacity, surrounded by ring or crescentic-shape, dense airspace consolidation, mainly in the left

26、 lower lobe and the right upper lobe. Transbronchial biopsy showing organising pneumonia三反暈征三反暈征-非特異性間質(zhì)性肺炎非特異性間質(zhì)性肺炎The British Journal of Radiology, May 2011A 52-year-old female presented with a cough and New York Heart Association (NYHA) class 2 dyspnoea of 4 months duration，CT images show a centra

27、l ground-glass opacity surrounded by crescent or ring-shaped areas of consolidation, showing the reversed halo sign. (e) 6 days and (f) 6 months of steroid therapy, both showed improvement.四反暈征四反暈征-結(jié)節(jié)病結(jié)節(jié)病Sarcoidosis in a 44-year-old female. High-resolution CT image shows bilateral nodular opacities

28、with the reversed halo sign (RHS) (arrows) and small pulmonary nodules with predominant perilymphatic distribution. Thepresence of the RHS associated with nodules in perilymphatic distribution and mediastinal and hilar lymphadenopathy (not shown) should raise suspicion of sarcoidosis.五反暈征五反暈征-肺栓塞肺栓塞

29、Acute pulmonary embolism with pulmonary infarction in a 64-year-old female. (a) CT image shows the reversed halo sign in the superior segment of the right lower lobe. (b) CT image (mediastinal window settings) shows a clot in the distal right main pulmonary artery extending to the superior segmental

30、 branch of the right lower lobe pulmonary artery. (c) 2 month follow-up CT scan shows cavitation of the infarcted pulmonary parenchyma.Multifocal pulmonary adenocarcinoma in a 70-year-old female. CT image shows bilateral ulmonarynodules with the reversed halo sign (black arrows) and ground-glass pul

31、monary nodules (white arrows).六反暈征六反暈征-腫瘤腫瘤Metastatic renal cell carcinoma in a 73-year-old male. The CT scan shows multiple bilateral lesions with reversed halo sign (RHS), biopsy proven to represent metastatic renal cell carcinoma in a background of fibrosis and necrosis. In patients with a known

32、primary malignancy, RHS lesions may represent atypical presentation of metastatic disease. The main differential diagnosis is organising pneumonia, which can be related to drug toxicity if the patient is receiving chemotherapy.六反暈征六反暈征-腫瘤腫瘤Reversed halo sign (RHS) following radiofrequency ablation (

33、RFA) of a pulmonary adenocarcinoma in a 64-year-old female. (a) CT image shows the adenocarcinoma in the left lower lobe. (b) CT scan performed 1 month after RFA of the tumour shows development of the RHS. When present shortly after RFA, the RHS should not be confused with recurrence of disease.七反暈征七反暈征-射頻消融術(shù)后改變射頻消融術(shù)后改變 放療相關(guān)肺疾病急性期放療相關(guān)肺疾病急性期 腫瘤壞死腫瘤壞死 炎癥反應(yīng)，肺組織壞死炎癥反應(yīng)，肺組織壞死 繼發(fā)性機(jī)化性肺炎繼發(fā)性機(jī)化性肺炎八反暈征八反暈征-放療后改變放療后改變八反暈征八反暈征-放療后改變放療后改變Reversed halo sign