结节病典型和不典型型表现培训课件.ppt
- 【下载声明】
1. 本站全部试题类文档,若标题没写含答案,则无答案;标题注明含答案的文档,主观题也可能无答案。请谨慎下单,一旦售出,不予退换。
2. 本站全部PPT文档均不含视频和音频,PPT中出现的音频或视频标识(或文字)仅表示流程,实际无音频或视频文件。请谨慎下单,一旦售出,不予退换。
3. 本页资料《结节病典型和不典型型表现培训课件.ppt》由用户(晟晟文业)主动上传,其收益全归该用户。163文库仅提供信息存储空间,仅对该用户上传内容的表现方式做保护处理,对上传内容本身不做任何修改或编辑。 若此文所含内容侵犯了您的版权或隐私,请立即通知163文库(点击联系客服),我们立即给予删除!
4. 请根据预览情况,自愿下载本文。本站不保证下载资源的准确性、安全性和完整性, 同时也不承担用户因使用这些下载资源对自己和他人造成任何形式的伤害或损失。
5. 本站所有资源如无特殊说明,都需要本地电脑安装OFFICE2007及以上版本和PDF阅读器,压缩文件请下载最新的WinRAR软件解压。
- 配套讲稿:
如PPT文件的首页显示word图标,表示该PPT已包含配套word讲稿。双击word图标可打开word文档。
- 特殊限制:
部分文档作品中含有的国旗、国徽等图片,仅作为作品整体效果示例展示,禁止商用。设计者仅对作品中独创性部分享有著作权。
- 关 键 词:
- 结节 典型 表现 培训 课件
- 资源描述:
-
1、结节病典型和不典型型表现结节病典型和不典型型表现Sarcoidosis is a multisystem disorder that is characterized by noncaseous epithelioid cell granulomas,which may affect almost any organ.结节病是一种以非干酪样坏死的上皮细胞肉芽肿为特点的多系统疾病,几乎可以累及所有器官。Sarcoidosis may be asymptomatic or chronic.It commonly improves or clears up spontaneously(自愈或好转).
2、More than 2/3 of people with lung sarcoidosis have no symptoms after 9 years.About 50%have relapses.About 10%develop serious disability.S a r c o i d o s i s i s a mu l t i s y s t e m d Sarcoidosis of the lung is primarily an interstitial lung disease in which the inflammatory process involves the
3、alveoli,small bronchi,and small blood vessels.Typical and Atypical Features of Pulmonary Sarcoidosis at High-Resolution CT Typical features 1 Lymphadenopathy:hilar,mediastinal(right paratracheal),bilateral,symmetric,and well defined 2 Nodules:micronodules(24 mm in diameter;well defined,bilateral);ma
4、cronodules(5 mm in diameter,coalescing)3 Lymphangitic spread:peribronchovascular,subpleural,interlobular septal 4 Fibrotic changes:reticular opacities,architectural distortion,traction bronchiectasis,bronchiolectasis,volume loss Bilateral perihilar opacities 5 Predominant upper-and middle-zone locat
5、ions of parenchymal abnormalities 结节病原本是肺间质性病变,累及肺泡,支气管和小血管淋巴结增大,两侧对称,境界清楚大小结节淋巴管播散,支气管血管鞘,胸膜下,小叶间隔纤维化改变,网状阴影,肺结构扭曲,牵拉性支扩,肺容积缩小,两肺门旁致密影中上肺为主典型特征 S a r c o i d o s i s o f t h e l u n g i s p Atypical features 1 Lymphadenopathy:unilateral,isolated,anterior and posterior mediastinal 2 Airspace consoli
6、dation:masslike opacities,conglomerate masses,solitary pulmonary nodules,confluent alveolar opacities(alveolar sarcoid pattern)3 Ground-glass opacities 4 Linear opacities:interlobular septal thickening,intralobular linear opacities 5 Fibrocystic changes:cysts,bullae,blebs,emphysema,honeycomb-like op
7、acities with upper-and middle-zone predominance 单侧孤立前后纵隔淋巴结增大肺泡实变:肿块,实质性结节,实变融合毛玻璃阴影线状阴影小叶间隔增厚小叶年线状阴影不典型表现囊性纤维化改变:囊,大泡,小泡,肺气肿,蜂窝样改变 A t y p i c a l f e a t u r e s 5 6 Miliary opacities 粟粒样改变 7 Airway involvement:mosaic attenuation pattern,tracheobronchial abnormalities,atelectasis 气道累及:马赛克改变,气管支气管异
