1、呼吸系統(tǒng)放射學(xué)診療空洞與空腔cavity and air containing space肺內(nèi)病變組織發(fā)生壞死，壞死組織經(jīng)引流支氣管排出而形成 Cavity is formed as a result of tissue necrosis and communicated with the bronchus. 空洞cavity 蟲蝕樣空洞（無壁空洞）薄壁空洞Thin-walled cavity厚壁空洞thick-walled cavity 壁厚3mm以上，見于肺膿瘍、肺結(jié)核、肺癌等X線表現(xiàn)薄壁空洞Thin-walled cavity 洞壁厚3mm以下內(nèi)壁光滑境界清楚的園形透亮區(qū)，見于肺結(jié)核結(jié)核

2、性空洞常無或僅少量液體多為薄壁TB cavity with a little or not fluid level 蟲蝕樣空洞（無壁空洞）實(shí)變肺野內(nèi)多發(fā)小的透亮區(qū)，蟲濁樣，見于干酪性肺炎癌性空洞內(nèi)壁多呈結(jié)節(jié)狀 Thick-walled cavity Irregular inner ling厚壁空洞thick-walled cavity 壁厚3mm以上，見于肺膿瘍、肺結(jié)核、肺癌等肺膿瘍空洞多有明顯液片多為厚壁 Thick wall cavity with surround exudative lesions associated with a fluid level 空腔 air contain

3、ing space 肺內(nèi)腔隙的病理性擴(kuò)大 肺大皰、肺氣囊、肺氣囊腫、囊狀支擴(kuò)空 腔 性 病 變右下肺囊腫 肺部基本病變 肺間質(zhì)病變 interstitial lesion:發(fā)生在間質(zhì)的彌漫性病變: 即病變主要分布在支氣管血管周圍、 小葉間隔、肺泡間隔.X線表現(xiàn) 肺紋理增粗、網(wǎng)狀strip紋理、蜂窩狀honeycomb 或伴廣泛小結(jié)節(jié)影netting-nodules （間質(zhì)結(jié)節(jié)）彌漫性肺間質(zhì)病變(diffuse interstitial disease)HRCT： 小葉內(nèi)間質(zhì)增粗 小葉內(nèi)細(xì)支氣管血管周圍 和肺泡間隔的間質(zhì)增厚彌漫性肺間質(zhì)病變(diffuse interstitial diseas

4、e) 多發(fā)小結(jié)節(jié)及粟粒病變 ( multinodular and miliary diseases)彌漫性肺泡病變diffuse alveolar disease廣泛分布，含氣支氣管征，毛玻璃密度 胸膜病變pleural lesion 胸腔積液 （pleural effusion） 游離性胸腔積液 free pleural effusion 少量積液 中量積液 大量積液 局限性胸腔積液localized pleural effusion 包裹性積液 葉間積液 肺底積液少量胸腔積液pleural effusion X線表現(xiàn) 先積聚于后肋膈角 液量300ml以上時側(cè)肋膈角變平變鈍 pleural

5、effusion中量胸腔積液pleural effusion X線表現(xiàn)下肺野均勻致密影肋膈角消失、膈面影被掩蓋而顯示不清上緣呈外高內(nèi)低弧形液面，其形成機(jī)理:胸腔內(nèi)負(fù)壓狀態(tài) 液體重力 肺組織彈性 液體表面張力作用大量胸腔積液pleural effusion患側(cè)肺野均勻致密，或僅肺尖透亮縱隔向健側(cè)移位肋間隙增寬大量積液pleural effusion 縱隔？肋骨？橫膈？左全肺不張胸腔心包積液CT表現(xiàn) pleural effusion 包裹性積液Loculated pleural effusion 包裹性積液 Loculated pleural effusion葉間積液interlobar fiss

6、ure pleural effusion斜裂或水平裂梭形，兩端與葉間裂相連液量多時呈球形 葉間積液interlobar fissure pleural effusion葉間積液interlobar fissure pleural effusion氣胸 pneumothorax 空氣進(jìn)入胸腔形成 air come into chest cavity. Cause: 壁層胸膜破裂 臟層胸膜破裂Edge of the collapsed lungs肺與胸壁之間透明含氣區(qū)increased radiolucent area ，其中不見肺紋理 液氣胸 hydropneumothorax胸腔內(nèi)氣體與液體并

