医学专题胸部常见CT征象认读

1、胸部常见CT征象认读麻涌医院放射科 卢劲松2021/7/20 星期二1The Secondary Pulmonary Lobule肺小叶（直径1-2.5CM）2021/7/20 星期二2小叶支气管、终末细支气管2021/7/20 星期二3肺动脉pulmonary artery 2021/7/20 星期二4小叶间隔interlobular septa 2021/7/20 星期二5肺静脉pulmonary vein 2021/7/20 星期二6腺泡pulmonary acini 2021/7/20 星期二7正常HRCT.2021/7/20 星期二8中央肺动脉。2021/7/20 星期二9支气管与相

2、邻肺动脉直径大致相等。2021/7/20 星期二10肺动脉常分为两个直径相当的分支。2021/7/20 星期二11肺静脉常分成许多细小的分支,这些分支与主支构成直角。2021/7/20 星期二12叶间裂（厚度小于1mm，边缘光滑，均一厚度）2021/7/20 星期二13常见伪影双侧下肺近心脏处，肺血管脉动伪影。低密度区， 可以错当作扩大的支气管。 2021/7/20 星期二14常见伪影主叶裂伪影。2021/7/20 星期二15常见伪影血管双重伪影。2021/7/20 星期二16正常小叶间隔normal septa 2021/7/20 星期二17正常小叶中心动脉2021/7/20 星期二18正常

3、小叶中心动脉centrilobular artery 22021/7/20 星期二19肺静脉Pulmonary veins 2021/7/20 星期二20肺间质病变发生于：慢性间质性肺炎、弥漫性间质纤维化、结节病、癌性淋巴管炎、结缔组织病（红斑狼疮、类风湿性关节炎、硬皮病、皮肌炎）、尘肺（矽肺、煤矽肺、石棉肺）、组织细胞病、淋巴管平滑肌瘤病。：界面征、小叶间隔增厚、小叶中心结构增厚、胸膜下线、长疤痕线（扭曲肺结构）、蜂窝样改变、结节影、牵拉性支扩、磨玻璃样改变。2021/7/20 星期二21Case 1 F/60y 乳腺癌术后，现呼吸困难。2021/7/20 星期二22分析：（1）小叶间隔增厚

4、2021/7/20 星期二23分析：（2）支气管血管周围间质增厚支气管袖口症：2021/7/20 星期二24分析：(3)斜裂增厚2021/7/20 星期二25分析：（4）大结节影2021/7/20 星期二26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。2021/7/20 星期二27上病例为癌性淋巴管炎。2021/7/20 星期二28Case

5、2 79岁、淋巴瘤病史2021/7/20 星期二292021/7/20 星期二30小叶间隔增厚？(a) Yes(b) No2021/7/20 星期二31双侧光滑增厚的小叶间隔2021/7/20 星期二32支气管血管间质是否增厚？(a) Yes(b) No2021/7/20 星期二33增厚的支气管血管间质2021/7/20 星期二34胸膜下间质增厚？(a) Yes(b) No2021/7/20 星期二35斜裂增厚2021/7/20 星期二36What is the most likely diagnosis?最可能的诊断？(a) Pulmonary edema(肺水肿）(b) Interstit

6、ial fibrosis（间质纤维化）(c) Lymphangitic spread of lymphoma（癌性淋巴管炎）2021/7/20 星期二37Diagnosis: Lymphangitic spread of lymphoma, with interlobular septal thickening。癌性淋巴管炎（小叶间隔增厚）2021/7/20 星期二38lymphocytic interstitial pneumonitis (LIP) 淋巴间质局限性肺炎2021/7/20 星期二39Case 3 58-year-old man with heart disease 2021/

7、7/20 星期二40小叶间隔增厚？(a) Yes(b) No2021/7/20 星期二41双侧小叶间隔增厚2021/7/20 星期二42支气管血管间质增厚？(a) Yes(b) No2021/7/20 星期二43支气管血管间质增厚2021/7/20 星期二44Is there thickening of the subpleural interstitium?(胸膜下间质增厚？)(a) Yes(b) No2021/7/20 星期二45NO!2021/7/20 星期二46What is the most likely diagnosis?(最可能的诊断？)(a) Pulmonary edema肺

