修翻譯張(七年制)呼吸影像27

呼吸系統(tǒng)影像診斷學(xué)ImagingdiagnosticsoftheRespiratorysystem鄭州大學(xué)第一附屬醫(yī)院MRI室thefirstaffiliatedhospitalradiologydepartmentoftheZhengzhouUniversity

張焱ZhangYanL200812@163.com三、胸部基本病變的影像Basicimagingfindingsindiseaseofrespiratorysystem氣管支氣管病變diseaseofthetracheobronchus：（一）支氣管阻塞及其后果bronchiobstructionandtheresults：病因：etiopathogenisis①管內(nèi):intralumen異物、分泌物和血塊等foreignbody,excretionandbloodclot②管壁：tubalwall

腫瘤、痙攣、先天性和炎癥等tumor,spasm,congenitalandinflammation③管外：extralumen

有腫瘤、增大淋巴結(jié)壓迫等tumorandenlargementofthelymphnodes病理pathologically：①部分阻塞引起肺氣腫obstructiveemphysema(incompleteobstruction)②完全阻塞引起肺不張atelectasis(completeobstruction)1.阻塞性肺氣腫obstructionemphysema：①部分阻塞致肺內(nèi)氣體不能完全排出，肺泡過度膨脹形成肺氣腫incompleteobstructioncausetoemphysema②終未細(xì)支氣管以遠(yuǎn)的含氣腔隙過度充氣、異常擴(kuò)大，可伴有不可逆性肺泡壁的破壞enlargementofalveoli,accompaniedbydestructionofalveolarwalls③若多個(gè)肺泡膨脹破裂，融合則成肺大泡bullaisformedduetoruptureofalveolarwallandcommunicatedwitheachother,pneumatocele（1）彌漫性肺氣腫diffuseobstructionemphysema：①兩肺紋理變細(xì)、少、分散及肺透過度增大lungmarkingsappearthinnerthannormal,increaselucencyofbothlungs②膈肌低、動(dòng)度弱depressionandflatteningofthediaphragm③肋間隙增寬；心影狹長intercostalspacewiden,heartshadowappearslongandnarrow（2）局限性肺氣腫localizedemphysema：①局部透過度高increaselucencyoftheaffected②肺紋理細(xì)、少、分散lungmarkingsappearasthinneroftheinvolvedarea③肺門、葉間胸膜、縱隔及膈肌移位displacementofhilum,pleura,mediastinumanddiaphragmtotheunaffectedside④有時(shí)可見縱隔擺動(dòng)pendularmovementofthemediastinumCTfindings：⑴小葉中央型肺氣腫病變累及肺小葉中央部分，上葉多見⑵全小葉型肺氣腫病變累及全部肺小葉，下葉多見⑶間隔旁型肺氣腫病變累及肺小葉邊緣，多見于胸膜下或小葉間隔周圍