7、存there is fluid with air above it ,either in the pleura spacepleural adhesions, thickening and calcification輕度胸膜肥厚、粘連多見于肋膈角處costophrenic angle 肋膈角變淺變平膈頂變平直而不呈園頂狀flatening of the dome of diaphragm 呼吸時膈運(yùn)動受限 膈胸膜粘連有時表現(xiàn)幕狀突起 胸膜鈣化pleural calcificationcalcification along the chest wall on the surface of the

8、 pleuraPleural calcification usually resulted from TB,hemorrhage 常見病X線診斷X-ray demonstrationsIn common diseases支氣管疾病支氣管擴(kuò)張bronchiectasisEtiology：following by chronic bronchitis, suppurative inflammation,pulmonic pneumonia, pulmonary atelectasis and fibrosisPathogenesis：慢性感染支氣管壁組織破壞； 支氣管內(nèi)分泌物和長期咳嗽 支氣管內(nèi)壓

9、增高； 肺不張和肺纖維化外在性牽拉 支氣管疾病支氣管擴(kuò)張bronchiectasiscontinuous cough and purulent sputumA history of recurrent haemoptysisbronchiectasis分型：柱狀擴(kuò)張Cylindrical bronchiectasis 囊狀擴(kuò)張Cystic bronchiectasis 混合型擴(kuò)張Mixed bronchiectasisbronchiectasis X-線表現(xiàn) PLAIN FILM 正常 more than 50%obscure recognition bronchi Dilated bronc

10、hi, sometimes with fluid levels, are seen only in gross diseasebronchiectasis -CT：軌道征dilatation of the bronchus, which usually is accompanied by bronchial wall thickening 印界征signet ring configuration :Dilated bronchus and concomitant pulmonary artery 囊柱狀改變Large elliptical circular opacities 肺炎pneumo

11、niaAccording to anatomic distributing,pneumonia can be as follows: Lobar pneumoniaBronchopneumoniainterstitial pneumoniaLobar pneumonia臨床caused by pneumococcusrapid development of high pyrexia a characteristic rusty color sputum The basic pathologic lesion is acute inflammatory exudation of the pulm

12、onary parenchyma 大葉性肺炎 pathologic changings充血期The congestive stage (it is about 24 hours after onset) 紅色肝變期The red consolidation stage 灰色肝變期The gray consolidation stage 消散期Resolution stage Lobar pneumonia充血期It may be no X-ray changes or with an increase of lung markings or with a faint shadow in the

13、 inflammatory area many of the alveoli are still aeratedLobar pneumonia-肝變期The X-ray feature is a large homogenous radiopaque shadow there is no volume loss air bronchogram is common Borders of the shadow appear as a sharply defined margin Lobar pneumoniaLobar pneumoniaLobar pneumoniaLobar pneumonia

14、 Resolution stage the alveolar exudates are absorbed there are filled with air in the alveoli the shadow of consolidation becomes scatterresorption may be delayed up to one or two months Lobular pneumonia (bronchopneumonia) caused lobular pneumonia are streptococcus, staphylococcus, pneumococcusThe

15、common symptoms are fever, cough, purulent sputum and pleuritic pain etc Small bronchus wall congest and swelling,interstitial inflammation involving immersinglobularpatchy opacities and consolidation小支氣管不同程度阻塞-Emphysema or lobular atelectasis Bronchopneumonia 病理變化Lobular pneumonia X-ray featuresThe

16、re is intensification of lung markings Small patchy opaque shadows are seen in the middle and lower lung fields especially by the heart border Emphysema of the both lungs is usually visible. Confluence of these patchy opacities may produce segmental large area of consolidation. Delayed or incomplete

17、 resolution may result in bronchiectasis and fibrosis 間質(zhì)性肺炎interstitial pneumoniaInterstitial pneumonia involves mainly the interstitial tissue of lungs, including the bronchovascular bundles and intralobular septa it may be caused by viral or bacterial infectionClinic signs：shortness of breath, cou

18、gh,cyanosispathology： interstitial inflammation immersing Lymphatitis,lymphadenitis Small bronchus inflammation- obstruct emphysema and atelectasis 肺泡也可輕度炎性浸潤 多伴不同程度的間質(zhì)纖維結(jié)締組織增生interstitial pneumoniaX-ray features of interstitial pneumonia There are fine streak-like, net-like, nodular or nod-reticula

