修翻译张七年制呼吸影像27课件

1、呼吸系统影像诊断学Imaging diagnostics of the Respiratory system 郑州大学第一附属医院MRI室the first affiliated hospital radiology department of the Zhengzhou University 张焱Zhang Yan L修翻译张七年制呼吸影像27课件三、胸部基本病变的影像Basic imaging findings in disease of respiratory system三、胸部基本病变的影像气管支气管病变disease of the tracheobronchus：（一）支气管阻塞及

2、其后果bronchi obstruction and the results： 病因 ： etiopathogenisis管内 : intralumen异物、分泌物和血块等foreign body, excretion and blood clot管壁 ： tubal wall肿瘤、痉挛、先天性和炎症等tumor, spasm,congenital and inflammation管外：extralumen有肿瘤、增大淋巴结压迫等tumor and enlargement of the lymph nodes气管支气管病变disease of the tracheob病理 pathologic

3、ally：部分阻塞引起肺气肿obstructive emphysema (incomplete obstruction)完全阻塞引起肺不张atelectasis (complete obstruction)病理 pathologically：1.阻塞性肺气肿 obstruction emphysema：部分阻塞致肺内气体不能完全排出，肺泡过度膨胀形成肺气肿incomplete obstruction cause to emphysema终未细支气管以远的含气腔隙过度充气、异常扩大，可伴有不可逆性肺泡壁的破坏enlargement of alveoli ,accompanied by destr

4、uction of alveolar walls若多个肺泡膨胀破裂，融合则成肺大泡bulla is formed due to rupture of alveolar wall and communicated with each other, pneumatocele1.阻塞性肺气肿 obstruction emphysem（1）弥漫性肺气肿diffuse obstruction emphysema ：两肺纹理变细、少、分散及肺透过度增大lung markings appear thinner than normal, increase lucency of both lungs膈肌低、动度

5、弱depression and flattening of the diaphragm肋间隙增宽；心影狭长intercostal space widen, heart shadow appears long and narrow（1）弥漫性肺气肿diffuse obstruction （2）局限性肺气肿localized emphysema ：局部透过度高increase lucency of the affected肺纹理细、少、分散lung markings appear as thinner of the involved area 肺门、叶间胸膜、纵隔及膈肌移位displacement

6、 of hilum, pleura, mediastinum and diaphragm to the unaffected side有时可见纵隔摆动pendular movement of the mediastinum（2）局限性肺气肿localized emphysema ：CT findings：小叶中央型肺气肿病变累及肺小叶中央部分，上叶多见全小叶型肺气肿病变累及全部肺小叶，下叶多见间隔旁型肺气肿 病变累及肺小叶边缘，多见于胸膜下或小叶间隔周围CT findings： 弥 漫 性 肺 气 肿diffuse obstruction emphysema 弥 漫 性 肺 气 肿diffus

7、e ob 右上慢性纤维空洞肺结核伴左侧代偿性肺气肿 局 限 性 肺 气 肿 右上慢性纤维空洞肺结核伴左侧代偿性肺气肿 局 小叶中心性肺气肿 正常肺HRCT 小叶中心性肺气肿 正常肺HRCT 小叶中心性肺气肿 正常肺HRCT 小叶中心性肺气肿 正常肺HRCT 小叶中心性肺气肿 正常肺HRCT 小叶中心性肺气肿 正常肺HRCT 小叶中心型 全小叶型 小叶中心型 全小叶型 间隔旁型 肺大泡 间隔旁型 肺大泡 2.阻塞性肺不张（obstructive atelectasis）：支气管完全阻塞complete obstruction of the bronchus有时并发肺炎或支气管扩张concomit

8、ant conditions such as pneumonia or bronchiectasis 2.阻塞性肺不张（obstructive atelect（1）一侧性肺不张atelectasis of an entire lung：患侧肺密度高increase density of the affected 肋间隙狭窄narrowing of the intercostals spaces on the affected side膈肌升高the affected side presents elevation of diaphragm纵隔移向患侧displacement of medias