彌漫性肺氣腫

diffuseobstructionemphysema

右上慢性纖維空洞肺結(jié)核伴左側(cè)代償性肺氣腫

局限性肺氣腫

小葉中心性肺氣腫正常肺HRCT小葉中心性肺氣腫正常肺HRCT

小葉中心性肺氣腫正常肺HRCT

小葉中心型全小葉型

間隔旁型肺大泡

2.阻塞性肺不張（obstructiveatelectasis）：①支氣管完全阻塞completeobstructionofthebronchus②有時(shí)并發(fā)肺炎或支氣管擴(kuò)張concomitantconditionssuchaspneumoniaorbronchiectasis（1）一側(cè)性肺不張atelectasisofanentirelung：①患側(cè)肺密度高increasedensityoftheaffected②肋間隙狹窄narrowingoftheintercostalsspacesontheaffectedside③膈肌升高theaffectedsidepresentselevationofdiaphragm④縱隔移向患側(cè)displacementofmediastinumtotheaffectedside⑤健側(cè)代償性肺氣腫compensatoryemphysemaontheoppositesidelung（2）肺葉不張lobaratelectasis：①肺葉體積小，密度高theaffectedlobeappearsasahighdensitylesion,lossoflungvolume②鄰近肺組織代償性肺氣腫compensatoryemphysemaontheadjacentlobe③葉間胸膜及肺門移位displacementofpleuraandhilumtotheaffectedarea④患側(cè)膈肌升高theaffectedsidepresentselevationofdiaphragm⑤患區(qū)肋間隙狹窄narrowingoftheintercostalsspacesontheaffectedside（3）肺段不張：不張肺段一般呈三角形致密影，體積縮小，尖向肺門theaffectedsegmentappearsasadensetriangularshadow,lossoflungvolume,theapexofthetriangularshadowatthehilumanditsbaseattheoutside（4）肺小葉不張：不張肺小葉呈多數(shù)小斑片狀致密影，周圍可有透明的氣腫帶multiplepatchydenseshadowandlucentbandssurroundtheaffectedlobules

各葉肺不張示意圖右肺上葉不張（二）肺部病變diseaseofthelung1.滲出與實(shí)變exudationandconsolidation（1）病理pathologically：①部分肺泡內(nèi)被病理性液體代替稱滲出theairwithintheacinusisincompletelyreplacedbypathologicalexudatesorfluid②全部肺泡內(nèi)被病理液體或組織代替稱實(shí)變

theairwithintheacinusiscompletelyreplacedbypathologicalexudatesortissue（2）X線表現(xiàn)X-rayfindings：滲出病灶：exudativelesion：①均勻云絮狀影floccularhomogeneousshadow②邊緣模糊ill-defined實(shí)變病灶consolidation：①片狀均勻致密影homogeneouspatchydenseshadow邊界不清ill-defined②近葉間胸膜處則邊緣清楚thebordernearthepleuraisclearly③實(shí)變區(qū)內(nèi)有時(shí)可見支氣管氣像airbronchogramsmaybeseeninconsolidationopacity（3）臨床意義clinicsignificance：見于：①肺炎pneumonia②滲出性肺結(jié)核exudativepulmonarytuberculosis③肺出血pneumorrhagia④肺水腫等pneumochysis2.增殖Proliferation（1）病理pathologically：肺組織內(nèi)充滿肉芽組織（細(xì)胞和纖維）代表慢性炎癥

filledwithgranulationtissue,itischronicinflammation（2）X線表現(xiàn)X-rayfindings：①呈腺泡結(jié)節(jié)狀nodular②密度較高h(yuǎn)ighdensity③邊界較清楚的致密影well-defined④有時(shí)多數(shù)病灶融合一起，呈塊狀tendtocoalesce（3）臨床意義：慢性肺炎，肺結(jié)核等chronicpneumoniaandpulmonarytuberculosis

滲出性病變增殖性病變

支氣管肺炎粟粒性肺結(jié)核3.纖維化（Fibrosis）：（1）病理pathologically：肺組織內(nèi)局限或彌漫被纖維組織代替稱纖維化thelungtissueislocallyordiffusereplacedbyfibroustissue是急、慢性炎癥愈合形式之一endresultofacuteorchronicinflammation（2）X線表現(xiàn)X-rayfindings：A.彌漫性diffuse：①常累及肺間質(zhì)involvedpulmonaryinterstitium②呈索條狀、網(wǎng)點(diǎn)狀、塊狀致密影denselinearorreticularornodularshadow③邊緣清楚well-defined④密度高h(yuǎn)ighdensityB.局限性local：①呈索條、網(wǎng)點(diǎn)狀或塊狀denselinearorreticularornodularshadow②邊緣清楚well-defined③高密度致密影highdensityshadow④常伴有縱隔、肺門、膈肌向患區(qū)移位displacementofmediastinum,hilumanddiaphragmtotheaffectedarea⑤患區(qū)肋間變窄等narrowingoftheintercostalsspacesontheaffectedarea（3）臨床意義：①彌漫性常見于肺間質(zhì)纖維化、放射性肺炎、結(jié)締組織病等diffusefibroususuallyistheresultofpulmonaryinterstitialfibrosis,radiationpneumoniaandconnectivetissuedisease②局限性常見于肺結(jié)核、塵肺和支氣管擴(kuò)張等localfibroususuallyistheresultofpulmonarytuberculosis,pneumonoconiosisandbronchiectasis4.鈣化（Calcification）（1）病理pathologically：肺組織內(nèi)有鈣質(zhì)沉著稱鈣化calcification:calcareousdepositinlung是退行性或壞死組織愈合形式之一healingprocessofretrogressionornecrotictissue（2）X線表現(xiàn)X-rayfindings：呈斑點(diǎn)、球形、塊狀等特高密度影邊緣銳利spotsorglobularornodularshadow,veryhighdensity,well-defined（3）臨床意義：①常見于肺結(jié)核pulmonarytuberculosis②塵肺pneumonoconiosis③錯(cuò)構(gòu)瘤harmatoma④肺包蟲等pulmonaryhydatid