8、常,肺不张 8 Pleural disease:effusion,chylothorax,hemothorax,pneumothorax,pleural thickening,calcification Pleural plaquelike opacities 9 Mycetoma,aspergilloma 霉菌球 6 Mi l i a r y o p a c i t i e sDuring the past decade,advances have been made in the study of sarcoidosis The Mycobacterium tuberculosis cat
9、alase-peroxidase(mKatG)protein,a potential antigen,has been identified,结核分枝杆菌过氧化氢酶过氧化物酶(mkatg)蛋白,作为一个潜在的抗原已被确定。PET scanning has proven valuable in locating occult sites for diagnostic biopsy.PET扫描已被证明在定位活检诊断隐匿性病灶的价值 Endobronchial ultrasound-guided transbronchial needle aspiration(EBUS-TBNA)of medias
10、tinal lymph nodes has facilitated diagnosis,often eliminating the need for more-invasive procedures,such as mediastinoscopy.支气管内超声引导下经支气管针吸活检(EBUS-TBNA)的纵隔淋巴结有利于诊断,往往避免更具侵袭性的操作,如纵隔镜。Gene expression analyses have more clearly defined cytokine dysregulation in sarcoidosis Currently,no reliable prognos
11、tic biomarkers have been identified.目前,还没有可靠的预后标志物已被确定。The tumor necrosis factor(TNF)inhibitors,a relatively new class of steroid-sparing agents,have been used in patients with refractory disease.It is unclear whether medications used to treat pulmonary arterial hypertension are safe and effective f
12、or the treatment of sarcoidosis-associated pulmonary hypertension.肿瘤坏死因子(TNF)抑制剂,一个相对较新的类固醇保代理类药品,已被用于治疗难治性疾病。目前还不清楚是否用于治疗肺动脉高压的药物治疗结节病相关性肺动脉高压是安全和有效的。D u r i n g t h e p a s t d e c a d e,a d v a n cPathologic Correlation 相关病理相关病理 Granulomas in the lung parenchyma have a characteristic distribution
13、 in relation to lymphatics in the peribronchovascular interstitial space,subpleural interstitial space,and,to a lesser extent,the interlobular septa(ie,a lymphangitic distribution)肺实质肉芽肿分布与支气管血管鞘,胸膜下结缔组织,小叶间隔中淋巴管相关肺实质肉芽肿分布与支气管血管鞘,胸膜下结缔组织,小叶间隔中淋巴管相关.Thickened bronchovascular bundles and small perivas
14、cular nodules seen at CT corresponded to granulomas within the connective tissue sheath surrounding pulmonary airways and vessels.Pleural or subpleural nodules were correlated with granulomas adjacent to the visceral pleuraCT上支气管血管鞘增厚和小结节是与包绕气道血管结缔组织鞘中肉芽肿,胸膜和胸膜下结节与肉芽肿,胸膜和胸膜下结节与脏层胸膜旁肉芽肿相关。脏层胸膜旁肉芽肿相关。
15、P a t h o l o g i c C o r r e l a t i o n 相关病 Ground-glass opacities represented an accumulation of many granulomatous lesions,with or without fibrosis,in the alveolar septa and around the small vessels.No alveolitis was seen 肺泡间隔小血管周围大量肉芽肿是毛玻璃阴影主要原因,可伴纤维化,但没有肺泡炎。肉芽肿是毛玻璃阴影主要原因,可伴纤维化,但没有肺泡炎。Large par
16、enchymal nodules(1 cm in diameter)represented coalescent granulomas 大结节是肉芽肿病变的融合肉芽肿病变的融合 Air bronchiolograms within regions of dense consolidation on CT images corresponded to bronchiolar dilatation with surrounding fibrosis 支气管充气症是纤维化旁的支扩 honeycomb-like pattern of microscopic cysts seen at patholog