8、水肿(b) Interstitial fibrosis间质纤维化(c) Lymphangitic spread of carcinoma癌性淋巴管炎2021/7/20 星期二47(a) Pulmonary edema肺水肿Correct. Because of the history of heart disease心脏病史, characteristic abnormalities典型的异常, ymmetry对称, and the predominance of septal thickening in dependent lung, this diagnosis must be consi

9、dered 考虑most likely. 2021/7/20 星期二48文献：间质性肺水肿（1）肺血重新分布：左心衰-肺淤血。（2）支气管周围袖口症：正常厚度约1mm结缔组织内液体存积增厚。X-肺纹理及肺门血管增粗、模糊.（3）肺透过度下降：液体分布到支气管血管周围、小叶间隔、小叶内支气管血管周围、肺泡间隔透过度下降。（4）间隔线：Kerley B线x上与肋膈角处与胸膜垂直。（5）胸膜增厚：液体入脏层胸膜下薄层结缔组织胸膜下结缔组织水肿-水肿位于脏层胸膜与结体组织间，不随体位移动。（）胸腔积液：胸膜腔内液体来自壁层胸膜。2021/7/20 星期二49不同原因的肺水肿心源性肺水肿：左心衰（见于心

10、梗、二尖瓣病变。肾性肺水肿：急慢性肾功能衰竭，可合并尿毒症水钠潴留、左心衰肺水肿上腔静脉、奇静脉增宽。肺微血管损伤性肺水肿：除肺水肿外，还可见出血及细胞渗出 肺血分布正常、无袖口症、间隔线。肺泡实变斑片状，肺野外为分布。毒性气体吸入、胃液吸入、药物、溺水、颅内压升高、高原性肺水肿、复张性肺水肿。2021/7/20 星期二50Case 4 a 53-year-old woman with and abnormal chest radiograph and mild shortness（短缺） of breath（异常胸片，气短） 2021/7/20 星期二512021/7/20 星期二52Is

11、septal thickening present?(a) Yes(b) No小叶间隔增厚吗？2021/7/20 星期二53增厚的小叶间隔2021/7/20 星期二54Are the septa smooth or nodular in appearance?(a) Smooth(b) Nodular小叶间隔增厚是结节状还是光滑增厚？2021/7/20 星期二55小叶间隔结节状增厚2021/7/20 星期二56胸膜下间质结节影2021/7/20 星期二57支气管袖口症2021/7/20 星期二58Possible diagnoses include:(a) pulmonary edema肺水肿

12、(b) interstitial fibrosis间质纤维化(c) sarcoidosis结节病最可能的诊断？2021/7/20 星期二59sarcoidosis结节病Correct. Nodular thickening of interlobular septa and fissures can be seen in this disease and lymphangitic spread of carcinoma. （小叶间隔结节状改变可见于结节病、癌性淋巴管炎、尘肺）。支气管血管间质、胸膜下间质结节状改变对结节病有特征性的诊断。2021/7/20 星期二60Case 5 a 42-ye

13、ar-old man with mild shortness of breath for a number of years（气促多年）2021/7/20 星期二61Is septal thickening visible?(a) Yes(b) NoNext Page 小叶间隔增厚吗？2021/7/20 星期二62增厚的小叶间隔2021/7/20 星期二63扭曲的肺结构2021/7/20 星期二64叶间裂的扭曲2021/7/20 星期二65Diagnosis: End-stage sarcoidosis with fibrosis and interlobular septal thicken

14、ing.结节病伴随征象：肺结构扭曲、小叶间隔结节状增厚、牵拉性支扩、蜂窝肺等。2021/7/20 星期二66文献：肺间质病变界面征：支气管血管间质增厚支气管血管束增粗、支气管袖口症；液体边缘光滑、肿瘤或肉芽组织结节状界面。胸膜下线：近胸膜面1cm内弧线状影为肺纤维化征象。长疤痕线：蜂窝肺：结节影：小结节2-5mm，肉芽、肿瘤、纤维组织。肺结构扭曲变形及牵拉支扩：磨玻璃样改变：2021/7/20 星期二67Case 6 a 68-year-old woman with rheumatoid arthritis（风湿性关节炎） and progressive 累计shortness 短缺of br

15、eath over a 2-year period2021/7/20 星期二682021/7/20 星期二69The predominant abnormal finding on these scans is?(a) interlobular septal thickening小叶间隔增厚。(b) honeycombing蜂窝肺主要的异常表现？ 2021/7/20 星期二70蜂窝肺2021/7/20 星期二71部分层面小叶间隔增厚2021/7/20 星期二72What does honeycombing reflect histologically?(a) Interstitial edem