19、r shadows Emphysema of both lungs in infant patients Possibly there is enlargement and increase in density of the hilar shadowCT, especially HRCT can depict the early sign of interstitial pneumonia. It may present as thickened septainterstitial pneumonia 肺膿腫pulmonary abscessPurulence bacteria-inflam

20、mation focus-Necrosis and fluidify-abscessinfect approach：inhale hematogenous direct spreedstage： acute,subacute and chronic stage 病理：滲出與實(shí)變壞死液化空洞形成: The lung abscess begins as an area of gangrenous bronchopneumoniaRadiological features排膿之前：大片致密影 排膿以后：大片影內(nèi)出現(xiàn)空洞與液平面pulmonary abscess- Acute stage Lung a

21、bscess 急性期高燒寒戰(zhàn)、咳嗽、咳膿臭痰、胸痛等symptoms include high pyrexia and pleuritic pain pulmonary necrosis has occurred The sputum is often foul smelling and blood-stainedpulmonary abscess- Subacute stagedefined as the period between 6 weeks and 3 months after the onset of infectionfibrosis of the wall becomes e

22、stablished appears as a cavity or multiple abscess cavities with fluid level as air enters these foci the cavity with thick wall surrounded by exudative lesionpulmonary abscess Chronic stageAfter 3 months the abscess was considered to be chronic持續(xù)性咳嗽咳痰等X-ray features:空洞周圍纖維組織增生形成厚壁空洞one or more irre

23、gular cavities and with multiloculationsome fibrotic lesions by the cavity or in the cavitary wallThickened pleura are usually seen pulmonary abscess血源性肺膿瘍：hematogenous pulmonary abscess膈下膿腫或肝膿腫擴(kuò)展到肺 形成肺膿腫：pulmonary abscesshematogenous pulmonary abscess 肺結(jié)核Pulmonary tuberculosis 由結(jié)核桿菌引起的慢性傳染病basic pa

24、thological changes：滲出exudation 增殖proliferationPulmonary tuberculosis 愈合方式： 吸收absorb 纖維化fibrosis 鈣化calcify cavity purify or cavity scar overPulmonary tuberculosis 干酪樣壞死caseation 液化及空洞形成 necrotic material be extruded - formation of a cavity 播散:血行播散hematogenous dissemination 經(jīng)淋巴管播散 支氣管播散 局部擴(kuò)展至鄰近肺組織Pulm

25、onary tuberculosis 惡化表現(xiàn) 結(jié)核病臨床分類（1998） In 1998, the Chinese Antituberculous Association adapted a new classification of pulmonary tuberculosis. It has been divided into 5 types :Primary tuberculosis (Type )Hematogenous pulmonary tuberculosis (Type )Secondary pulmonary tuberculosis (Type )Tuberculous

26、pleuritis (Type )Extrapulmonary tuberculosis (Type ) 原發(fā)性肺結(jié)核primary tuberculosis 原發(fā)性肺結(jié)核primary complex The combination of the primary pulmonary tuberculous focus, lymphangitis and intrathoracic lymphadenitis It occurs chiefly in children臨床表現(xiàn)：低熱、盜汗、乏力、 食欲減退、輕咳X線表現(xiàn)分為：原發(fā)綜合征 胸內(nèi)淋巴結(jié)結(jié)核 原發(fā)綜合征primary complexa

27、n exudative lesion in the any portion of the lung field enlargement of hilar lymph nodes or mediastinal lymph nodes lymphangitis streaky shadows原發(fā)綜合征治療前后primary complex The primary focus is usually absorbedX線表現(xiàn) 結(jié)節(jié)型（腫瘤型）：邊界清楚 炎癥型：邊界模糊 增大淋巴結(jié)加淋巴結(jié)周圍炎intrathoracic tuberculous lymphadenitisprimary tubercu

28、losisAxial contrast-enhanced CT scan demonstrates multiple enlarged mediastinal lymph nodes血行播散型肺結(jié)核hematogenous pulmonary tubculosis（粟粒性肺結(jié)核）急性acute亞急性subacute慢性chronic 急性血型播散型肺結(jié)核acute hematogenous pulmonary tubculosis or acute miliary TB 概念 The onset of the disease is sudden大量結(jié)核桿菌一次或短期內(nèi)數(shù)次進(jìn)入血循環(huán)播散到肺引起

