医科大学精品课件：17-胸部影像诊断-临床阶段.ppt

1、1,Radiology Diagnosis of Common Respiratory Diseases,宋焱 Department of Radiology Beijing Hospital,2,RML Consolidation,LUL atelectasis,Nodule and nipple,Pneumothorax,3,Diagnosis of Common Diseases,Airway diseases Pulmonary diseases Mediastinal tumor or tumorlike diseases,4,Airway diseases,Bronchiectas

2、is Foreign body,Irreversible dilation of a portion of the bronchial tree Common cause serious childhood infection cystic fibrosis,5,Bronchiectasis,6,Pattern of bronchiectasis,Cylindrical Cystic Varicose Mixed,Radiographic findings,Mainly involve the middle and lower lobe Obscure of the lung marking

3、Cystic shadows / Signet-ring sign tram tracks,8,9,10,Bronchography,11,Lack of bronchial tapering,12,13,14,15,HRCT Findings,Bronchiectasis with inflammation Fluid in the cyst Patchy consolidation Distributed lesion along the bronchial,16,M / 55 Cough Recurrent fever 3mos,17,A foreign body in L main b

4、ronchus,18,Pulmonary diseases,Pneumonia Lung abscess ARDS Pulmonary tuberculosis Primary bronchogenic lung cancer Pulmonary embolism,19,Pneumonia,Lobar pneumonia Bronchopneumonia Acute interstitial pneumonia Mycoplasmal pneumonia Fungal pneumonia Pneumonia in the immunocompromised host Allergic pneu

5、monia Radiation pneumonitis,20,Lobar pneumonia,Pathogenetic feature rapid production of edema fluid with relatively mild cellular reaction(neutrophils) edema fluid seems to be through the pores of kohn and small peripherel collateral channels but not along the bronchovascular bundles,21,Lobar pneumo

6、nia,Radiographic findings affects predominantly one lobe consolidation clear boundary (fissure) homogeneous density with or without air-bronchogram no volume loss,22,RML lobar pneumonia,23,bronchopneumonia,Radiographic findings middle or lower lobe lung markings are obscure patch like shadow goes al

7、ong with the lung markings,24,Bronchopneumonia,25,26,Pneumocystis jiroveci pneumonia PJP,27,Pulmonary abscess,Inhalation of infected material, cause a severe purulent reaction, the center of the abscess liquefies and may drainage Causes: Inhalation Septic infarct Secondary to bronchial obstruction b

8、y neoplasm,28,29,Radiographic findings,Acute pulmonary abscess Patchy consolidation Inhomogeneous in density (necrosis) cavity,30,Radiographic findings,Chronic pulmonary abscess Single or multiple cavities (mass) Internal margin : smooth or shaggy Air-fluid level: common Ring enhancement in contrast

9、 CT,31,LUL abscess,32,33,ARDS,34,ARDS,35,心源性肺水肿,ARDS,Komiya. J Thorac Imaging 2013,36,37,38,Pulmonary diseases,Pneumonia Lung abscess ARDS Pulmonary tuberculosis Primary bronchogenic lung cancer Pulmonary embolism,39,Pulmonary Tuberculosis,Primary pulmonary tuberculosis Hematogenous pulmonary tuberc

10、ulosis Second pulmonary tuberculosis Tuberculous pleuritis,40,Tuberculosis,exudation,proliferation,healing,progressive,干酪样坏死,液化及空洞形成,播散,吸收,纤维化,钙化,空洞瘢痕性愈合,空洞净化,41,Primary pulmonary tuberculosis,Primary complex initial focus lymphatic channel inflammation regional lymph node Hilum or mediastinal LN en

11、largement,42,Primary complex,43,44,Hematogenous Pulmonary Tuberculosis,Acute miliary tuberculosis： 1.52mm in diameter diffuse random distribution Chronic disseminated tuberculosis： different in size major in upper field,Size, distribution, density,45,46,47,Chronic disseminated tuberculosis,48,Second

12、 pulmonary tuberculosis,Focal lesion Tuberculoma Caseous pneumonia Fibro cavernous pulmonary tuberculosis,49,Postprimary TB,Sites of involvement: Classically the apical and posterior segments of the upper lobe, superior segment of lower lobe Findings: patchy consolidation, cavity, calcification, fib

13、rosis, nodule or mass,50,51,52,53,54,55,Tuberculoma,2-3cm in size Smooth margin, may slight lobular satellite nodule and fibrotic lines Calcification common： ring-like, laminated, cental, diffuse No-calcification： Contrast CT: ring-like or curvilinear enhancement, central necrotic material,56,Tuberc