16、a肺间质水肿(b) Interstitial infiltration 渗透by cells(c) Interstitial fibrosis蜂窝肺的组织学肺间质纤维化的后期表现。2021/7/20 星期二73Diagnosis: Rheumatoid lung disease, with fibrosis and honeycombing. 风湿性肺疾病，肺纤维化、蜂窝肺。壁厚0.8-1MM，胸膜下3-4cm范围内或近叶裂处；早期囊腔小而少；囊壁为折叠破坏的肺泡壁及气道壁。2021/7/20 星期二74Case 7 a 74-year-old woman with progressive s

17、hortness of breath over 6 months 2021/7/20 星期二75The most significant abnormal finding in this study is:(a) interlobular septal thickening小叶间隔增厚(b) honeycombing蜂窝肺(c) subpleural emphysema胸膜下肺气肿主要的异常表现？2021/7/20 星期二76蜂窝肺2021/7/20 星期二77What is the most likely diagnosis?(a) Idiopathic pulmonary fibrosis

18、 (IPF)特发性肺间质纤维化(b) Autoimmune disease (e.g., rheumatoid lung disease)自身免疫性疾病(c) End-stage hypersensitivity pneumonitis过敏性肺炎(d) Asbestosis石棉肺(e) Drug-related lung injury麻醉药物肺损害(f) Sarcoidosis结节病最可能的诊断？2021/7/20 星期二78IPF: 特发性肺间质纤维化磨玻璃密度：肺野周围活动性肺泡炎症。网状改变：小叶间隔、小叶中心结构增厚蜂窝状改变的前期。蜂窝状改变：胸膜下间质纤维化：胸膜下弧线状影、脏层胸

19、膜及叶间胸膜增厚。肺气肿：小叶中心型肺气肿。肺实变：支扩：2021/7/20 星期二79蜂窝肺2021/7/20 星期二80牵拉性支扩2021/7/20 星期二81小叶间隔增厚2021/7/20 星期二82Case 8 86-year-old man with chronic myelogenous leukemia骨髓性的白血病, treated using methotrexate化疗, now complains of shortness of breath 气短.2021/7/20 星期二832021/7/20 星期二84Does this man show evidence of f

20、ibrosis and UIP?(a) Yes(b) No显示明显的纤维化和普通间质性肺炎？屑性间质性肺炎（DIP）、普通性间质性肺炎（UIP） 。2021/7/20 星期二85(a) YesCorrect. Findings indicative of usual interstitial pneumonitis (UIP) visible in this patient include:honeycombing; 蜂窝肺irregular fissures; 叶裂扭曲irregular interlobular septal thickening; 小叶间隔不规则增厚。traction b

21、ronchiectasis.牵拉性支扩2021/7/20 星期二86蜂窝肺2021/7/20 星期二87叶裂扭曲2021/7/20 星期二88不规则小叶间隔增厚2021/7/20 星期二89牵拉性支扩2021/7/20 星期二90The most likely diagnosis is:可能的诊断？(a) idiopathic pulmonary fibrosis (IPF)(b) lung involvement by leukemia白血病肺浸润。(c) drug-related lung injury化疗药物肺损害。2021/7/20 星期二91(c) drug-related lung

22、 injuryCorrect. The pattern of fibrosis seen in this patient is nonspecific, and could be caused by IPF. The recent history of treatment with methotrexate makes drug-related fibrosis most likely. Lung involvement by leukemia would likely result in an appearance similar to that of lymphangitic spread

23、 of carcinoma with septal thickening being the predominant finding. 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。2021/7/20 星期二92Case 9 in a 63-year-old man with a history of scleroderma硬皮病 and progressive shortness of breath进行性喘憋 2021/7/20 星期二93Findings include: interlobular septal thickening; 小叶间隔增厚。tractio

24、n bronchiectasis; 牵拉性支扩subpleural honeycombing; 胸膜下蜂窝肺irregular fissures.叶裂扭曲2021/7/20 星期二94小叶间隔增厚2021/7/20 星期二95牵拉性支扩2021/7/20 星期二96胸膜下蜂窝肺2021/7/20 星期二97斜裂扭曲2021/7/20 星期二98Can you be confident that lung fibrosis is present?(a) Yes(b) No你能确定肺纤维化存在？2021/7/20 星期二99YesCorrect. The presence of honeycomb