纖維性病變（塵肺）鈣化性病變（結(jié)核球）5.腫塊（Mass）與結(jié)節(jié)（nodule）：

（1）病理pathologically：肺組織內(nèi)有良性或惡性瘤細(xì)胞生長稱腫塊或結(jié)節(jié)benignormalignantcellgrowthinlung

直徑小于或等于2cm的稱結(jié)節(jié)大于2cm的為腫塊thesizeofthenoduleusuallyislessthan2cm,massusuallylargerthan2cm含液囊腫、結(jié)核瘤和炎性假瘤，因影像表現(xiàn)與良性腫瘤相似，也包括在腫塊范圍massincludingliquidcyst,tuberculomaandinflammatorypseudotumor結(jié)節(jié)或腫塊可單發(fā)，也可多發(fā)singleormultiple結(jié)節(jié)與腫塊除了其大小不同外，其他表現(xiàn)相同

justdifferentsize單發(fā)常見于：Single：①肺癌lungcancer②結(jié)核球tuberculoma③炎性假瘤等inflammatorypseudotumor多發(fā)multiple：

最常見于肺轉(zhuǎn)移瘤pulmonarymetastasis其他可見于alsocanhappenin：①血源性金黃色葡萄球菌肺炎hematogeneousstaphylococciaureuspneumonia②壞死性肉芽腫necroticgranuloma③多發(fā)性肺囊腫multiplepulmonarycyst④寄生蟲囊腫等parasiticcyst臨床意義：①常見于肺囊腫lungcyst②肺結(jié)核pulmonarytuberculosis③炎性假瘤inflammatorypseudotumor④良性及惡性腫瘤等benignormalignanttumor（2）X線表現(xiàn)X-rayfindings：呈圓、橢圓形均勻密度的致密影roundorovalhomogeneousdenseshadow良性：benign：①邊界清楚well-defined②生長慢slowlygrowth③不發(fā)生壞死nonecrosis結(jié)核球tuberculoma：①常為圓形其內(nèi)可有點(diǎn)狀鈣化roundshapewithpunctatecalcification②周圍常有衛(wèi)星病灶satellite炎性假瘤inflammatorypseudotumor：①多為5cm以下類圓形腫塊ovalmass,lessthan5cm②腫塊上方或側(cè)方常有尖角狀突起cuspcornuupsideorlateralofthemass③病變近葉間胸膜或外圍時(shí)可見鄰近胸膜的粘連、增厚adjacentpleuraadhereandthickening惡性malignant：①邊界不規(guī)則irregularborder②呈浸潤性生長快而不均衡infiltrativegrowthanddisproportion③可發(fā)生壞死necrosis④常有短細(xì)毛刺向周圍伸出usuallyspiculatedinfiltrating⑤靠近胸膜時(shí)可有線狀、幕狀或星狀影與胸膜相連而形成胸膜凹陷征pleuralindentationsign:peripherallinear,tentedorastralshadowbetweenaperipherallocatedtumorandthepleura⑥較大的惡性腫瘤特別是鱗癌，中心易發(fā)生壞死而形成厚壁空洞

thickwalledcavityusuallyseeninlargemalignanttumor,especiallysquamouscarcinoma轉(zhuǎn)移瘤metastasis：①常多發(fā)multiple②大小不一varioussize以中下野較多mainlyinthemiddleandlowerlungfields③密度均勻homogeneousdensity④邊緣整齊well-defined

