胸部常见CT征象认读.ppt

胸部常见CT征象认读TheSecondaryPulmonaryLobule肺小叶（直径1-2.5CM）小叶支气管、终末细支气管肺动脉pulmonaryartery小叶间隔interlobularsepta肺静脉pulmonaryvein腺泡pulmonaryacini常见伪影常见伪影常见伪影正常小叶间隔normalsepta正常小叶中心动脉正常小叶中心动脉centrilobularartery2肺静脉Pulmonaryveins肺间质病变Case1F/60y乳腺癌术后，现呼吸困难。分析：（1）小叶间隔增厚分析：（2）支气管血管周围间质增厚分析：(3)斜裂增厚分析：（4）大结节影网状阴影：病理上主要为小叶间隔增厚、小叶内间隔增厚、小叶核心增厚、胸膜下线影、蜂窝肺和支气管血管周围间质增厚等改变。可见于特发性间质性肺炎、结节病、癌性淋巴管炎、特发性含铁血黄素沉积、感染性疾病等。

双肺网状阴影多见与特发性间质性肺炎、结缔组织病肺浸润、结节病等。

单侧以癌性淋巴管炎和放射性肺炎为主。Case279岁、淋巴瘤病史小叶间隔增厚？双侧光滑增厚的小叶间隔支气管血管间质是否增厚？增厚的支气管血管间质胸膜下间质增厚？斜裂增厚lymphocyticinterstitialpneumonitis(LIP)Case358-year-oldmanwithheartdisease双侧小叶间隔增厚支气管血管间质增厚文献：间质性肺水肿不同原因的肺水肿Case4a53-year-oldwomanwithandabnormalchestradiographandmildshortness（短缺）ofbreath（异常胸片，气短）增厚的小叶间隔小叶间隔结节状增厚胸膜下间质结节影支气管袖口症Case5a42-year-oldmanwithmildshortnessofbreathforanumberofyears（气促多年）增厚的小叶间隔扭曲的肺结构叶间裂的扭曲文献：肺间质病变Case6a68-year-oldwomanwithrheumatoidarthritis（风湿性关节炎）andprogressive累计shortness短缺ofbreathovera2-yearperiod蜂窝肺部分层面小叶间隔增厚Case7a74-year-oldwomanwithprogressiveshortnessofbreathover6months蜂窝肺Whatisthemostlikelydiagnosis?
(a)Idiopathicpulmonaryfibrosis(IPF)特发性肺间质纤维化
(b)Autoimmunedisease(e.g.,rheumatoidlungdisease)自身免疫性疾病
(c)End-stagehypersensitivitypneumonitis过敏性肺炎
(d)Asbestosis石棉肺
(e)Drug-relatedlunginjury麻醉药物肺损害
(f)Sarcoidosis结节病
最可能的诊断？IPF:特发性肺间质纤维化蜂窝肺牵拉性支扩小叶间隔增厚Case886-year-oldmanwithchronicmyelogenousleukemia骨髓性的白血病,treatedusingmethotrexate化疗,nowcomplainsofshortnessofbreath气短.蜂窝肺叶裂扭曲不规则小叶间隔增厚牵拉性支扩(c)drug-relatedlunginjuryCorrect.Thepatternoffibrosisseeninthispatientisnonspecific,andcouldbecausedbyIPF.Therecenthistoryoftreatmentwithmethotrexatemakesdrug-relatedfibrosismostlikely.Lunginvolvementbyleukemiawouldlikelyresultinanappearancesimilartothatoflymphangiticspreadofcarcinomawithseptalthickeningbeingthepredominantfinding.
IPF一可有同种表现，但患者有最近化疗史，白血病肺浸润小叶间隔增厚明显。Case9ina63-year-oldmanwithahistoryofscleroderma硬皮病andprogressiveshortnessofbreath进行性喘憋小叶间隔增厚牵拉性支扩胸膜下蜂窝肺斜裂扭曲YesCorrect.Thepresenceofhoneycombingisdiagnosticoffibrosis.Tractionbronchiectasisisalsos