25、ing is diagnostic of fibrosis. Traction bronchiectasis is also strongly suggestive of fibrosis. Interlobular septal thickening and irregular fissures are nonspecific, and cannot be relied upon to diagnose fibrosis. 蜂窝肺、牵拉性支扩肺纤维化存在。小叶间隔增厚、斜裂扭曲对肺纤维化的诊断意义不大。2021/7/20 星期二100Diagnosis: Scleroderma, with

26、lung fibrosis, honeycombing, and traction bronchiectasis 硬皮病肺纤维化：蜂窝肺、牵拉性支扩。结缔组织病及肺血管炎主要为肺间质病变。肺内实变肺泡内渗出、肉芽肿形成、肺泡内出血、水肿。肺内多发结节肺内血管炎、肉芽肿、肺栓塞所形成。常见于：wengner类风湿性关节炎。肺间质病变肺间质性肺炎、肺泡炎间质纤维化、蜂窝肺。2021/7/20 星期二101Case 10 in a 61-year-old woman with progressive shortness of breath进行性喘憋 .2021/7/20 星期二102Which of

27、 the following findings are shown on this scan?上图包含症像:(a) Honeycombing蜂窝肺(b) A subpleural line胸膜下线(c) A peripheral and subpleural distribution外围胸膜下分布(d) All of the above以上全包括2021/7/20 星期二103All of the aboveCorrect. Small subpleural cysts are present typical of mild honeycombing. 轻度的蜂窝肺An irregular l

28、ine parallels the pleural surface, termed a subpleural line. 胸膜下线2021/7/20 星期二104Which of the following is most likely in this case?最符合的诊断？(a) Idiopathic pulmonary fibrosis (IPF)特发性间质纤维化(b) Autoimmune disease (e.g., rheumatoid lung disease)自身免疫性疾病(c) End-stage hypersensitivity Pneumonitis过敏性肺炎(d) As

29、bestosis石棉肺(e) Drug-related lung injury药物肺损害(f) Sarcoidosis结节病2021/7/20 星期二105Idiopathic pulmonary fibrosis (IPF)Correct. Idiopathic pulmonary fibrosis (IPF). In the absence a history to suggest one of the specific diagnoses on this list, IPF is most likely. It accounts for 60% of cases having this

30、appearance. IPF在该病例无特异性，60%有该表现。2021/7/20 星期二106Case 11 a 34-year-old man with progressive shortness of breath喘憋2021/7/20 星期二1072021/7/20 星期二108The predominant abnormality in this case is:明显的异常表现(a) honeycombing蜂窝肺(b) intralobular interstitial thickening小叶间质增厚2021/7/20 星期二109intralobular interstitia

31、l thickeningCorrect. Honeycombing is not visible in this patient. A fine irregular reticular不规则的网状改变pattern is present in the lung periphery, representing intralobular interstitial thickening.小叶间质增厚 In some patients with pulmonary fibrosis, this finding will predominate. Other findings of fibrosis i

32、n this patient include traction bronchiectasis.牵拉性支扩 The differential diagnosis of this appearance is identical as that for honeycombing. 2021/7/20 星期二110小叶间质增厚2021/7/20 星期二111牵拉性支扩2021/7/20 星期二112Diagnosis: Idiopathic pulmonary fibrosis特发性间质纤维化, with intralobular interstitial thickening. 2021/7/20

33、星期二113Case 12 a 71-year-old man with progressive shortness of breath 2021/7/20 星期二1142021/7/20 星期二115The predominant abnormality in this case is:突出的表现(a) honeycombing蜂窝肺(b) intralobular interstitial thickening小叶间质增厚2021/7/20 星期二116intralobular interstitial thickeningCorrect. Honeycombing is not clea

34、rly seen in this patient. A fine but irregular reticular pattern不规则的网状改变 is present in the lung periphery外围, representing intralobular interstitial thickening小叶间质增厚. In some patients with pulmonary fibrosis, this finding will predominate. Other findings 其他征象of fibrosis in this patient include tracti

