呼吸系統(tǒng)影像診斷學(xué)

呼吸系統(tǒng)影像診斷學(xué)ImagingdiagnosticsoftheRespiratorysystem

1精選ppt（四）肺結(jié)核Pulmonarytuberculosis:2精選ppt1.臨床特點(diǎn)：clinicalcharacters（1）病原：pathogeny人或牛結(jié)核桿菌BacillustuberculosisorBacillustuberculosisbovis3精選ppt（2）病理：pathology①結(jié)核菌侵入人體后引起的基本病理變化為:basicpathologicalchangecausedbytuberculosis滲出及增殖exudationandproliferation

②機(jī)體抵抗力低下時(shí)，病變則出現(xiàn):pathologicalchangeoflowresistance干酪樣壞死，液化及空洞形成caseousnecrosis,colliquationandporosis.4精選ppt③機(jī)體抵抗力強(qiáng)或經(jīng)適當(dāng)治療后病灶：pathologicalchangeoflowresistanceorpost–treatment吸收absorption纖維化fibrosis鈣化calcification空洞瘢痕閉合或凈化空洞cavitycloseorasepsiscavity5精選ppt（3）分期:stages①進(jìn)展期：progression新發(fā)現(xiàn)病灶，病灶擴(kuò)大newlesionandexpansion病灶邊界變模糊obscureborder出現(xiàn)空洞或空洞增大，痰結(jié)核菌陽(yáng)性cavityappearanceorexpansion,spitpositive②好轉(zhuǎn)期：resolvingstage病灶縮小，邊界變清楚，病灶消失

clarityofborderandlesseningordisppearanceoflesion空洞縮小或消失lessenordisappearofnidus

痰結(jié)核菌轉(zhuǎn)陰性（連續(xù)3月，1次/月）spitnegative(3monthscontinous,1time/month)6精選ppt③穩(wěn)定期：stationarystage病灶無(wú)活動(dòng)lesioninactivity，空洞閉合cavitycloseup，痰結(jié)核菌連續(xù)6個(gè)月陰性（至少1次/月）spitnegative(6monthscontinus,1time/month)如有空洞，連續(xù)1年以上陰性，屬臨床治愈spitnegativecontinousmorethan1yearisclinicalcureifthecavityexsist再經(jīng)觀察2年仍無(wú)活動(dòng)，結(jié)核菌仍陰性focusinactivityformore2yearsandspitnegativecontinous

如有空洞，需觀察3年以上為臨床痊愈clinicalcureshouldbeobservefor3yearsifthecavityexist7精選ppt2.影像表現(xiàn)：1978年全國(guó)結(jié)核病防治會(huì)議natinalconferenceforcureandprevetionoftuberculosis分為五個(gè)類型：Ⅰ型type：原發(fā)性肺結(jié)核primarypulmonarytuberculosis（原發(fā)綜合征primarysyndrome，胸內(nèi)淋巴結(jié)核intrathoracicscrofula）Ⅱ型type：

血行播散型肺結(jié)核hematogenouspulmonarytuberculosis（急性粟粒型肺結(jié)核acutemilitarytuberculosis，亞急性或慢性血行播散型肺結(jié)核subacuteorchronichematogenouspulmonarytuberculosis）8精選pptⅢ型：浸潤(rùn)型肺結(jié)核（含結(jié)核瘤和干酪肺炎）exudativepulmonarytuberculosis(tuberculomaandcaseouspneumonia)Ⅳ型：慢性纖維空洞型肺結(jié)核chronicfibro-cavernouspulmonarytuberculosisⅤ型：胸膜炎型肺結(jié)核tuberculouspleurisy

9精選ppt1998新制定中國(guó)結(jié)核病分類法：chinesegroupingoftuberculosis：Ⅰ型原發(fā)性肺結(jié)核primarypulmonary

tuberculosis（原發(fā)綜合征primarysyndrome，胸內(nèi)淋巴結(jié)核intrathoracicscrofula）Ⅱ型血行播散型肺結(jié)核hematogenouspulmonarytuberculosis（急性粟粒型肺結(jié)核acutemilitarytuberculosis，亞急性或慢性血行播散型肺結(jié)核subacuteorchronichematogenouspulmonarytuberculosis）

10精選pptⅢ型：繼發(fā)性肺結(jié)核secondarypulmonarytuberculosis（含結(jié)核瘤tuberculoma、干酪肺炎caseouspneumonia、慢性纖維空洞型肺結(jié)核chronicfibro-cavernouspulmonarytuberculosis）Ⅳ型：結(jié)核性胸膜炎tuberculouspleurisyⅤ型：其他肺外結(jié)核如骨結(jié)核、腎結(jié)核和結(jié)核性腦膜炎等extrapulmonarytuberculosissuchasbasaltuberculosis，nephrotuberculosisandtubercularmeningitis11精選ppt（1）原發(fā)型肺結(jié)核:（Ⅰ型）primarypulmonarytuberculosis①原發(fā)綜合征(primarysyndrome)：典型表現(xiàn)呈“啞鈴狀或雙極期”:dumbbellorbipolarstage

12精選pptA.肺野原發(fā)病灶：primarylesionoflungfeild

邊界模糊的云絮狀陰影，可大可小patchyshadowofobscureborderandInequalityofsizeB.肺門及縱隔淋巴結(jié)腫大：enlargementofhilarandmediastinallymphnodes