17、ic analysis.蜂窝样改变在显微镜下就是很多的小囊结节病典型和不典型型表现培训课件 pulmonary sarcoidosis shows the typical perilymphatic distribution of micronodules(arrow).(外周淋巴分布的微结节)Photomicrograph of a lung biopsy specimen demonstrates numerous epithelioid granulomas(arrow)surrounding the bronchial walls and immediately beneath the
18、 normal bronchial epithelium(arrowheads).p u l mo n a r y s a r c o i d o s i s s h o w s t CT scan shows multiple micronodules with a peribronchovascular distribution in both lungs,predominantly in the upper and middle lobes.One cluster of nodules in the periphery of the left upper lobe(arrow)has c
19、oalesced to form a conglomerate lesion(macronodule).Coronal reformatted image from high-resolution CT clearly shows upper-lobe predominance of the micronodules.Low-magnification photomicrograph slice from the lower part of the right upper lobe shows multiple confluent granulomas infiltrating the per
20、ibronchovascular(arrows)and subpleural(arrowheads)interstitium.C T s c a n s h o w s mu l t i p l e mi c r CT scan shows mediastinal lymph node enlargement and a reticular pattern produced by nodularity and thickening of interlobular septa,pleural surfaces,and fissures,CT扫描显示纵隔淋巴结肿大和形成网状图案的小叶间隔增厚,及胸
21、膜表面,及产生的裂缝。(b)Photomicrograph of a specimen from fine-needle aspiration biopsy of an enlarged right paratracheal lymph node shows a group of histiocytes against a lymphocytic background,a cytologic structure characteristic of sarcoid granuloma.(c)Photomicrograph of a lung biopsy specimen from anothe
22、r patient shows progressive thickening of the interlobular septum(*)because of the accumulation of numerous sarcoid granulomas(arrowheads),an appearance that correlates well with the CT features seen in a.从扩大的右气管旁淋巴结细针穿刺活检标本显从扩大的右气管旁淋巴结细针穿刺活检标本显微镜下显示一组以淋巴细胞的背景的组织细胞,具有结节病肉芽肿细胞的结构特征。(微镜下显示一组以淋巴细胞的背景的组
23、织细胞,具有结节病肉芽肿细胞的结构特征。(C)从另)从另一个病人的肺活检标本的显微照片显示小叶间隔一个病人的肺活检标本的显微照片显示小叶间隔增厚(增厚(*),大量积累的肉芽肿结节(箭头)。),大量积累的肉芽肿结节(箭头)。C T s c a n s h o w s me d i a s t i n a l l y m expiratory CT scan obtained in a patient with pulmonary sarcoidosis shows a mosaic pattern consisting of multiple areas of low attenuation(a
24、rrows)interspersed with larger areas of normal lung parenchyma.This appearance is produced by air trapping.Photomicrographs of a transbronchial lung biopsy specimen show accumulations of sarcoid granulomas(*)in the mucosal and submucosal layers of bronchiolar epithelium(arrows in b).呼气相呼气相CT扫描在肺结节病患
25、者显示马赛克征,由低密度的多个区域(箭头)穿插着大面积的正常扫描在肺结节病患者显示马赛克征,由低密度的多个区域(箭头)穿插着大面积的正常肺实质。这种现象是由空气滞留产生。肺实质。这种现象是由空气滞留产生。一经支气管镜肺活检标本显示的积累结节病肉芽肿的显微照片(一经支气管镜肺活检标本显示的积累结节病肉芽肿的显微照片()在粘膜和粘膜下的细支气管)在粘膜和粘膜下的细支气管上皮层(箭头上皮层(箭头B)。)。e x p i r a t o r y C T s c a n o b t a i n e d i .(11a)CT scan shows a diffuse ground-glass patter
展开阅读全文