35、on bronchiectasis牵拉性支扩, and irregular interlobular septal thickening不规则小叶间隔增厚. The differential diagnosis of this appearance is identical to that for honeycombing. 2021/7/20 星期二117小叶间质增厚2021/7/20 星期二118牵拉性支扩2021/7/20 星期二119不规则小叶间隔增厚2021/7/20 星期二120Diagnosis: Idiopathic pulmonary fibrosis特发性间质纤维化, wi

36、th intralobular interstitial thickening. 2021/7/20 星期二121Case 13 34-year-old woman with lupus erytematosus 狼疮红斑2021/7/20 星期二1222021/7/20 星期二123Can you diagnose fibrosis?能诊断纤维化？(a) Yes(b) No2021/7/20 星期二124YesCorrect. HRCT obtained in the supine and prone positions 仰卧和俯卧位shows a number of findings in

37、dicating fibrosis指示, including: honeycombing which is mild in degree; 轻度蜂窝肺traction bronchiectasis; 牵拉性支扩intralobular interstitial thickening;小叶间质增厚interlobular septal thickening小叶间隔增厚; and a subpleural distribution.胸膜下分布2021/7/20 星期二125轻度蜂窝肺2021/7/20 星期二126牵拉性支扩2021/7/20 星期二127小叶间质增厚2021/7/20 星期二12

38、8小叶间隔增厚2021/7/20 星期二129Diagnosis: Systemic lupus erythematosus（SLE系统性红斑狼疮肺部表现肺结缔组织病, with fibrosis and honeycombing. 2021/7/20 星期二130Case 14 a 65-year-old woman with rheumatoid arthritis风湿性关节炎 and mild dyspnea 轻度呼吸困难2021/7/20 星期二131Can you diagnose fibrosis?能诊断纤维化？(a) Yes(b) No2021/7/20 星期二132Correc

39、t including: traction bronchiectasis;牵拉性支扩 intralobular interstitial thickening;小叶间质增厚 a subpleural line.胸膜下线2021/7/20 星期二133牵拉性支扩2021/7/20 星期二134小叶间质增厚2021/7/20 星期二135胸膜下线2021/7/20 星期二136Diagnosis: Rheumatoid lung disease肺结缔组织病, with mild pulmonary fibrosis轻度肺纤维化 and intralobular interstitial thick

40、ening小叶间质增厚. 2021/7/20 星期二137Case 15 a 26-year-old woman with mixed connective tissue disease混合结缔组织病, basilar crackles on physical examination双肺底水泡音, and restrictive disease on pulmonary function tests 肺功能受限2021/7/20 星期二1382021/7/20 星期二139Can you diagnose fibrosis?能诊断纤维化？(a) Yes(b) No2021/7/20 星期二14

41、0YesCorrect.Including: traction bronchiectasis; 牵拉性支扩intralobular interstitial thickening小叶间质增厚;a subpleural distribution胸膜下分布 2021/7/20 星期二141牵拉性支扩2021/7/20 星期二142小叶间质增厚2021/7/20 星期二143Diagnosis: Mixed connective tissue disease混合结缔组织病, with pulmonary fibrosis, and intralobular interstitial thickeni

42、ng 2021/7/20 星期二144Case 16 a 81-year-old man with significant occupational exposure to asbestos 石棉职业史2021/7/20 星期二1452021/7/20 星期二146Is pulmonary fibrosis present?肺纤维化存在？(a) Yes(b) No2021/7/20 星期二147YesCorrect. Findings of fibrosis include: traction bronchiectasis; 牵拉性支扩intralobular interstitial thi

43、ckening; 小叶间质增厚a subpleural distribution. 胸膜下分布irregular interlobular septal thickening不规则的小叶间隔增厚2021/7/20 星期二148牵拉性支扩2021/7/20 星期二149小叶间质增厚2021/7/20 星期二150胸膜下分布2021/7/20 星期二151小叶间隔增厚2021/7/20 星期二152Diagnosis: 石棉肺Asbestosis with traction bronchiectasis 牵拉性支扩and intralobular interstitial thickening小叶

44、间质纤维化. 2021/7/20 星期二153纵隔窗2021/7/20 星期二154pleural thickening and calcification 胸膜增厚、钙化椎旁区域横膈胸膜肥厚钙化2021/7/20 星期二155Case 17 a 58-year-old man with a history of asbestos exposure石棉史 2021/7/20 星期二156可见椎旁胸膜增厚、不规则线状影2021/7/20 星期二157The pleural thickening is typical of asbestos exposure胸膜增厚是典型的石棉肺表现. Would