CT：腫塊的輪廓可呈多個(gè)弧形凸起，弧形相間則為凹入而形成分葉形腫塊，稱為分葉征sublobesign:lobulatedmass多見于肺癌lungcancer分葉征瘤體內(nèi)有時(shí)可見直徑1mm～3mm的低密度影l(fā)owdensityshadowinthemass,lessthan1cmandlargerthan3cm稱為空泡征（小泡征）bronchusencapsulatedairsign空泡征瘤體邊緣可有不同程度的棘狀或毛刺狀突起spiculatedinfiltrating稱為棘狀突起或毛刺征spine-likeprocess毛刺征鄰近胸膜的腫塊其內(nèi)成纖維反應(yīng)收縮牽拉胸膜可形成胸膜凹陷征pleuralindentationsign:aperipherallocatedmasslesiondragthepleura多見于周圍型肺癌

peripherallungcancer腫塊內(nèi)如發(fā)現(xiàn)脂肪密度影，則有助于錯(cuò)構(gòu)瘤的診斷fatdensityinthemassconducetodiagnosisofhamartoma增強(qiáng)掃描enhancementscanning：①結(jié)核球僅周邊環(huán)形輕度強(qiáng)化tuberculoma:ringlikeslightlyenhancement②肺良性腫瘤可不強(qiáng)化或輕度均勻性強(qiáng)化benigntumor:noenhancedorslightlyhomogeneousenhancement③肺部炎性假瘤可呈環(huán)狀強(qiáng)化或輕度均勻性強(qiáng)化inflammatorypseudotumor:ringlikeorslightlyhomogeneousenhancement④肺惡性腫瘤malignanttumor：常為均勻強(qiáng)化或中心強(qiáng)化homogeneousorcentralenhancement且常呈一過性強(qiáng)化temporaryenhancement結(jié)節(jié)nodus：1.腺泡狀結(jié)節(jié)（直徑在1cm以下）aciniformnodus(lessthan1cm)：邊緣較清楚，呈梅花瓣?duì)畹慕Y(jié)節(jié)，即相當(dāng)于腺泡范圍的實(shí)變well-defined,petal-likenodus2.粟粒狀結(jié)節(jié)影（4mm以下）mililarynodularshadow：粟粒型肺結(jié)核的結(jié)節(jié)具有大小一致，分布均勻的特點(diǎn)nodusofmililarypulmonarytuberculosiswiththesamesize,thesamedensityandhomogeneousdistribution癌性淋巴管炎所形成的粟粒結(jié)節(jié)，分布可不均勻mililarynodusoflymphangitiscarcinomatosawithinhomogeneousdistribution6.空洞及空腔（Cavityandaircontainingspace）：（1）病理pathologically：肺組織壞死液化物經(jīng)支氣管排出后殘留的缺損稱空洞resultoftheexpulsionofnecrosismaterialintothebronchus空腔（intrapulmonaryaircontainingspace）：①與空洞不同differentfromcavity②是肺內(nèi)生理腔隙的病理性擴(kuò)大pathologicalenlargementofpulmonaryphysiologicallacuna③肺大泡、含氣肺囊腫及肺氣囊等部屬于空腔includingbullae,lunggascystandsaccuspneumaticus空洞壁wall：①由壞死組織、肉芽組織、纖維組織、腫瘤組織所形成necrotictissue,granulationtissue,fibroustissueandtumor②多見于結(jié)核、肺癌oftenseeninpulmonarytuberculosisandlungcancer根據(jù)洞壁的厚度thicknessofthewall：①厚壁空洞thickwalledcavity②薄壁空洞thinwalledcavity③無壁空洞mouth-eatencavity厚壁空洞的洞壁厚度等于或超過3mmthethicknessofthewallofthecavityismorethan3mm薄壁空洞的洞壁厚度小于3mmthethicknessofthewallofthecavityislessthan3mm（2）X線表現(xiàn)及臨床意義(X-rayfindingsandclinical)：

