醫(yī)學(xué)影像學(xué) 教學(xué)片3-呼吸系統(tǒng)3 學(xué)習(xí)資料

呼吸系統(tǒng)呼吸系統(tǒng)疾病的X線、CT表現(xiàn)（三）DepartmentofRadiologyWMC肺結(jié)核的CT表現(xiàn)DepartmentofRadiologyWMC原發(fā)性肺結(jié)核DepartmentofRadiologyWMC原發(fā)性肺結(jié)核DepartmentofRadiologyWMC肺結(jié)核伴兩肺血行播散DepartmentofRadiologyWMC左肺結(jié)核（滲出、增殖為主）DepartmentofRadiologyWMC左肺結(jié)核（滲出、增殖為主）DepartmentofRadiologyWMC肺結(jié)核伴空洞（滲出為主）

DepartmentofRadiologyWMC兩肺結(jié)核（空洞為主）DepartmentofRadiologyWMC干酪性肺炎DepartmentofRadiologyWMC結(jié)核球DepartmentofRadiologyWMC肺結(jié)核（干酪為主）DepartmentofRadiologyWMC

山雨欲來DepartmentofRadiologyWMC肺腫瘤分為：原發(fā)性和繼發(fā)性。原發(fā)性又分為：良性和惡性腫瘤。良性腫瘤少見，惡性腫瘤中98%是支氣管肺癌。DepartmentofRadiologyWMCDepartmentofRadiologyWMC右上中央型肺癌橫S征DepartmentofRadiologyWMC左中央肺癌伴阻塞性肺炎DepartmentofRadiologyWMC右上肺癌伴不張DepartmentofRadiologyWMC左上肺癌伴不張；增強(qiáng)前后對比DepartmentofRadiologyWMC左上葉中央型肺癌上葉不張DepartmentofRadiologyWMC周圍型肺癌DepartmentofRadiologyWMC分葉征：由于腫瘤各部分生長速度不均勻，或由于腫瘤在生長過程中受到血管、支氣管的阻擋而造成的腫瘤表面凹凸不平。DepartmentofRadiologyWMC毛刺征：因惡性腫瘤向周圍浸潤生長，造成邊緣模糊，形成自瘤灶向周圍伸展的，無分支的細(xì)短線條影，呈毛刷狀，稱毛刺征。DepartmentofRadiologyWMC空泡征：瘤灶內(nèi)未受腫瘤累及的正常含氣的肺泡和擴(kuò)張扭曲的細(xì)支氣管表現(xiàn)為腫塊影內(nèi)點(diǎn)狀、蜂窩狀的低密度透亮影多見于直徑<3cm的腺癌、鱗腺癌和細(xì)支氣管肺泡癌DepartmentofRadiologyWMC胸膜凹陷征：一般認(rèn)為系腫瘤的成纖維作用，即瘤灶內(nèi)纖維瘢痕組織收縮，其收縮力通過瘤體鄰近纖維網(wǎng)架傳遞到臟層胸膜面，將臟層胸膜拉近腫瘤內(nèi)，凹入的胸膜與壁層胸膜之間構(gòu)成空隙，內(nèi)為生理性液體充填。凹入?yún)^(qū)肺組織形成溝槽，與凹陷的胸膜一起被周圍膨脹的含氣肺野襯托，表現(xiàn)為連接于胸壁與腫瘤之間的“Y”或“V”形細(xì)線條密影或喇叭狀影，亦可稱為“兔耳征”。DepartmentofRadiologyWMCDepartmentofRadiologyWMCDepartmentofRadiologyWMCDepartmentofRadiologyWMCDepartmentofRadiologyWMCDepartmentofRadiologyWMCDepartmentofRadiologyWMC左上肺癌（分葉狀）DepartmentofRadiologyWMCDepartmentofRadiologyWMCDepartmentofRadiologyWMCDepartmentofRadiologyWMCDepartmentofRadiologyWMCDepartmentofRadiologyWMC右周圍型肺癌分葉征DepartmentofRadiologyWMC左上肺周圍型肺癌雙上肺結(jié)核DepartmentofRadiologyWMC右上肺癌(空泡征)DepartmentofRadiologyWMC右上肺癌DepartmentofRadiologyWMC偏心性空洞