邊界清晰或模糊、圓或分葉狀塊影

the

borderisclearorobscureandthelesionisrotateorsublobe

C.淋巴管炎：angialymphitis

連接淋巴結(jié)和原發(fā)灶之間索條狀影thestreakshadowisconnectionoflymphnodesandprimarylesion13精選ppt②胸內(nèi)淋巴結(jié)結(jié)核(tuberculosisofintrathoraciclymphonodes)：原發(fā)病灶吸收absorptionofprimarylesion但淋巴結(jié)核因干酪化而愈合緩慢，slowcicatrizationofscrofulabecauseofcaseation

故只有淋巴結(jié)炎adenolymphitis14精選ppt典型表現(xiàn):classicalcharacters肺門或縱隔有圓或橢圓結(jié)節(jié)狀陰影，單個(gè)或多個(gè)singleormultiplenodositasrotateorellipselesionofhilusoflungormediastinal

邊界清晰者clearborder

：腫瘤型tumortype

邊界模糊者obscureboder：炎癥型Inflammatorytype

15精選ppt16精選ppt原發(fā)綜合征肺結(jié)核胸內(nèi)淋巴結(jié)肺結(jié)核

primarysyndrometuberculosisofintrathoraciclymphonodes17精選ppt（2）血行播散型肺結(jié)核hematogenouspulmonarytuberculosis

（Ⅱ型）①急性粟粒型肺結(jié)核（acutemiliarytuberculosis）：結(jié)核菌一次大量進(jìn)入肺循環(huán)massofBacillustuberculosiscomeintopulmonarycircuIation所以肺部病變廣泛，臨床癥狀較重pulmonarylesioniswideandclinicalsymptomissevere18精選ppt1.病變?cè)缙冢篹arlystage

只見肺呈磨玻璃樣groundglasspulmonary2.發(fā)病10天大約后：10daysafteronste

見1.5~2mm大小的粟粒狀影miliarylesion大小一致，分布均勻，密度相似normalsize,densityandequalityofdistribution正常肺紋理看不清

normallungmarkingcannotbeobserved3.治療后數(shù)月內(nèi)吸收absorptionafterseveralmonths’treatment惡化則融合，出現(xiàn)空洞amalgamationfordegenerationandcavitypresent19精選ppt20精選ppt21精選ppt②亞急性或慢性血行播散型肺結(jié)核:（又稱慢性播散型肺結(jié)核，chronicdisseminatedpulmonarytuberculosis）：結(jié)核菌少量，多次進(jìn)入肺循環(huán)fewBacillustuberculosiscomeintopulmonarycirculationtimeaftertime癥狀較輕slightsymptom22精選ppt典型表現(xiàn):classicalcharacters為結(jié)節(jié)狀病灶nodositaslesion主要分布在兩肺上、中部mediansuperiorlung（少數(shù)可單側(cè)）大小不一，分布不均，密度不一致，呈多種性質(zhì)病灶abnormalsize,densityandasymmetryofdistributionandmultinature23精選ppt急性粟粒型肺結(jié)核亞急性、慢性血行播散型

肺結(jié)核24精選ppt（3）浸潤(rùn)型肺結(jié)核（infiltrativepulmonarytuberculosis）:為繼發(fā)性肺結(jié)核，最常見

secondpulmonarytuberculosisandbestcommonX線表現(xiàn)有三種形式：25精選ppt①常見表現(xiàn)：好發(fā)于兩肺或一側(cè)肺的鎖骨上、下區(qū)regionesofsupraclavicularorinfraclavicula

可以呈多種性質(zhì)multinature，多種形態(tài)multianatomy，多個(gè)小葉性病灶multilesionofsublobe病灶邊界模糊obscureborder病灶可融合成大片或出現(xiàn)空洞lesionmergeortogethercavitypresent26精選ppt②結(jié)核瘤（球）tuberculoma：系干酪樣結(jié)核病變被纖維組織包繞而成caseastionoftuberculosiscircumfusedbyfibroustissue一般為圓或橢圓形致密影rotateorellipsehighdensitylesion大小2~3cm多數(shù)輪廓光滑outlineissmooth病灶內(nèi)可有鈣化或小空洞calcificationorsmallcavityinthelesion病灶周圍常有衛(wèi)星病灶satellitearoundthelesion

27精選ppt③干酪性肺炎caseouspneumonia

：機(jī)體抵抗力差，對(duì)結(jié)核菌高度過(guò)敏而形成，分大葉性和小葉性Lowresistanceandhypersensitivetotuberculosis.Divideintolobarandlobularpneumonia.大葉性呈肺段或大葉實(shí)變陰影，內(nèi)有無(wú)壁空洞，其余部位可有播散病灶Lobarpneumoniaishighdensitylesionofsegmentorlobarandcavitywithoutwallinit.Disseminatuslesionsinotherregions.小葉性病灶呈小片狀陰影，常與大葉性病灶同時(shí)存在Lobularlesionislobularshadowandcoexistwithlobarlesion28精選ppt

浸潤(rùn)型肺結(jié)核

常見表現(xiàn)結(jié)核球29精選ppt浸潤(rùn)型肺結(jié)核（干酪性肺炎）

平片斷層片30精選ppt31精選ppt32精選ppt（4）慢性纖維空洞型肺結(jié)核（Ⅳ型）

Chronic

fibrocavitarypulmonarytuberculosis①為各型結(jié)核惡化、好轉(zhuǎn)與穩(wěn)定交替發(fā)展而來(lái)的晚期肺結(jié)核Latepulmonarytuberculosisbydegeneration,improvementandstabilizationofalltuberculosis

33精選ppt②X線、CT