修翻译张(七年制)呼吸影像27

呼吸系统影像诊断学ImagingdiagnosticsoftheRespiratorysystem郑州大学第一附属医院MRI室thefirstaffiliatedhospitalradiologydepartmentoftheZhengzhouUniversity

张焱ZhangYanL200812@163.com三、胸部基本病变的影像Basicimagingfindingsindiseaseofrespiratorysystem气管支气管病变diseaseofthetracheobronchus：（一）支气管阻塞及其后果bronchiobstructionandtheresults：病因：etiopathogenisis①管内:intralumen异物、分泌物和血块等foreignbody,excretionandbloodclot②管壁：tubalwall

肿瘤、痉挛、先天性和炎症等tumor,spasm,congenitalandinflammation③管外：extralumen

有肿瘤、增大淋巴结压迫等tumorandenlargementofthelymphnodes病理pathologically：①部分阻塞引起肺气肿obstructiveemphysema(incompleteobstruction)②完全阻塞引起肺不张atelectasis(completeobstruction)1.阻塞性肺气肿obstructionemphysema：①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incompleteobstructioncausetoemphysema②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enlargementofalveoli,accompaniedbydestructionofalveolarwalls③若多个肺泡膨胀破裂，融合则成肺大泡bullaisformedduetoruptureofalveolarwallandcommunicatedwitheachother,pneumatocele（1）弥漫性肺气肿diffuseobstructionemphysema：①两肺纹理变细、少、分散及肺透过度增大lungmarkingsappearthinnerthannormal,increaselucencyofbothlungs②膈肌低、动度弱depressionandflatteningofthediaphragm③肋间隙增宽；心影狭长intercostalspacewiden,heartshadowappearslongandnarrow（2）局限性肺气肿localizedemphysema：①局部透过度高increaselucencyoftheaffected②肺纹理细、少、分散lungmarkingsappearasthinneroftheinvolvedarea③肺门、叶间胸膜、纵隔及膈肌移位displacementofhilum,pleura,mediastinumanddiaphragmtotheunaffectedside④有时可见纵隔摆动pendularmovementofthemediastinumCTfindings：⑴小叶中央型肺气肿病变累及肺小叶中央部分，上叶多见⑵全小叶型肺气肿病变累及全部肺小叶，下叶多见⑶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

弥漫性肺气肿

diffuseobstructionemphysema

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

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

间隔旁型肺大泡

2.阻塞性肺不张（obstructiveatelectasis）：①支气管完全阻塞completeobstructionofthebronchus②有时并发肺炎或支气管扩张concomitantconditionssuchaspneumoniaorbronchiectasis（1）一侧性肺不张atelectasisofanentirelung：①患侧肺密度高increasedensityoftheaffected②肋间隙狭窄narrowingoftheintercostalsspacesontheaffectedside③膈肌升高theaffectedsidepresentselevationofdiaphragm④纵隔移向患侧displacementofmediastinumtotheaffectedside⑤健侧代偿性肺气肿compensatoryemphysemaontheoppositesidelung（2）肺叶不张lobaratelectasis：①肺叶体积小，密度高theaffectedlobeappearsasahighdensitylesion,lossoflungvolume②邻近肺组织代偿性肺气肿compensatoryemphysemaontheadjacentlobe③叶间胸膜及肺门移位displacementofpleuraandhilumtotheaffectedarea④患侧膈肌升高theaffectedsidepresentselevationofdiaphragm⑤患区肋间隙狭窄narrowingoftheintercostalsspacesontheaffectedside（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theaffectedsegmentappearsasadensetriangularshadow,lossoflungvolume,theapexofthetriangularshadowatthehilumanditsbaseattheoutside（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multiplepatchydenseshadowandlucentbandssurroundtheaffectedlobules

各叶肺不张示意图右肺上叶不张（二）肺部病变diseaseofthelung1.渗出与实变exudationandconsolidation（1）病理pathologically：①部分肺泡内被病理性液体代替称渗出theairwithintheacinusisincompletelyreplacedbypathologicalexudatesorfluid②全部肺泡内被病理液体或组织代替称实变