A.蟲蝕樣空洞mouth-eatencavity：①又稱無壁空洞②在大片致密壞死組織陰影內(nèi)有小而形狀不一的多發(fā)性透明區(qū)multiplesmallanddifferentlyshapedlucentareainpatchydenseshadow③常見于干酪樣肺炎o(hù)ftenseenincheesypneumoniaB.薄壁空洞thinwalledcavity

：①洞壁厚度<3mmthicknessislessthan3mm②邊緣清晰well-defined③內(nèi)壁光滑smoothinnerlining④一般無液平面noair-fluidlevelinthecavity⑤周圍很少有實(shí)變的圓環(huán)狀透明區(qū)seldomconsolidatedringlikelucentaera⑥常見于肺結(jié)核pulmonarytuberculosisC.厚壁空洞thickwalledcavity：①洞壁厚度>3mmthicknessismorethan3mm②洞周圍常有實(shí)變區(qū)commonconsolidatedarea③內(nèi)壁可不規(guī)則或出現(xiàn)壁結(jié)節(jié)irregularinnerliningorwallednodus④有或無液平面air-fluidlevelinthecavity常見于oftenseenin：①肺膿腫lungabscess②慢性纖維空洞性肺結(jié)核chronicfibroticcavitarypulmonarytuberculosis③肺癌等lungcancerD.空腔intrapulmonaryaircontainingspace：①壁較空洞壁更薄而光滑thewallisthinnerandmoresmooththanthecavity’s②周圍無實(shí)變noconsolidated③一般腔內(nèi)無液平面commonnoair-fluidlevelinthecavity常見于:oftenseenin：①肺氣腫emphysema②肺含氣囊腫lunggascyst③肺大泡bullae④囊狀支氣管擴(kuò)張等cysticbronchiectasis

良性腫塊（肺囊腫）

惡性腫塊（肺癌）無壁空洞（干酪性肺炎）薄壁空洞（肺結(jié)核）厚壁空洞（慢性肺膿腫）肺空腔（肺氣囊腫）7.肺間質(zhì)病變（Interstitiallesionsoflung）（1）病理：①肺間質(zhì)內(nèi)滲液或漏出effusionortransudateintheinterstitium②炎性滲出inflammatoryexudation③肉芽組織增生granulationhyperblastosis④纖維化fibrousdegeneration⑤炎性細(xì)胞或腫瘤細(xì)胞浸潤infiltrationofinflammatorycellandtumorcell常見的肺間質(zhì)病變commonInterstitiallesionsoflung：①慢性支氣管炎chronicbronchitis②特發(fā)性肺纖維化idiopathicfibrosisofthelung③癌性淋巴管炎lymphangitiscarcinomatosa④塵肺pneumonoconiosis④結(jié)締組織病等connectivetissuedisease臨床意義：①肺間質(zhì)水腫interstitialedema②感染infection③特發(fā)性間質(zhì)纖維化idiopathicfibrosisofthelung④粟粒型肺結(jié)核mililarypulmonarytuberculosis⑤癌性淋巴管播散lymphangitiscarcinomatosa（2）X線表現(xiàn)X-rayfeature：①多呈索條狀linearshadow②網(wǎng)狀reticularshadow③蜂窩狀honeycombshadow④小結(jié)節(jié)狀或網(wǎng)點(diǎn)狀影smallnodularorspotsshadows發(fā)生于小支氣管、血管周圍間隙及小葉間隔的病變affectioninvolvesbronchia,