癌性DepartmentofRadiologyWMC左上葉下舌段肺癌厚壁空洞癌性空洞癌性空洞DepartmentofRadiologyWMC肺癌伴轉(zhuǎn)移DepartmentofRadiologyWMC肺癌伴縱隔、胸膜轉(zhuǎn)移DepartmentofRadiologyWMC右周圍型肺癌右肺門及

縱隔淋巴結(jié)轉(zhuǎn)移

DepartmentofRadiologyWMC左肺癌，左4、7后肋骨轉(zhuǎn)移及縱隔轉(zhuǎn)移DepartmentofRadiologyWMC兩肺腺癌肺內(nèi)轉(zhuǎn)移DepartmentofRadiologyWMC肺內(nèi)轉(zhuǎn)移性腫瘤DepartmentofRadiologyWMC兩

肺

轉(zhuǎn)

移

性

腫

瘤DepartmentofRadiologyWMCDepartmentofRadiologyWMC兩肺轉(zhuǎn)移瘤DepartmentofRadiologyWMC肝癌伴兩肺轉(zhuǎn)移DepartmentofRadiologyWMC結(jié)腸癌兩肺轉(zhuǎn)移伴空洞形成DepartmentofRadiologyWMC

錯構(gòu)瘤DepartmentofRadiologyWMCDepartmentofRadiologyWMC縱隔原發(fā)腫瘤DepartmentofRadiologyWMC縱隔增寬DepartmentofRadiologyWMC小胸腺瘤DepartmentofRadiologyWMC胸腺瘤（囊性變）DepartmentofRadiologyWMC侵襲性胸腺瘤DepartmentofRadiologyWMC縱隔畸胎瘤伴胸水DepartmentofRadiologyWMC縱隔淋巴結(jié)結(jié)核DepartmentofRadiologyWMC淋巴瘤DepartmentofRadiologyWMC神經(jīng)源性腫瘤DepartmentofRadiologyWMCDepartmentofRadiologyWMC胸部外傷DepartmentofRadiologyWMC左側(cè)多條肋骨骨折伴氣胸及皮下肌間積氣DepartmentofRadiologyWMC右皮下氣腫、肋骨骨折外傷性濕肺DepartmentofRadiologyWMC右肋骨骨折、皮下氣腫，肺挫傷DepartmentofRadiologyWMC左上肺血腫DepartmentofRadiologyWMC圖片討論請對下面的圖片做出診斷并描述你所觀察到的影像學(xué)征象DepartmentofRadiologyWMCDepartmentofRadiologyWMCDepartmentofRadiologyWMCA肺癌并空洞形成B肺膿腫并空洞形成C肺結(jié)核并空洞形成

DepartmentofRadiologyWMC新疆天山哈薩克族牧場DepartmentofRadiologyWMC肺內(nèi)腫塊的鑒別診斷結(jié)核球：無分葉或淺分葉，

2~3cm

，大多邊緣光滑、密度均勻，不強(qiáng)化或環(huán)形強(qiáng)化（干酪樣壞死），球內(nèi)有層狀、環(huán)狀及點(diǎn)狀鈣化灶，附近常見“衛(wèi)星灶”。肺癌：常見分葉（深分葉），有毛刺，胸膜凹陷征多見，中等強(qiáng)化〉（20hu），粗大鈣化，無衛(wèi)星灶。炎性假瘤：類圓形或橢圓形，多數(shù)<5cm，中等密度，密度均勻，顯著均勻強(qiáng)化，硬化血管瘤型可見斑點(diǎn)狀鈣化，有包膜者邊緣光滑，無包膜者可見輕度滲出性病變。Departmentof