theairwithintheacinusiscompletelyreplacedbypathologicalexudatesortissue（2）X线表现X-rayfindings：渗出病灶：exudativelesion：①均匀云絮状影floccularhomogeneousshadow②边缘模糊ill-defined实变病灶consolidation：①片状均匀致密影homogeneouspatchydenseshadow边界不清ill-defined②近叶间胸膜处则边缘清楚thebordernearthepleuraisclearly③实变区内有时可见支气管气像airbronchogramsmaybeseeninconsolidationopacity（3）临床意义clinicsignificance：见于：①肺炎pneumonia②渗出性肺结核exudativepulmonarytuberculosis③肺出血pneumorrhagia④肺水肿等pneumochysis2.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

filledwithgranulationtissue,itischronicinflammation（2）X线表现X-rayfindings：①呈腺泡结节状nodular②密度较高highdensity③边界较清楚的致密影well-defined④有时多数病灶融合一起，呈块状tendtocoalesce（3）临床意义：慢性肺炎，肺结核等chronicpneumoniaandpulmonarytuberculosis

渗出性病变增殖性病变

支气管肺炎粟粒性肺结核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thelungtissueislocallyordiffusereplacedbyfibroustissue是急、慢性炎症愈合形式之一endresultofacuteorchronicinflammation（2）X线表现X-rayfindings：A.弥漫性diffuse：①常累及肺间质involvedpulmonaryinterstitium②呈索条状、网点状、块状致密影denselinearorreticularornodularshadow③边缘清楚well-defined④密度高highdensityB.局限性local：①呈索条、网点状或块状denselinearorreticularornodularshadow②边缘清楚well-defined③高密度致密影highdensityshadow④常伴有纵隔、肺门、膈肌向患区移位displacementofmediastinum,hilumanddiaphragmtotheaffectedarea⑤患区肋间变窄等narrowingoftheintercostalsspacesontheaffectedarea（3）临床意义：①弥漫性常见于肺间质纤维化、放射性肺炎、结缔组织病等diffusefibroususuallyistheresultofpulmonaryinterstitialfibrosis,radiationpneumoniaandconnectivetissuedisease②局限性常见于肺结核、尘肺和支气管扩张等localfibroususuallyistheresultofpulmonarytuberculosis,pneumonoconiosisandbronchiectasis4.钙化（Calcification）（1）病理pathologically：肺组织内有钙质沉着称钙化calcification:calcareousdepositinlung是退行性或坏死组织愈合形式之一healingprocessofretrogressionornecrotictissue（2）X线表现X-rayfindings：呈斑点、球形、块状等特高密度影边缘锐利spotsorglobularornodularshadow,veryhighdensity,well-defined（3）临床意义：①常见于肺结核pulmonarytuberculosis②尘肺pneumonoconiosis③错构瘤harmatoma④肺包虫等pulmonaryhydatid

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benignormalignantcellgrowthinlung

直径小于或等于2cm的称结节大于2cm的为肿块thesizeofthenoduleusuallyislessthan2cm,massusuallylargerthan2cm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massincludingliquidcyst,tuberculomaandinflammatorypseudotumor结节或肿块可单发，也可多发singleormultiple结节与肿块除了其大小不同外，其他表现相同

justdifferentsize单发常见于：Single：①肺癌lungcancer②结核球tuberculoma③炎性假瘤等inflammatorypseudotumor多发multiple：

最常见于肺转移瘤pulmonarymetastasis其他可见于alsocanhappenin：①血源性金黄色葡萄球菌肺炎hematogeneousstaphylococciaureuspneumonia②坏死性肉芽肿necroticgranuloma③多发性肺囊肿multiplepulmonarycyst④寄生虫囊肿等parasiticcyst临床意义：①常见于肺囊肿lungcyst②肺结核pulmonarytuberculosis③炎性假瘤inflammatorypseudotumor④良性及恶性肿瘤等benignormalignanttumor（2）X线表现X-rayfindings：呈圆、椭圆形均匀密度的致密影roundorovalhomogeneousdenseshadow良性：benign：①边界清楚well-defined②生长慢slowlygrowth③不发生坏死nonecrosis结核球tuberculoma：①常为圆形其内可有点状钙化roundshapewithpunctatecalcification②周围常有卫星病灶satellite炎性假瘤inflammatorypseudotumor：①多为5cm以下类圆形肿块ovalmass,lessthan5cm②肿块上方或侧方常有尖角状突起cuspcornuupsideorlateralofthemass③病变近叶间胸膜或外围时可见邻近胸膜的粘连、增厚adjacentpleuraadhereandthickening恶性malignant：①边界不规则irregularborder②呈浸润性生长快而不均衡infiltrativegrowthanddisproportion③可发生坏死necrosis④常有短细毛刺向周围伸出usuallyspiculatedinfiltrating⑤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pleuralindentationsign:peripherallinear,tentedorastralshadowbetweenaperipherallocatedtumorandthepleura⑥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

thickwalledcavityusuallyseeninlargemalignanttumor,especiallysquamouscarcinoma转移瘤metastasis：①常多发multiple②大小不一varioussize以中下野较多mainlyinthemiddleandlowerlungfields③密度均匀homogeneousdensity④边缘整齐well-defined