perivascularspaceandinterlobularseptum表現(xiàn)findings：網(wǎng)狀與細(xì)線狀影或蜂窩狀影reticularshadoworlinearshadoworhoneycombshadow局限性線條狀影見于肺內(nèi)病變沿肺間質(zhì)向肺門或向外圍擴(kuò)散locatedlinearshadowisoftenseeninpulmonarydiseasediffusealongtheinterstitium如肺癌腫塊與肺門之間或與胸膜之間的細(xì)條狀影

peripherallinearshadowbetweenaperipherallocatedtumorandthehilumorthepleura肺結(jié)核愈合后,其周圍肺間質(zhì)可發(fā)生纖維化interstitialfibrosisinhealingprocessofpulmonarytuberculosis表現(xiàn)findings：①條索狀影streak-likeshadow②走行不規(guī)則irregulardisposition③粗細(xì)不一varyingthickness小葉間隔內(nèi)有液體或組織增生fluidorhyperblastosisininterlobularseptum表現(xiàn)：不同部位的間隔線septallineindifferentplace常見的有間隔B線septallineB表現(xiàn)為：①兩下肺野近肋隔角處的外帶，有數(shù)條垂自于胸膜的線狀影severallinearshadowinouterzoneoflowerfieldnearthecostophrenicangles②長約2cm③也可見中上肺野外帶outerzoneofmiddleandupperfields多見于：①肺靜脈高壓venouspulmonaryhypertension②肺間質(zhì)水腫pulmonaryinterstitialedemaCT檢查CTfindings：①CT檢查對肺間質(zhì)病變的檢出很敏感CT

examinationissensitivetothepulmonaryinterstitialdisease②尤其是高分辨力CT可以發(fā)現(xiàn)早期輕微肺纖維化especiallyHRCTcandepicttheearlysignofpulmonaryfibrosis③顯示小葉間隔增厚等微細(xì)改變showthickenedinterlobularseptum④對肺間質(zhì)病變的診斷具有重要的價(jià)值importantfordiagnosisofpulmonaryinterstitialdisease小葉間隔增厚thickenedinterlobularseptum

表現(xiàn)為：①與胸膜相連的線狀影l(fā)inearshadowconnectedwithpleura長1cm～2cm②病變明顯時(shí)可呈多角形的網(wǎng)狀影polygonalreticularshadow肺纖維化時(shí)，由于廣泛的小葉間隔增厚，相鄰增厚的小葉間隔相連thickenedinterlobularseptumcommunicatedwitheachother在胸膜下1cm以內(nèi)，可見與胸壁平行的弧形線狀影arclinearshadowsparallelchestwall長2cm~5cm稱為胸膜下線肺纖維化后期在兩中、下肺野的胸膜下區(qū)可見蜂窩狀影l(fā)aterstageofpulmonaryfibrosis,honeycombshadowsinmiddleandlowerfields高分辨力CT不但可敏感檢出肺小結(jié)節(jié)detectpulmonarytuberculumminus還可鑒別實(shí)質(zhì)結(jié)節(jié)與間質(zhì)結(jié)節(jié)

identifyparenchymatousnodusandinterstitialnodus間質(zhì)結(jié)節(jié)interstitialnodus：常分布在肺門鄰近的血管支氣管束、小葉間隔、胸膜下及葉間裂處vessel,interlobularseptum,subpleuraandinterlobarfissureadjacenttothehilum肺間質(zhì)較廣泛的纖維化widespreadfibrosis：可見肺組織扭曲變形、病變區(qū)肺組織容積縮小lossofpulmonaryvolum亦可見牽拉性支氣管擴(kuò)張bronchiectasis

肺間質(zhì)性病變（水泥肺）肺間質(zhì)纖維化間質(zhì)性肺水腫（二狹心衰）K氏A、B線風(fēng)心病K氏線（三）胸膜病變pleiraldisease：