9、tinum to the affected side健侧代偿性肺气肿compensatory emphysema on the opposite side lung（1）一侧性肺不张atelectasis of an ent（2）肺叶不张 lobar atelectasis ：肺叶体积小，密度高the affected lobe appears as a high density lesion, loss of lung volume邻近肺组织代偿性肺气肿compensatory emphysema on the adjacent lobe叶间胸膜及肺门移位displacement of pl

10、eura and hilum to the affected area患侧膈肌升高the affected side presents elevation of diaphragm患区肋间隙狭窄narrowing of the intercostals spaces on the affected side（2）肺叶不张 lobar atelectasis ：（3）肺段不张：不张肺段一般呈三角形致密影，体积缩小，尖向肺门the affected segment appears as a dense triangular shadow, loss of lung volume, the apex

11、 of the triangular shadow at the hilum and its base at the outside（4）肺小叶不张：不张肺小叶呈多数小斑片状致密影，周围可有透明的气肿带multiple patchy dense shadow and lucent bands surround the affected lobules（3）肺段不张： 各 叶 肺 不 张 示 意 图 各 叶 肺 不 张 示 意 图修翻译张七年制呼吸影像27课件修翻译张七年制呼吸影像27课件右肺上叶不张右肺上叶不张（二）肺部病变 disease of the lung 1.渗出与实变 exudat

12、ion and consolidation（1）病理 pathologically：部分肺泡内被病理性液体代替称渗出the air within the acinus is incompletely replaced by pathological exudates or fluid全部肺泡内被病理液体或组织代替称实变 the air within the acinus is completely replaced by pathological exudates or tissue（二）肺部病变 disease of the lung（2）X线表现 X-ray findings：渗出病灶：e

13、xudative lesion：均匀云絮状影floccular homogeneous shadow边缘模糊ill-defined （2）X线表现 X-ray findings：实变病灶 consolidation：片状均匀致密影homogeneous patchy dense shadow边界不清ill-defined近叶间胸膜处则边缘清楚the border near the pleura is clearly实变区内有时可见支气管气像air bronchograms may be seen in consolidation opacity实变病灶 consolidation：（3）临床意

14、义clinic significance：见于：肺炎pneumonia渗出性肺结核exudative pulmonary tuberculosis肺出血pneumorrhagia肺水肿等pneumochysis（3）临床意义clinic significance：2.增殖 Proliferation （1）病理 pathologically：肺组织内充满肉芽组织（细胞和纤维）代表慢性炎症 filled with granulation tissue ,it is chronic inflammation2.增殖 Proliferation（2）X线表现 X-ray findings ：呈腺泡结

15、节状nodular密度较高high density边界较清楚的致密影well-defined有时多数病灶融合一起，呈块状tend to coalesce（3）临床意义：慢性肺炎，肺结核等chronic pneumonia and pulmonary tuberculosis（2）X线表现 X-ray findings ：修翻译张七年制呼吸影像27课件 渗出性病变 增殖性病变 支气管肺炎 粟粒性肺结核 渗出性病变 增殖性病变 3.纤维化（Fibrosis）：（1）病理 pathologically：肺组织内局限或弥漫被纤维组织代替称纤维化the lung tissue is locally or

16、 diffuse replaced by fibrous tissue是急、慢性炎症愈合形式之一end result of acute or chronic inflammation 3.纤维化（Fibrosis）：（2）X线表现 X-ray findings：A.弥漫性 diffuse：常累及肺间质involved pulmonary interstitium呈索条状、网点状、块状致密影dense linear or reticular or nodular shadow边缘清楚well-defined密度高high density（2）X线表现 X-ray findings：B.局限性lo

17、cal：呈索条、网点状或块状dense linear or reticular or nodular shadow边缘清楚well-defined高密度致密影high density shadow常伴有纵隔、肺门、膈肌向患区移位displacement of mediastinum, hilum and diaphragm to the affected area患区肋间变窄等narrowing of the intercostals spaces on the affected areaB.局限性local：（3）临床意义：弥漫性常见于肺间质纤维化、放射性肺炎、结缔组织病等diffuse f

