呼吸系统放射学诊疗空洞与空腔

1、呼吸系统放射学诊疗空洞与空腔cavity and air containing space肺内病变组织发生坏死，坏死组织经引流支气管排出而形成 Cavity is formed as a result of tissue necrosis and communicated with the bronchus. 空洞cavity 虫蚀样空洞（无壁空洞）薄壁空洞Thin-walled cavity厚壁空洞thick-walled cavity 壁厚3mm以上，见于肺脓疡、肺结核、肺癌等X线表现薄壁空洞Thin-walled cavity 洞壁厚3mm以下内壁光滑境界清楚的园形透亮区，见于肺结核结核

2、性空洞常无或仅少量液体多为薄壁TB cavity with a little or not fluid level 虫蚀样空洞（无壁空洞）实变肺野内多发小的透亮区，虫浊样，见于干酪性肺炎癌性空洞内壁多呈结节状 Thick-walled cavity Irregular inner ling厚壁空洞thick-walled cavity 壁厚3mm以上，见于肺脓疡、肺结核、肺癌等肺脓疡空洞多有明显液片多为厚壁 Thick wall cavity with surround exudative lesions associated with a fluid level 空腔 air contain

3、ing space 肺内腔隙的病理性扩大 肺大疱、肺气囊、肺气囊肿、囊状支扩空 腔 性 病 变右下肺囊肿 肺部基本病变 肺间质病变 interstitial lesion:发生在间质的弥漫性病变: 即病变主要分布在支气管血管周围、 小叶间隔、肺泡间隔.X线表现 肺纹理增粗、网状strip纹理、蜂窝状honeycomb 或伴广泛小结节影netting-nodules （间质结节）弥漫性肺间质病变(diffuse interstitial disease)HRCT： 小叶内间质增粗 小叶内细支气管血管周围 和肺泡间隔的间质增厚弥漫性肺间质病变(diffuse interstitial diseas

4、e) 多发小结节及粟粒病变 ( multinodular and miliary diseases)弥漫性肺泡病变diffuse alveolar disease广泛分布，含气支气管征，毛玻璃密度 胸膜病变pleural lesion 胸腔积液 （pleural effusion） 游离性胸腔积液 free pleural effusion 少量积液 中量积液 大量积液 局限性胸腔积液localized pleural effusion 包裹性积液 叶间积液 肺底积液少量胸腔积液pleural effusion X线表现 先积聚于后肋膈角 液量300ml以上时侧肋膈角变平变钝 pleural

5、effusion中量胸腔积液pleural effusion X线表现下肺野均匀致密影肋膈角消失、膈面影被掩盖而显示不清上缘呈外高内低弧形液面，其形成机理:胸腔内负压状态 液体重力 肺组织弹性 液体表面张力作用大量胸腔积液pleural effusion患侧肺野均匀致密，或仅肺尖透亮纵隔向健侧移位肋间隙增宽大量积液pleural effusion 纵隔？肋骨？横膈？左全肺不张胸腔心包积液CT表现 pleural effusion 包裹性积液Loculated pleural effusion 包裹性积液 Loculated pleural effusion叶间积液interlobar fiss

6、ure pleural effusion斜裂或水平裂梭形，两端与叶间裂相连液量多时呈球形 叶间积液interlobar fissure pleural effusion叶间积液interlobar fissure pleural effusion气胸 pneumothorax 空气进入胸腔形成 air come into chest cavity. Cause: 壁层胸膜破裂 脏层胸膜破裂Edge of the collapsed lungs肺与胸壁之间透明含气区increased radiolucent area ，其中不见肺纹理 液气胸 hydropneumothorax胸腔内气体与液体并

7、存there is fluid with air above it ,either in the pleura spacepleural adhesions, thickening and calcification轻度胸膜肥厚、粘连多见于肋膈角处costophrenic angle 肋膈角变浅变平膈顶变平直而不呈园顶状flatening of the dome of diaphragm 呼吸时膈运动受限 膈胸膜粘连有时表现幕状突起 胸膜钙化pleural calcificationcalcification along the chest wall on the surface of the

8、 pleuraPleural calcification usually resulted from TB,hemorrhage 常见病X线诊断X-ray demonstrationsIn common diseases支气管疾病支气管扩张bronchiectasisEtiology：following by chronic bronchitis, suppurative inflammation,pulmonic pneumonia, pulmonary atelectasis and fibrosisPathogenesis：慢性感染支气管壁组织破坏； 支气管内分泌物和长期咳嗽 支气管内压