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sublobesign:lobulatedmass多见于肺癌lungcancer分叶征瘤体内有时可见直径1mm～3mm的低密度影lowdensityshadowinthemass,lessthan1cmandlargerthan3cm称为空泡征（小泡征）bronchusencapsulatedairsign空泡征瘤体边缘可有不同程度的棘状或毛刺状突起spiculatedinfiltrating称为棘状突起或毛刺征spine-likeprocess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pleuralindentationsign:aperipherallocatedmasslesiondragthepleura多见于周围型肺癌

peripherallungcancer肿块内如发现脂肪密度影，则有助于错构瘤的诊断fatdensityinthemassconducetodiagnosisofhamartoma增强扫描enhancementscanning：①结核球仅周边环形轻度强化tuberculoma:ringlikeslightlyenhancement②肺良性肿瘤可不强化或轻度均匀性强化benigntumor:noenhancedorslightlyhomogeneousenhancement③肺部炎性假瘤可呈环状强化或轻度均匀性强化inflammatorypseudotumor:ringlikeorslightlyhomogeneousenhancement④肺恶性肿瘤malignanttumor：常为均匀强化或中心强化homogeneousorcentralenhancement且常呈一过性强化temporaryenhancement结节nodus：1.腺泡状结节（直径在1cm以下）aciniformnodus(lessthan1cm)：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-likenodus2.粟粒状结节影（4mm以下）mililarynodularshadow：粟粒型肺结核的结节具有大小一致，分布均匀的特点nodusofmililarypulmonarytuberculosiswiththesamesize,thesamedensityandhomogeneousdistribution癌性淋巴管炎所形成的粟粒结节，分布可不均匀mililarynodusoflymphangitiscarcinomatosawithinhomogeneousdistribution6.空洞及空腔（Cavityandaircontainingspace）：（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resultoftheexpulsionofnecrosismaterialintothebronchus空腔（intrapulmonaryaircontainingspace）：①与空洞不同differentfromcavity②是肺内生理腔隙的病理性扩大pathologicalenlargementofpulmonaryphysiologicallacuna③肺大泡、含气肺囊肿及肺气囊等部属于空腔includingbullae,lunggascystandsaccuspneumaticus空洞壁wall：①由坏死组织、肉芽组织、纤维组织、肿瘤组织所形成necrotictissue,granulationtissue,fibroustissueandtumor②多见于结核、肺癌oftenseeninpulmonarytuberculosisandlungcancer根据洞壁的厚度thicknessofthewall：①厚壁空洞thickwalledcavity②薄壁空洞thinwalledcavity③无壁空洞mouth-eatencavity厚壁空洞的洞壁厚度等于或超过3mmthethicknessofthewallofthecavityismorethan3mm薄壁空洞的洞壁厚度小于3mmthethicknessofthewallofthecavityislessthan3mm（2）X线表现及临床意义(X-rayfindingsandclinical)：

A.虫蚀样空洞mouth-eatencavity：①又称无壁空洞②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multiplesmallanddifferentlyshapedlucentareainpatchydenseshadow③常见于干酪样肺炎oftenseenincheesypneumoniaB.薄壁空洞thinwalledcavity

：①洞壁厚度<3mmthicknessislessthan3mm②边缘清晰well-defined③内壁光滑smoothinnerlining④一般无液平面noair-fluidlevelinthecavity⑤周围很少有实变的圆环状透明区seldomconsolidatedringlikelucentaera⑥常见于肺结核pulmonarytuberculosisC.厚壁空洞thickwalledcavity：①洞壁厚度>3mmthicknessismorethan3mm②洞周围常有实变区commonconsolidatedarea③内壁可不规则或出现壁结节irregularinnerliningorwallednodus④有或无液平面air-fluidlevelinthecavity常见于oftenseenin：①肺脓肿lungabscess②慢性纤维空洞性肺结核chronicfibroticcavitarypulmonarytuberculosis③肺癌等lungcancerD.空腔intrapulmonaryaircontainingspace：①壁较空洞壁更薄而光滑thewallisthinnerandmoresmooththanthecavity’s②周围无实变noconsolidated③一般腔内无液平面commonnoair-fluidlevelinthecavity常见于:oftenseenin：①肺气肿emphysema②肺含气囊肿lunggascyst③肺大泡bullae④囊状支气管扩张等cysticbronchiectasis