45、 you diagnose asbestosis诊断石棉肺吗?(a) Yes(b) No2021/7/20 星期二158NoCorrect. Linear opacities线状影 as seen in this case (termed parenchymal bands肺实质带) are common in patients with pleural thickening胸膜增厚, but are not necessarily associated不必须考虑 with lung fibrosis肺纤维化. 2021/7/20 星期二159肺实质带parenchymal bands 位于下

46、肺部，肺内条状影；肺实质内的纤维化。2021/7/20 星期二160尽管如此，结合病史，考虑Asbestos exposure with pleural disease and parenchymal bands 石棉至椎旁胸膜增厚、肺实质带。2021/7/20 星期二161Case 18 a 67-year-old man with a history of asbestos exposure 石棉史2021/7/20 星期二162NoCorrect. HRCT at lung windows shows irregular linear opacities不规则的线状影 ( “crows

47、feet”乌鸦脚), without evidence of honeycombing无蜂窝肺, intralobular interstitial thickening小叶间质增厚, or traction bronchiectasis牵拉性支扩. This appearance does not indicate asbestosis无石棉特征. Linear opacities, as seen in this case (parenchymal bands肺实质带) are common in patients with pleural thickening related to as

48、bestos exposure, but are not necessarily associated with lung fibrosis不必须考虑肺纤维化. They represent focal areas of atelectasis焦点为肺膨胀不全, associated 联系with the pleural thickening, or focal areas of scarring焦点区疤痕. 2021/7/20 星期二163乌鸦脚（crows feet), 2021/7/20 星期二164即尽管如此，结合病史考虑Asbestos exposure with pleural d

49、isease and parenchymal bands 。另一病例：胸膜下线椎旁胸膜增厚2021/7/20 星期二165Case 19 a 56-year-old man with significant occupational exposure to asbestos 石棉史2021/7/20 星期二166Is there pleural thickening 胸膜增厚you would consider考虑 likely 可能due to asbestos exposure石棉?(a) Yes(b) No2021/7/20 星期二167Yescorrect. A focal焦点, ca

50、lcified pleural plaque胸膜钙斑 is visible anteriorly, typical of asbestos exposure石棉肺典型表现. Although plaques are more likely posterior in location常见后胸膜, this appearance is highly suggestive高度提示. 2021/7/20 星期二168Can a definite diagnosis of pulmonary fibrosis on the prone lung window scans be made?肺窗能明确诊断肺

51、纤维化吗？ (a) Yes(b) No2021/7/20 星期二169NoCorrect. There is mild septal thickening 轻度间隔增厚and reticulation 网状in the posterior subpleural region后胸膜下 on the right. This is unassociated 无联系with adjacent临近 pleural thickening. This is a very subtle abnormality轻微的异常 which could represent the earliest stage of a

52、sbestosis石棉肺早期表现. However, in the absence of a more definite abnormality明确的异常 or similar 类似findings on the left, it would be difficult 困难to make a definite diagnosis of fibrosis石棉肺或肺纤维化的诊断 or asbestosis. 2021/7/20 星期二170小叶间质增厚轻度网状改变2021/7/20 星期二171Diagnosis: Asbestosis exposure石棉肺. Possible fibrosis

53、可能纤维化.文献：石棉肺1胸膜改变：胸膜斑、弥漫性胸膜增厚、胸腔积液。2肺改变：弥漫性肺间质纤维化HRCT胸膜下弧线、胸膜下点状致密影、肺实质带、蜂窝状改变、胸膜下磨玻璃表现（肺泡壁小叶间隔增厚）；圆形肺不张（支气管血管结构进入-彗星尾征）。 2021/7/20 星期二172Case 20 a 57-year-old woman with years of progressive dyspnea 多年呼吸困难2021/7/20 星期二1732021/7/20 星期二174Is pulmonary fibrosis present?肺纤维化存在吗？(a) Yes(b) No2021/7/20 星期二175YesCorrect. This patient shows a number of许多 findings indicative of pulmonary fibrosis肺纤维化征象. These include: Extensive 广泛的traction bronchiectasis 牵拉性支扩involving both upper lobes双上叶; Irregular reticular opacities不规则的网状 and distortion of lung ar