29、者 臨床 起病急、病情重，可有高熱febrile寒戰(zhàn) 氣急、咳嗽等cough and breathlessness 急性血型播散型肺結(jié)核acute miliary TB X線表現(xiàn) No changes in the early stage About 2 weeks after onset, it will begin to show a lot of fine, pin-point mottling opacities varying up to 1-2 mm in diameter分布distribution均勻、大小size相同、密度相同正常肺紋理不能顯示acute miliary TB

30、High-resolution CT scan obtained with lung windowing demonstrates numerous fine, nodules bilaterallyacute miliary TB Subacute or chronic hematogenous pulmonary tuberculosis亞急性或慢性血行播散型肺結(jié)核 概念 少量結(jié)核桿菌在較長時間內(nèi)多次 進(jìn)入血流播散至肺所致 臨床 癥狀可不明顯或輕度結(jié)核中毒癥 狀惡化者病灶融合形成空洞或轉(zhuǎn)為慢纖空Subacute or chronic hematogenous pulmonary tuber

31、culosis X-ray features a lot of nodular shadows in both lung fields The shadows are not uniform in size, in density and in distributioninfiltrative pulmonary tuberculosis Symptomsmany patients diagnosed by X-raylow pyrexia, lassitude, weight loss, night sweats, cough productive of mucoid sputum and

32、haemoptysisinfiltrative pulmonary tuberculosisX-ray features:multiple basic X-ray features ： exudation, proliferation, fibrosis, calcification and cavitationthe lesion is at the apex and subclavicular region of the upper lobe and the superior segment of the lower lobe 干酪性肺炎caseous pneumonia The case

33、ous pneumonia occurs in poor health patientThe patient is usually with high fever病理： 大葉性：大片滲出性結(jié)核性炎變 干酪樣壞死而形成 小葉性：干酪空洞或干酪樣化的 淋巴 結(jié)破潰經(jīng)支氣管播 散形成 caseous pneumonia X-ray features multiple cavities usually seen usually with bronchogenic disseminated focus in both low fieldsinfiltrative pulmonary tuberculos

34、isThe tuberculoma is formed by fibrous tissue encysted caseous lesionThe size is larger than 1.5cm in diameter多見于上葉尖、后段、下葉背段 Infiltrative pulmonary tuberculosis結(jié)核瘤結(jié)核瘤X-ray featuresa round or oval opaque shadow with well-defined margin and high density typically in the upper lobes There may be calcif

35、ic lesion “Satellite” lesions These lesions are stable for long periods of time Cavitation is extremely rare with tuberculomainfiltrative pulmonary tuberculosisinfiltrative pulmonary tuberculosisinfiltrative pulmonary tuberculosis 慢性纖維空洞型肺結(jié)核chronic fibro-cavitative pulmonary TB屬繼發(fā)性肺結(jié)核，晚期類型由于好壞交替，多種病

36、理改變并存 Symptoms : repeated low pyrexia, cough productive of mucoid sputum and haemoptysis Some patients may be without marked symptomschronic fibro-cavitative pulmonary TBImage features:With Fibrotic cavity (纖維厚壁空洞) With many Fibrotic lesions(廣泛纖維化) Usually with bronchogenic dissemination to the lowe

37、r lung fields支氣管播散病灶 結(jié)核性胸膜炎 tuberculosis pleuritispleural effusion Pleural thickening CT can demonstrate pleural effusion and thickened pleura clearly Axial contrast-enhanced CT scan demonstrates a large, right-sided pleural effusion 原發(fā)性支氣管肺癌primary bronchogenic carcinoma primary bronchogenic carcin

38、oma Primary bronchogenic carcinoma arises fromthe bronchial epithelium bronchial glands epithelium of the alveolusThe incidence of the carcinoma is now steadily increasingprimary bronchogenic carcinoma Bronchogenic carcinoma is usually classified histologically into squamous cell carcinoma adenocarc

39、inoma (including alveolar cell carcinoma) undifferentiated carcinomas small cell (oat cell) various large cell types Clinical features Cough, haemoptysis, sputum, breathlessness Obstruction of the bronchus Spread to the pleura Tumor invasion of mediastinum (1) left recurrent laryngeal nerve palsy(2) superior vena caval obstruction(3) Dysphagia(4) phrenic nerve paralysis(5) apical tumors involving