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）厚壁空洞（慢性肺脓肿）肺空腔（肺气囊肿）7.肺间质病变（Interstitiallesionsoflung）（1）病理：①肺间质内渗液或漏出effusionortransudateintheinterstitium②炎性渗出inflammatoryexudation③肉芽组织增生granulationhyperblastosis④纤维化fibrousdegeneration⑤炎性细胞或肿瘤细胞浸润infiltrationofinflammatorycellandtumorcell常见的肺间质病变commonInterstitiallesionsoflung：①慢性支气管炎chronicbronchitis②特发性肺纤维化idiopathicfibrosisofthelung③癌性淋巴管炎lymphangitiscarcinomatosa④尘肺pneumonoconiosis④结缔组织病等connectivetissuedisease临床意义：①肺间质水肿interstitialedema②感染infection③特发性间质纤维化idiopathicfibrosisofthelung④粟粒型肺结核mililarypulmonarytuberculosis⑤癌性淋巴管播散lymphangitiscarcinomatosa（2）X线表现X-rayfeature：①多呈索条状linearshadow②网状reticularshadow③蜂窝状honeycombshadow④小结节状或网点状影smallnodularorspotsshadows发生于小支气管、血管周围间隙及小叶间隔的病变affectioninvolvesbronchia,

perivascularspaceandinterlobularseptum表现findings：网状与细线状影或蜂窝状影reticularshadoworlinearshadoworhoneycombshadow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locatedlinearshadowisoftenseeninpulmonarydiseasediffusealongtheinterstitium如肺癌肿块与肺门之间或与胸膜之间的细条状影

peripherallinearshadowbetweenaperipherallocatedtumorandthehilumorthepleura肺结核愈合后,其周围肺间质可发生纤维化interstitialfibrosisinhealingprocessofpulmonarytuberculosis表现findings：①条索状影streak-likeshadow②走行不规则irregulardisposition③粗细不一varyingthickness小叶间隔内有液体或组织增生fluidorhyperblastosisininterlobularseptum表现：不同部位的间隔线septallineindifferentplace常见的有间隔B线septallineB表现为：①两下肺野近肋隔角处的外带，有数条垂自于胸膜的线状影severallinearshadowinouterzoneoflowerfieldnearthecostophrenicangles②长约2cm③也可见中上肺野外带outerzoneofmiddleandupperfields多见于：①肺静脉高压venouspulmonaryhypertension②肺间质水肿pulmonaryinterstitialedemaCT检查CTfindings：①CT检查对肺间质病变的检出很敏感CT

examinationissensitivetothepulmonaryinterstitialdisease②尤其是高分辨力CT可以发现早期轻微肺纤维化especiallyHRCTcandepicttheearlysignofpulmonaryfibrosis③显示小叶间隔增厚等微细改变showthickenedinterlobularseptum④对肺间质病变的诊断具有重要的价值importantfordiagnosisofpulmonaryinterstitialdisease小叶间隔增厚thickenedinterlobularseptum

表现为：①与胸膜相连的线状影linearshadowconnectedwithpleura长1cm～2cm②病变明显时可呈多角形的网状影polygonalreticularshadow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thickenedinterlobularseptumcommunicatedwitheachother在胸膜下1cm以内，可见与胸壁平行的弧形线状影arclinearshadowsparallelchestwall长2cm~5cm称为胸膜下线肺纤维化后期在两中、下肺野的胸膜下区可见蜂窝状影laterstageofpulmonaryfibrosis,honeycombshadowsinmiddleandlowerfields高分辨力CT不但可敏感检出肺小结节detectpulmonarytuberculumminus还可鉴别实质结节与间质结节

identifyparenchymatousnodusandinterstitialnodus间质结节interstitialnodus：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,interlobularseptum,subpleuraandinterlobarfissureadjacenttothehilum肺间质较广泛的纤维化widespreadfibrosis：可见肺组织扭曲变形、病变区肺组织容积缩小lossofpulmonaryvolum亦可见牵拉性支气管扩张bronchiectasis