18、ibrous usually is the result of pulmonary interstitial fibrosis, radiation pneumonia and connective tissue disease局限性常见于肺结核、尘肺和支气管扩张等local fibrous usually is the result of pulmonary tuberculosis, pneumonoconiosis and bronchiectasis（3）临床意义：4.钙化（Calcification）（1）病理pathologically：肺组织内有钙质沉着称钙化calcificat

19、ion :calcareous deposit in lung 是退行性或坏死组织愈合形式之一healing process of retrogression or necrotic tissue4.钙化（Calcification）（2）X线表现 X-ray findings ：呈斑点、球形、块状等特高密度影边缘锐利spots or globular or nodular shadow, very high density, well-defined（2）X线表现 X-ray findings ：（3）临床意义：常见于肺结核pulmonary tuberculosis尘肺pneumonoco

20、niosis错构瘤harmatoma肺包虫等pulmonary hydatid（3）临床意义： 纤维性病变（尘肺） 钙化性病变（结核球） 纤维性病变（尘肺） 钙化性病变（结核球） 5.肿块（Mass）与结节（nodule ）： （1）病理 pathologically：肺组织内有良性或恶性瘤细胞生长称肿块或结节benign or malignant cell growth in lung 直径小于或等于2cm的称结节大于2cm的为肿块the size of the nodule usually is less than 2cm,mass usually larger than 2cm 5.肿块

21、（Mass）与结节（nodule ）： 含液囊肿、结核瘤和炎性假瘤，因影像表现与良性肿瘤相似，也包括在肿块范围mass including liquid cyst, tuberculoma and inflammatory pseudotumor结节或肿块可单发，也可多发single or multiple 含液囊肿、结核瘤和炎性假瘤，因影像表现与良性结节与肿块除了其大小不同外，其他表现相同 just different size结节与肿块除了其大小不同外，其他表现相同单发常见于：Single：肺癌lung cancer结核球tuberculoma炎性假瘤等inflammatory pseud

22、otumor单发常见于：Single：多发multiple：最常见于肺转移瘤 pulmonary metastasis其他可见于also can happen in：血源性金黄色葡萄球菌肺炎hematogeneous staphylococci aureus pneumonia坏死性肉芽肿necrotic granuloma多发性肺囊肿multiple pulmonary cyst寄生虫囊肿等parasitic cyst多发multiple：最常见于肺转移瘤 pulmonar临床意义：常见于肺囊肿lung cyst肺结核pulmonary tuberculosis炎性假瘤inflammator

23、y pseudotumor良性及恶性肿瘤等benign or malignant tumor临床意义：（2）X线表现 X-ray findings：呈圆、椭圆形均匀密度的致密影round or oval homogeneous dense shadow良性：benign：边界清楚 well-defined生长慢 slowly growth不发生坏死 no necrosis（2）X线表现 X-ray findings：结核球 tuberculoma：常为圆形其内可有点状钙化round shape with punctate calcification 周围常有卫星病灶satellite结核球 t

24、uberculoma：炎性假瘤inflammatory pseudotumor：多为5cm以下类圆形肿块oval mass, less than 5cm肿块上方或侧方常有尖角状突起cusp cornu upside or lateral of the mass病变近叶间胸膜或外围时可见邻近胸膜的粘连、增厚adjacent pleura adhere and thickening 炎性假瘤inflammatory pseudotumor：恶性malignant：边界不规则 irregular border呈浸润性生长快而不均衡infiltrative growth and disproporti

25、on可发生坏死 necrosis恶性malignant：常有短细毛刺向周围伸出usually spiculated infiltrating靠近胸膜时可有线状、幕状或星状影与胸膜相连而形成胸膜凹陷征pleural indentation sign: peripheral linear, tented or astral shadow between a peripheral located tumor and the pleura较大的恶性肿瘤特别是鳞癌，中心易发生坏死而形成厚壁空洞 thick walled cavity usually seen in large malignant tum

26、or, especially squamous carcinoma 常有短细毛刺向周围伸出转移瘤metastasis：常多发multiple大小不一various size以中下野较多mainly in the middle and lower lung fields密度均匀homogeneous density边缘整齐well-defined转移瘤metastasis： CT：肿块的轮廓可呈多个弧形凸起，弧形相间则为凹入而形成分叶形肿块，称为分叶征sublobe sign: lobulated mass多见于肺癌lung cancer CT：分叶征分叶征瘤体内有时可见直径1mm3mm的低密度