9、增高； 肺不张和肺纤维化外在性牵拉 支气管疾病支气管扩张bronchiectasiscontinuous cough and purulent sputumA history of recurrent haemoptysisbronchiectasis分型：柱状扩张Cylindrical bronchiectasis 囊状扩张Cystic bronchiectasis 混合型扩张Mixed bronchiectasisbronchiectasis X-线表现 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：轨道征dilatation of the bronchus, which usually is accompanied by bronchial wall thickening 印界征signet ring configuration :Dilated bronchus and concomitant pulmonary artery 囊柱状改变Large elliptical circular opacities 肺炎pneumo

11、niaAccording to anatomic distributing,pneumonia can be as follows: Lobar pneumoniaBronchopneumoniainterstitial pneumoniaLobar pneumonia临床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 大叶性肺炎 pathologic changings充血期The congestive stage (it is about 24 hours after onset) 红色肝变期The red consolidation stage 灰色肝变期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-肝变期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小支气管不同程度阻塞-Emphysema or lobular atelectasis Bronchopneumonia 病理变化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 间质性肺炎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 肺泡也可轻度炎性浸润 多伴不同程度的间质纤维结缔组织增生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 肺脓肿pulmonary abscessPurulence bacteria-inflam

20、mation focus-Necrosis and fluidify-abscessinfect approach：inhale hematogenous direct spreedstage： acute,subacute and chronic stage 病理：渗出与实变坏死液化空洞形成: The lung abscess begins as an area of gangrenous bronchopneumoniaRadiological features排脓之前：大片致密影 排脓以后：大片影内出现空洞与液平面pulmonary abscess- Acute stage Lung a

21、bscess 急性期高烧寒战、咳嗽、咳脓臭痰、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持续性咳嗽咳痰等X-ray features:空洞周围纤维组织增生形成厚壁空洞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血源性肺脓疡：hematogenous pulmonary abscess膈下脓肿或肝脓肿扩展到肺 形成肺脓肿：pulmonary abscesshematogenous pulmonary abscess 肺结核Pulmonary tuberculosis 由结核杆菌引起的慢性传染病basic pa

24、thological changes：渗出exudation 增殖proliferationPulmonary tuberculosis 愈合方式： 吸收absorb 纤维化fibrosis 钙化calcify cavity purify or cavity scar overPulmonary tuberculosis 干酪样坏死caseation 液化及空洞形成 necrotic material be extruded - formation of a cavity 播散:血行播散hematogenous dissemination 经淋巴管播散 支气管播散 局部扩展至邻近肺组织Pulm

25、onary tuberculosis 恶化表现 结核病临床分类（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 ) 原发性肺结核primary tuberculosis 原发性肺结核primary complex The combination of the primary pulmonary tuberculous focus, lymphangitis and intrathoracic lymphadenitis It occurs chiefly in children临床表现：低热、盗汗、乏力、 食欲减退、轻咳X线表现分为：原发综合征 胸内淋巴结结核 原发综合征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原发综合征治疗前后primary complex The primary focus is usually absorbedX线表现 结节型（肿瘤型）：边界清楚 炎症型：边界模糊 增大淋巴结加淋巴结周围炎intrathoracic tuberculous lymphadenitisprimary tubercu

28、losisAxial contrast-enhanced CT scan demonstrates multiple enlarged mediastinal lymph nodes血行播散型肺结核hematogenous pulmonary tubculosis（粟粒性肺结核）急性acute亚急性subacute慢性chronic 急性血型播散型肺结核acute hematogenous pulmonary tubculosis or acute miliary TB 概念 The onset of the disease is sudden大量结核杆菌一次或短期内数次进入血循环播散到肺引起

29、者 临床 起病急、病情重，可有高热febrile寒战 气急、咳嗽等cough and breathlessness 急性血型播散型肺结核acute miliary TB X线表现 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均匀、大小size相同、密度相同正常肺纹理不能显示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亚急性或慢性血行播散型肺结核 概念 少量结核杆菌在较长时间内多次 进入血流播散至肺所致 临床 症状可不明显或轻度结核中毒症 状恶化者病灶融合形成空洞或转为慢纤空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： 大叶性：大片渗出性结核性炎变 干酪样坏死而形成 小叶性：干酪空洞或干酪样化的 淋巴 结破溃经支气管播 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多见于上叶尖、后段、下叶背段 Infiltrative pulmonary tuberculosis结核瘤结核瘤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 慢性纤维空洞型肺结核chronic fibro-cavitative pulmonary TB属继发性肺结核，晚期类型由于好坏交替，多种病

36、理改变并存 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 (纤维厚壁空洞) With many Fibrotic lesions(广泛纤维化) Usually with bronchogenic dissemination to the lowe

37、r lung fields支气管播散病灶 结核性胸膜炎 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 原发性支气管肺癌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