14、uloma,57,Caseous pneumonia,58,59,Tuberculous pleuritis,Unilateral pleural effusion Pleural thickening adhesion calcification,60,23/M TB pleurisy,2 mos later,61,62,Pulmonary diseases,Pneumonia Lung abscess ARDS Pulmonary tuberculosis Primary bronchogenic lung cancer Pulmonary embolism,63,Pulmonary tu

15、mor,Lung cancer central peripheral pancoast tumor Lung metastasis,64,Bronchogenic lung carcer,The most common cause of cancer-related death in worldwide 1015% of patients survive 5y Incidence of unresectability 8085% The most important causative agent is tobacco smoke,65,Pathologic classification,Sq

16、uamous cell carcinoma Adenocarcinoma bronchioloalveolar carcinoma Small cell carcinoma Large cell carcinoma,66,Central cancer,Radiographic findings hilar mass narrowing of central airway atelectasis or pneumonitis widen of mediastinum,67,68,RUL central type of lung cancer,69,70,Peripheral type,Shape

17、 spherical or oval Nodule-lung interface lobulation, irregulariy of the border, spiculated, corona radiata, pleural tail sign Density most homogenent soft tissue density may cavity, bubble-like lucencies, calcification,71,M/68,72,Lobular border,73,Pleural tail sign Pleural retraction 胸膜尾征 胸膜凹陷征 Pleu

18、ral indentation,74,75,76,Pancoast cancer,77,“bronchioloalveolar cacinoma” BAC,78,L lung BAC,79,Diffuse BAC,80,Classification of Pul. adenocarcinoma（2011）,Preinvasive lesion 不典型腺瘤样增生（AAH） 原位腺癌（AIS）（3cm 原BAC） Minimally Invasive Adenocarcinoma（MIA） （ 3cm 伏壁生长为主，5mm浸润） Invasive adenocarcinoma 伏壁生长为主（原非粘

19、液型BAC，5mm浸润，LPA） 腺泡型为主 乳头型为主 微乳头型为主 实性为主伴粘液 变异型腺癌,81,M / 66 MIA,Lee HJ et al. J Thorac Imaging 2012: 27（ 6）,82,Pulmonary Metastasis,May from vascular or lymphatic system Usually multiple, solitary uncommon Verying size Lower lobe and peripheral predominance May cavitation or calcification Spiral CT

20、or MDCT: the most reliable imaging method,83,metastasis,84,85,cavitary mets,86,Mets with calcification,87,Pulmonary diseases,Pneumonia Lung abscess ARDS Pulmonary tuberculosis Primary bronchogenic lung cancer Pulmonary embolism,88,89,Saddle thrombosis,90,Advantages： An acurrate tool of diagnosing PE

21、 Can provide prognostic information: right heart strain Allows assessment of rest thoracic Disadvantages： Contrast allergy Renal disfunction Radiation dose,CT Pulmonary Angiography (CTPA),91,M I P,92,93,Primary mediastinal tumor or tumor-like lesions,Mediastinal compartment Common diseases,94,第四胸椎下缘

22、,气管 升主动脉 心前缘为线,食道前壁及心脏后缘为线,纵隔六分法,胸骨柄体交界,95,Mediastinal Compartments,96,Primary mediastinal tumor,Anterior mediastinal tumor intrathoracic goiter thymoma germcell tumor Middle mediastinal tumor bronchogenic cyst lymphoma Posterior mediastinal tumor neurogenic tumor,97,Diagnosis,Anatomic location Shap

23、e smooth or irregular Density cyst fat calcification,98,Intrathoracic goiter,99,100,Thymoma,101,Teratoma,102,Mediastinal lymph node enlargement,Lymphoma Metastatic carcinoma Sarcoidosis Infection (TB) Castleman disease (giant lymph node hyperplasia),103,Lymphoma,Radiologic findings middle (anterior)

24、 mediastinum unilateral and bilateral mass CT findings multiple enlarged lymph nodes bilateral medastinal and hilar LN enlarged nodes may be in contiguous or noncontiguous (non-hodgkins) stations,104,Lymphoma (Hodgkins),105,106,NHL,3 P,107,TB,108,Sarcoidosis,109,Same Patient,110,Castleman disease,11

25、1,112,113,Radiologic diagnosis of mediastinal diseases,Radiography first imaging study, lower sensitivity CT choice of examining mainstay for evaluating mediastinal abnormality MRI may be useful in depicting spinal involvement poor demonstration of calcification,114,Main points,terminology： Signet-ring sign、Primary complex、Pancoast tumor、teratoma、Intrathoracic goiter、lobular borders 大叶性肺炎的影像学特点及变化规律 急性肺脓肿的影像学表现 急性和亚急性粟粒性肺结核的影像特点 结核球和周围性肺癌的鉴别 中心型肺癌生长方式与影像学表现的关系 肺转移瘤的影像学表现 纵隔肿瘤与纵隔定位的关系,115,谢谢！,