27、影low density shadow in the mass, less than 1cm and larger than 3cm称为空泡征 （小泡征） bronchus encapsulated air sign 瘤体内有时可见直径1mm3mm的低密度影空泡征空泡征瘤体边缘可有不同程度的棘状或毛刺状突起spiculated infiltrating称为棘状突起或毛刺征spine-like process瘤体边缘可有不同程度的棘状或毛刺状突起毛刺征毛刺征邻近胸膜的肿块其内成纤维反应收缩牵拉胸膜可形成胸膜凹陷征pleural indentation sign :a peripheral loc

28、ated mass lesion drag the pleura多见于周围型肺癌 peripheral lung cancer邻近胸膜的肿块其内成纤维反应收缩牵拉胸膜可形成胸膜凹陷征肿块内如发现脂肪密度影，则有助于错构瘤的诊断fat density in the mass conduce to diagnosis of hamartoma 肿块内如发现脂肪密度影，则有助于错构瘤的诊断增强扫描enhancement scanning：结核球仅周边环形轻度强化tuberculoma: ring like slightly enhancement肺良性肿瘤可不强化或轻度均匀性强化benign tum

29、or: no enhanced or slightly homogeneous enhancement肺部炎性假瘤可呈环状强化或轻度均匀性强化inflammatory pseudotumor: ring like or slightly homogeneous enhancement肺恶性肿瘤malignant tumor：常为均匀强化或中心强化homogeneous or central enhancement且常呈一过性强化temporary enhancement增强扫描enhancement scanning： 结节 nodus：1.腺泡状结节（直径在1cm以下） aciniform

30、nodus (less than 1cm)： 边缘较清楚，呈梅花瓣状的结节，即相当于腺泡范围的实变well-defined, petal-like nodus 结节 nodus：2.粟粒状结节影（4mm以下）mililary nodular shadow：粟粒型肺结核的结节具有大小一致，分布均匀的特点nodus of mililary pulmonary tuberculosis with the same size, the same density and homogeneous distribution癌性淋巴管炎所形成的粟粒结节，分布可不均匀mililary nodus of lymp

31、hangitis carcinomatosa with inhomogeneous distribution2.粟粒状结节影（4mm以下）mililary nodula6.空洞及空腔（Cavity and air containing space）：（1）病理pathologically：肺组织坏死液化物经支气管排出后残留的缺损称空洞result of the expulsion of necrosis material into the bronchus6.空洞及空腔空腔（intrapulmonary air containing space）：与空洞不同different from cav

32、ity是肺内生理腔隙的病理性扩大pathological enlargement of pulmonary physiological lacuna肺大泡、含气肺囊肿及肺气囊等部属于空腔including bullae, lung gas cyst and saccus pneumaticus空腔（intrapulmonary air containi空洞壁wall：由坏死组织、肉芽组织、纤维组织、肿瘤组织所形成necrotic tissue, granulation tissue, fibrous tissue and tumor多见于结核、肺癌often seen in pulmonary

33、 tuberculosis and lung cancer空洞壁wall：根据洞壁的厚度thickness of the wall：厚壁空洞 thick walled cavity 薄壁空洞 thin walled cavity 无壁空洞 mouth-eaten cavity厚壁空洞的洞壁厚度等于或超过3mm the thickness of the wall of the cavity is more than 3mm 薄壁空洞的洞壁厚度小于3mm the thickness of the wall of the cavity is less than 3mm 根据洞壁的厚度thicknes

34、s of the wall：修翻译张七年制呼吸影像27课件（2）X线表现及临床意义 (X-ray findings and clinical )： A.虫蚀样空洞mouth-eaten cavity：又称无壁空洞在大片致密坏死组织阴影内有小而形状不一的多发性透明区multiple small and differently shaped lucent area in patchy dense shadow常见于干酪样肺炎 often seen in cheesy pneumonia （2）X线表现及临床意义 (X-ray findingsB.薄壁空洞 thin walled cavity ：洞

