修翻譯呼吸tb課件

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

鄭州大學(xué)第一附屬醫(yī)院放射科thefirstaffiliatedhospitalradiologydepartmentoftheZhengzhouUniversity

張焱ZhangYan〔四〕肺結(jié)核Pulmonarytuberculosis:1.臨床特點：clinicalcharacters〔1〕病原：pathogeny人或牛結(jié)核桿菌BacillustuberculosisorBacillustuberculosisbovis〔2〕病理：pathology①結(jié)核菌侵入人體后引起的根本病理變化為:basicpathologicalchangecausedbytuberculosis滲出及增殖exudationandproliferation②機體抵抗力低下時，病變那么出現(xiàn):pathologicalchangeoflowresistance干酪樣壞死，液化及空洞形成caseousnecrosis,colliquationandporosis.③機體抵抗力強或經(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cavitycloseorasepsiscavity〔3〕分期:stages①進展期：progression新發(fā)現(xiàn)病灶，病灶擴大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)③穩(wěn)定期：stationarystage病灶無活動lesioninactivity，空洞閉合cavitycloseup，痰結(jié)核菌連續(xù)6個月陰性〔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年仍無活動，結(jié)核菌仍陰性focusinactivityformore2yearsandspitnegativecontinous如有空洞，需觀察3年以上為臨床痊愈clinicalcureshouldbeobservefor3yearsifthecavityexist2.影像表現(xiàn)：1978年全國結(jié)核病防治會議natinalconferenceforcureandprevetionoftuberculosis分為五個類型：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〕Ⅲ型：浸潤型肺結(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tuberculouspleurisy1998新制定中國結(jié)核病分類法：chinesegroupingoftuberculosis：Ⅰ型原發(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〕Ⅲ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，nephrotuberculosisandtubercularmeningitis〔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

A.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thestreakshadowisconnectionoflymphnodesandprimarylesion②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adenolymphitis典型表現(xiàn):classicalcharacters肺門或縱隔有圓或橢圓結(jié)節(jié)狀陰影，單個或多個singleormultiplenodositasrotateorellipselesionofhilusoflungormediastinal

邊界清晰者clearborder

：腫瘤型tumortype

邊界模糊者obscureboder：炎癥型Inflammatorytype

原發(fā)綜合征肺結(jié)核胸內(nèi)淋巴結(jié)肺結(jié)核

primarysyndrometuberculosisofintrathoraciclymphonodes〔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)核菌一次大量進入肺循環(huán)massofBacillustuberculosiscomeintopulmonarycircuIation所以肺部病變廣泛，臨床病癥較重pulmonarylesioniswideandclinicalsymptomissevere1.病變早期：earlystage

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惡化那么融合，出現(xiàn)空洞amalgamationfordegenerationandcavitypresent②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，屢次進入肺循環(huán)fewBacillustuberculosiscomeintopulmonarycirculationtimeaftertime病癥較輕slightsymptom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,densityandasymmetryofdistributionandmultinature急性粟粒型肺結(jié)核亞急性、慢性血行播散型

肺結(jié)核〔3〕浸潤型肺結(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：①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lesionmergeortogethercavitypresent②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satellitearoundthelesion③干酪性肺炎caseouspneumonia

：機體抵抗力差，對結(jié)核菌高度過敏而形成，分大葉性和小葉性Lowresistanceandhypersensitivetotuberculosis.Divideintolobarandlobularpneumonia.大葉性呈肺段或大葉實變陰影，內(nèi)有無壁空洞，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存在Lobularlesionislobularshadowandcoexistwithlobarlesion

浸潤型肺結(jié)核

常見表現(xiàn)結(jié)核球浸潤型肺結(jié)核〔干酪性肺炎〕

平片斷層片〔4〕慢性纖維空洞型肺結(jié)核〔Ⅳ型〕Chronicfibrocavitarypulmonarytuberculosis①為各型結(jié)核惡化、好轉(zhuǎn)與穩(wěn)定交替開展而來的晚期肺結(jié)核Latepulmonarytuberculosisbydegeneration,improvementandstabilizationofallt