1.胸腔積液（Pleuraleffusion）

常見病因etiologicalfactor：①結(jié)核tuberculosis②化膿diapyesis③胸外傷chesttrauma④腫瘤tumor⑤心腎疾病等cardiorenaldisease（1）游離性胸腔積液pleuralfreeeffusion：A.少量積液smallamountoffreefuild：少量積液最先積聚于位置最低的后肋膈角，因而站立后前位檢查多難以發(fā)現(xiàn)Whenthepatientiserect,thefluidcollectsatthelowerpositionofthepleuralcavity.ItishardtodetectsmallamountoffreefluidonP-Aview.液量達(dá)250ml左右時(shí)，于站立后前位檢查也僅見肋膈角變鈍，變淺或填平thefuildinthepleuralcavityisabout250cc,itonlyshowsbluntingofthecostophrenicangleonP-Aview隨液量增加可依次閉塞外側(cè)肋膈角，掩蓋膈頂bluntingofthecostophrenicangle

，masking(obscurity)ofthediaphragm其上緣在第4肋前端以下，呈外高內(nèi)低的弧形凹面acurveofthefreefluidwhichishighestattheoutsideandtheconcavefaceisupwardonP-AviewB.中量積液moderateamountoffreefluid：中量積液上緣在第4肋前端平面以上，第2肋前端平面以下upperborderofthemoderateamountfreefluidishigherthan4thriblevelandlowerthanthe2ndriblevel中下肺野呈均勻致密影homogeneousdensityinmiddleandlowerfieldsC.大量積液largeamountoffreefluuid：大量積液上緣達(dá)第2肋前端以上upperborderofthefluidishigherthan2ndriblevel患側(cè)肺野呈均勻致密陰影homogeneousdensityintheaffectedfields有時(shí)僅見肺尖部透明lucentareainapexoflung可見肋間隙增寬widenoftheintercostalsspacesontheaffectedside橫膈下降depressionofthediaphragm縱隔向健側(cè)移位displacementofdiaphragmtotheunaffectedside（2）局限性胸腔積液（localizedpleuraleffusion）：A.包裹性積液（encapsulatedeffusion）：為胸膜炎時(shí)，臟、壁層胸膜發(fā)生粘連使積液局限于胸膜腔的某一部位，多見于胸下部側(cè)后胸壁thepleuraadhesionborderthevisceralandparietalpleura,thefluidislocatedinthepleuralcavity,mostlyinthelowerthoraciclateralchestwall切線位片上，包裹性積液表現(xiàn)為自胸壁向肺野突出之半圓形或扁丘狀陰影semicircularorflathummockyshadowwithawidebaseagainstthechestwallandaconvexinner其上下緣與胸壁的夾角呈鈍角Itsupperandloweredgeandtheanglewasbluntchestwall密度均勻homogeneousdensity邊緣清楚well-defined常見于結(jié)核tuberculosisB.葉間積液（interlobareffusion）：為局限于水平裂或斜裂的葉間裂積液theinterlobarfissureeffusionconfinedtothehorizontalfissureortheobliquefissure可單獨(dú)存在maybeseparate也可與游離性積液并存analsocoexistwithfreefluid發(fā)生于斜裂者，正位X線檢查多難以診斷，側(cè)位則易于發(fā)現(xiàn)Occurredinobliquefissure,situatedX-rayexaminationisdifficulttodiagnose,lateralviewfounditeasy典型表現(xiàn)是葉間裂部位的梭形影Typicalperformanceisfusiform-shapedshadowininterlobarfissure密度均勻，邊緣清楚homogeneousdensity,well-defined游離性積液進(jìn)人葉間裂時(shí)多局限于斜裂下部Freefluidconfinedtothelowerobliquefissurewhenitcollectsintheinterlobarfissure表現(xiàn)為尖端向上的三角形密度增高影peakupwardtriangledenseshadow葉間積液可由心衰或結(jié)核引起causedbyheartfailureortuberculosis少數(shù)腫瘤轉(zhuǎn)移也可表現(xiàn)為葉間積液AsmallnumberoftumormetastasiscanalsobeexpressedasoftheinterlobareffusionC.肺下積液（subpulmonaryeffusion）：為位于肺底與橫膈之間的胸腔積液pleuraleffusionsituatedbetweenthelungandthediaphragm右側(cè)較多見seemoreright被肺底積液向上推擠的肺下緣呈圓頂形inferiormarginoflungisdomeshapebecauseofthesubpulmonaryfluid易誤診為橫膈升高misdiagnosedaselevateddiaphragm肺底積液所致的“橫膈升高”圓頂最高點(diǎn)位于偏外l/3，且肋膈角深而銳利thehighestpointofthedomeof"elevateddiaphragm"inthepartiall/3,costophrenicangledeepandsharp