35、壁厚度3mm thickness is more than 3mm洞周围常有实变区common consolidated area内壁可不规则或出现壁结节irregular inner lining or walled nodus有或无液平面air-fluid level in the cavityC.厚壁空洞 thick walled cavity ：常见于 often seen in：肺脓肿lung abscess慢性纤维空洞性肺结核chronic fibrotic cavitary pulmonary tuberculosis 肺癌等lung cancer常见于 often seen i

36、n：D.空腔intrapulmonary air containing space ：壁较空洞壁更薄而光滑the wall is thinner and more smooth than the cavitys周围无实变no consolidated一般腔内无液平面common no air-fluid level in the cavityD.空腔intrapulmonary air contain常见于:often seen in ：肺气肿emphysema肺含气囊肿lung gas cyst 肺大泡bullae囊状支气管扩张等cystic bronchiectasis常见于: 良性肿块（

37、肺囊肿） 恶性肿块（肺癌） 良性肿块（肺囊肿） 恶性肿块（肺癌）无壁空洞（干酪性肺炎） 薄壁空洞（肺结核）无壁空洞（干酪性肺炎） 薄壁空洞（肺结核） 厚 壁 空 洞 （慢性肺脓肿） 厚 壁 空 洞 （慢性肺脓肿）修翻译张七年制呼吸影像27课件 肺空腔（肺气囊肿） 肺空腔（肺气囊肿）7.肺间质病变 （ Interstitial lesions of lung）（1）病理：肺间质内渗液或漏出effusion or transudate in the interstitium炎性渗出inflammatory exudation肉芽组织增生granulation hyperblastosis纤维化fi

38、brous degeneration炎性细胞或肿瘤细胞浸润infiltration of inflammatory cell and tumor cell7.肺间质病变 （ Interstitial lesio常见的肺间质病变common Interstitial lesions of lung ：慢性支气管炎chronic bronchitis特发性肺纤维化idiopathic fibrosis of the lung癌性淋巴管炎lymphangitis carcinomatosa尘肺pneumonoconiosis结缔组织病等 connective tissue disease常见的肺间质

39、病变common Interstitial l临床意义：肺间质水肿interstitial edema感染infection特发性间质纤维化idiopathic fibrosis of the lung粟粒型肺结核mililary pulmonary tuberculosis癌性淋巴管播散lymphangitis carcinomatosa临床意义：（2）X线表现 X-ray feature：多呈索条状linear shadow网状reticular shadow蜂窝状honeycomb shadow小结节状或网点状影small nodular or spots shadows（2）X线表现

40、X-ray feature：发生于小支气管、血管周围间隙及小叶间隔的病变affection involves bronchia, perivascular space and interlobular septum 表现 findings：网状与细线状影或蜂窝状影reticular shadow or linear shadow or honeycomb shadow发生于小支气管、血管周围间隙及小叶间隔的病变局限性线条状影见于肺内病变沿肺间质向肺门或向外围扩散located linear shadow is often seen in pulmonary disease diffuse al

41、ong the interstitium如肺癌肿块与肺门之间或与胸膜之间的细条状影 peripheral linear shadow between a peripheral located tumor and the hilum or the pleura局限性线条状影见于肺内病变沿肺间质向肺门或向外围扩散肺结核愈合后,其周围肺间质可发生纤维化interstitial fibrosis in healing process of pulmonary tuberculosis表现findings：条索状影streak-like shadow走行不规则irregular disposition粗

42、细不一 varying thickness肺结核愈合后,其周围肺间质可发生纤维化小叶间隔内有液体或组织增生fluid or hyperblastosis in interlobular septum表现：不同部位的间隔线septal line in different place小叶间隔内有液体或组织增生常见的有间隔B线 septal line B表现为：两下肺野近肋隔角处的外带，有数条垂自于胸膜的线状影several linear shadow in outer zone of lower field near the costophrenic angles长约2cm也可见中上肺野外带out

43、er zone of middle and upper fields多见于：肺静脉高压venous pulmonary hypertension肺间质水肿pulmonary interstitial edema常见的有间隔B线 septal line BCT检查CT findings：CT检查对肺间质病变的检出很敏感CT examination is sensitive to the pulmonary interstitial disease尤其是高分辨力CT可以发现早期轻微肺纤维化especially HRCT can depict the early sign of pulmonary

44、fibrosis显示小叶间隔增厚等微细改变show thickened interlobular septum 对肺间质病变的诊断具有重要的价值important for diagnosis of pulmonary interstitial diseaseCT检查CT findings：小叶间隔增厚thickened interlobular septum 表现为：与胸膜相连的线状影linear shadow connected with pleura长1cm2cm病变明显时可呈多角形的网状影polygonal reticular shadow小叶间隔增厚thickened interlob

45、ular s肺纤维化时，由于广泛的小叶间隔增厚，相邻增厚的小叶间隔相连thickened interlobular septum communicated with each other在胸膜下1cm以内，可见与胸壁平行的弧形线状影arc linear shadows parallel chest wall长2cm5cm称为胸膜下线 肺纤维化时，由于广泛的小叶间隔增厚，相邻增厚的小叶间隔相连肺纤维化后期在两中、下肺野的胸膜下区可见蜂窝状影later stage of pulmonary fibrosis ,honeycomb shadows in middle and lower fields

46、肺纤维化后期在两中、下肺野的胸膜下区可见蜂窝状影高分辨力CT不但可敏感检出肺小结节detect pulmonary tuberculum minus还可鉴别实质结节与间质结节 identify parenchymatous nodus and interstitial nodus高分辨力CT不但可敏感检出肺小结节间质结节interstitial nodus ：常分布在肺门邻近的血管支气管束、小叶间隔、胸膜下及叶间裂处vessel, interlobular septum, subpleura and interlobar fissure adjacent to the hilum肺间质较广泛的

47、纤维化widespread fibrosis：可见肺组织扭曲变形、病变区肺组织容积缩小loss of pulmonary volum亦可见牵拉性支气管扩张bronchiectasis间质结节interstitial nodus ： 肺间质性病变（水泥肺） 肺间质性病变（水泥肺）肺间质纤维化肺间质纤维化修翻译张七年制呼吸影像27课件间质性肺水肿（二狭心衰）K氏A、B线间质性肺水肿（二狭心衰）K氏A、B线风心病K氏线风心病K氏线（三）胸膜病变pleiral disease： 1.胸腔积液（Pleural effusion） 常见病因etiological factor：结核tuberculosis

48、化脓diapyesis胸外伤chest trauma肿瘤tumor心肾疾病等cardiorenal disease（三）胸膜病变pleiral disease：（1）游离性胸腔积液pleural free effusion ：A.少量积液small amount of free fuild：少量积液最先积聚于位置最低的后肋膈角，因而站立后前位检查多难以发现When the patient is erect, the fluid collects at the lower position of the pleural cavity. It is hard to detect small amo

49、unt of free fluid on P-A view.液量达250ml左右时，于站立后前位检查也仅见肋膈角变钝，变浅或填平the fuild in the pleural cavity is about 250cc,it only shows blunting of the costophrenic angle on P-A view（1）游离性胸腔积液pleural free effusi随液量增加可依次闭塞外侧肋膈角，掩盖膈顶blunting of the costophrenic angle ，masking (obscurity) of the diaphragm其上缘在第4肋前

50、端以下，呈外高内低的弧形凹面a curve of the free fluid which is highest at the outside and the concave face is upward on P-A view随液量增加可依次闭塞外侧肋膈角，掩盖膈顶B.中量积液moderate amount of free fluid：中量积液上缘在第4肋前端平面以上，第2肋前端平面以下upper border of the moderate amount free fluid is higher than 4th rib level and lower than the 2nd rib l

51、evel 中下肺野呈均匀致密影homogeneous density in middle and lower fieldsB.中量积液moderate amount of free C.大量积液large amount of free fluuid：大量积液上缘达第2肋前端以上upper border of the fluid is higher than 2nd rib level 患侧肺野呈均匀致密阴影homogeneous density in the affected fields有时仅见肺尖部透明lucent area in apex of lung可见肋间隙增宽widen of t