上緣光滑似膈肌影，但最高點(diǎn)外移，故有假膈肌影之稱borderoftheeffusionsmoothlikethediaphragm,buttherelocationofthehighestpoint,thefalsediaphragmshadow游離性胸腔積液

少量中量

游離性胸腔積液

局限性胸腔積液

大量包裹性胸腔積液

局限性胸腔積液

葉間胸腔積液左側(cè)肺下積液

2.氣胸及液氣胸Pneumothoraxandhydropneumothorax：空氣進(jìn)入胸膜腔內(nèi)為氣胸

theairenteringthepleuralcavity,itistermedpneumothorax胸膜腔內(nèi)液體與氣體同時(shí)存在為液氣胸thepleuralcavitycontainsairandfluid,itistermedhydropneumothorax（1）氣胸pneumothorax：A.病因cause：臟層或壁層胸膜破裂ruptureofthevisceralpleuraorpartialpleura臟層胸膜破裂多在胸膜下肺部病變的基礎(chǔ)上發(fā)生，稱自發(fā)性氣胸ruptureofthevisceralpleuraoccuronthebasisofsubpleurallunglesions,saidspontaneouspneumothorax見于found：嚴(yán)重肺氣腫severeemphysema胸膜下肺大泡subpleurabullae肺結(jié)核pulmonarytuberculosis肺膿腫等lungabscess胸膜裂口具活瓣作用時(shí)氣體只進(jìn)不出或進(jìn)多出少avalveeffectofpleuralsplit可形成張力性氣胸tensionpneumothoraxcanbeformed壁層胸膜破裂為壁層胸膜直接損傷破裂、體外空氣進(jìn)入胸腔directinjuryofpartialpleura,invitroairintothepleuralcavity如胸壁穿通傷、胸部手術(shù)及胸腔穿刺等suchaspenetratingwoundofchestwall,chestsurgeryandpleuralpuncture,etc.B.X線表現(xiàn)X-rayfindings：①氣胸區(qū)為無肺紋理透明區(qū)alucentzoneofdevoidoflungmarking②壓縮肺向肺門收縮，密度增高thelungcollapsedtothehilum,dense③肋間隙增寬，膈肌下降，縱隔對側(cè)移位intercostalspacewiden,depressionofthediaphragm,displacementofmediastinumtotheoppositesite④氣胸內(nèi)有時(shí)可見致密的胸膜粘連帶occasionallyvisibledensepleuraladhesionsinpneumothorax（2）液氣胸hydropneumothorax：①外傷、手術(shù)后及胸腔穿刺后均可產(chǎn)生液氣胸hydropneumothoraxaftertrauma,operationandchestpuncture②氣胸下部可見均勻致密的液平面homogeneousdenseair-fluidlevelinlowerhydropneumothorax③如臟、壁層胸膜粘連，也可形成局限性或多房性液氣胸pleuraladhesions,canbeformedlocalormultilocularhydropneumothorax④其余征象同氣胸withtheremainingsignsofpneumothorax左側(cè)氣胸右側(cè)液氣胸3.胸膜增厚、粘連、鈣化（Pleuralthickening,