52、he intercostals spaces on the affected side横膈下降depression of the diaphragm纵隔向健侧移位displacement of diaphragm to the unaffected side C.大量积液large amount of free flu（2）局限性胸腔积液（localized pleural effusion） ：A.包裹性积液（encapsulated effusion） ：为胸膜炎时，脏、壁层胸膜发生粘连使积液局限于胸膜腔的某一部位，多见于胸下部侧后胸壁the pleura adhesion border

53、the visceral and parietal pleura, the fluid is located in the pleural cavity, mostly in the lower thoracic lateral chest wall（2）局限性胸腔积液（localized pleural e切线位片上，包裹性积液表现为自胸壁向肺野突出之半圆形或扁丘状阴影semicircular or flat hummocky shadow with a wide base against the chest wall and a convex inner其上下缘与胸壁的夹角呈钝角Its u

54、pper and lower edge and the angle was blunt chest wall密度均匀homogeneous density边缘清楚well-defined常见于结核 tuberculosis切线位片上，包裹性积液表现为自胸壁向肺野突出之半圆形或扁丘状B.叶间积液（interlobar effusion）：为局限于水平裂或斜裂的叶间裂积液the interlobar fissure effusion confined to the horizontal fissure or the oblique fissure 可单独存在may be separate也可与游离

55、性积液并存an also coexist with free fluidB.叶间积液（interlobar effusion）：发生于斜裂者，正位X线检查多难以诊断，侧位则易于发现Occurred in oblique fissure, situated X-ray examination is difficult to diagnose, lateral view found it easy典型表现是叶间裂部位的梭形影Typical performance is fusiform-shaped shadow in interlobar fissure密度均匀，边缘清楚homogeneous

56、density, well-defined发生于斜裂者，正位X线检查多难以诊断，侧位则易于发现游离性积液进人叶间裂时多局限于斜裂下部Free fluid confined to the lower oblique fissure when it collects in the interlobar fissure表现为尖端向上的三角形密度增高影peak upward triangle dense shadow叶间积液可由心衰或结核引起caused by heart failure or tuberculosis少数肿瘤转移也可表现为叶间积液A small number of tumor met

57、astasis can also be expressed as of the interlobar effusion 游离性积液进人叶间裂时多局限于斜裂下部C.肺下积液（subpulmonary effusion） ：为位于肺底与横膈之间的胸腔积液pleural effusion situated between the lung and the diaphragm右侧较多见see more rightC.肺下积液（subpulmonary effusion） 被肺底积液向上推挤的肺下缘呈圆顶形inferior margin of lung is dome shape because of

58、the subpulmonary fluid易误诊为横膈升高misdiagnosed as elevated diaphragm肺底积液所致的“横膈升高”圆顶最高点位于偏外l/3，且肋膈角深而锐利the highest point of the dome of elevated diaphragm in the partial l / 3, costophrenic angle deep and sharp 上缘光滑似膈肌影，但最高点外移，故有假膈肌影之称border of the effusion smooth like the diaphragm, but the relocation o

59、f the highest point, the false diaphragm shadow 被肺底积液向上推挤的肺下缘呈圆顶形修翻译张七年制呼吸影像27课件修翻译张七年制呼吸影像27课件游 离 性 胸 腔 积 液少 量 中 量 游 离 性 胸 腔 积 液少 游离性胸腔积液 局限性胸腔积液 大 量 包裹性胸腔积液 游离性胸腔积液 局限性胸腔积局限性胸腔积液 叶间胸腔积液 左侧肺下积液局限性胸腔积液 叶间胸腔积液 2.气胸及液气胸 Pneumothorax and hydropneumothorax：空气进入胸膜腔内为气胸 the air entering the pleural cavity

60、 , it is termed pneumothorax胸膜腔内液体与气体同时存在为液气胸the pleural cavity contains air and fluid, it is termed hydropneumothorax 2.气胸及液气胸 Pneumothorax and h（1）气胸 pneumothorax ：A.病因cause：脏层或壁层胸膜破裂rupture of the visceral pleura or partial pleura（1）气胸 pneumothorax ：脏层胸膜破裂多在胸膜下肺部病变的基础上发生，称自发性气胸rupture of the visc