肺间质性病变（水泥肺）肺间质纤维化间质性肺水肿（二狭心衰）K氏A、B线风心病K氏线（三）胸膜病变pleiraldisease：

1.胸腔积液（Pleuraleffusion）

常见病因etiologicalfactor：①结核tuberculosis②化脓diapyesis③胸外伤chesttrauma④肿瘤tumor⑤心肾疾病等cardiorenaldisease（1）游离性胸腔积液pleuralfreeeffusion：A.少量积液smallamountoffreefuild：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Whenthepatientiserect,thefluidcollectsatthelowerpositionofthepleuralcavity.ItishardtodetectsmallamountoffreefluidonP-Aview.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thefuildinthepleuralcavityisabout250cc,itonlyshowsbluntingofthecostophrenicangleonP-Aview随液量增加可依次闭塞外侧肋膈角，掩盖膈顶bluntingofthecostophrenicangle

，masking(obscurity)ofthediaphragm其上缘在第4肋前端以下，呈外高内低的弧形凹面acurveofthefreefluidwhichishighestattheoutsideandtheconcavefaceisupwardonP-AviewB.中量积液moderateamountoffreefluid：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upperborderofthemoderateamountfreefluidishigherthan4thriblevelandlowerthanthe2ndriblevel中下肺野呈均匀致密影homogeneousdensityinmiddleandlowerfieldsC.大量积液largeamountoffreefluuid：大量积液上缘达第2肋前端以上upperborderofthefluidishigherthan2ndriblevel患侧肺野呈均匀致密阴影homogeneousdensityintheaffectedfields有时仅见肺尖部透明lucentareainapexoflung可见肋间隙增宽widenoftheintercostalsspacesontheaffectedside横膈下降depressionofthediaphragm纵隔向健侧移位displacementofdiaphragmtotheunaffectedside（2）局限性胸腔积液（localizedpleuraleffusion）：A.包裹性积液（encapsulatedeffusion）：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thepleuraadhesionborderthevisceralandparietalpleura,thefluidislocatedinthepleuralcavity,mostlyinthelowerthoraciclateralchestwall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semicircularorflathummockyshadowwithawidebaseagainstthechestwallandaconvexinner其上下缘与胸壁的夹角呈钝角Itsupperandloweredgeandtheanglewasbluntchestwall密度均匀homogeneousdensity边缘清楚well-defined常见于结核tuberculosisB.叶间积液（interlobareffusion）：为局限于水平裂或斜裂的叶间裂积液theinterlobarfissureeffusionconfinedtothehorizontalfissureortheobliquefissure可单独存在maybeseparate也可与游离性积液并存analsocoexistwithfreefluid发生于斜裂者，正位X线检查多难以诊断，侧位则易于发现Occurredinobliquefissure,situatedX-rayexaminationisdifficulttodiagnose,lateralviewfounditeasy典型表现是叶间裂部位的梭形影Typicalperformanceisfusiform-shapedshadowininterlobarfissure密度均匀，边缘清楚homogeneousdensity,well-defined游离性积液进人叶间裂时多局限于斜裂下部Freefluidconfinedtothelowerobliquefissurewhenitcollectsintheinterlobarfissure表现为尖端向上的三角形密度增高影peakupwardtriangledenseshadow叶间积液可由心衰或结核引起causedbyheartfailureortuberculosis少数肿瘤转移也可表现为叶间积液AsmallnumberoftumormetastasiscanalsobeexpressedasoftheinterlobareffusionC.肺下积液（subpulmonaryeffusion）：为位于肺底与横膈之间的胸腔积液pleuraleffusionsituatedbetweenthelungandthediaphragm右侧较多见seemoreright被肺底积液向上推挤的肺下缘呈圆顶形inferiormarginoflungisdomeshapebecauseofthesubpulmonaryfluid易误诊为横膈升高misdiagnosedaselevateddiaphragm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thehighestpointofthedomeof"elevateddiaphragm"inthepartiall/3,costophrenicangledeepandsharp

上缘光滑似膈肌影，但最高点外移，故有假膈肌影之称borderoftheeffusionsmoothlikethediaphragm,buttherelocationofthehighestpoint,thefalsediaphragmshadow游离性胸腔积液

少量中量

游离性胸腔积液

局限性胸腔积液

大量包裹性胸腔积液

局限性胸腔积液

叶间胸腔积液左侧肺下积液

2.气胸及液气胸Pneumothoraxandhydropneumothorax：空气进入胸膜腔内为气胸

theairenteringthepleuralcavity,itistermedpneumothorax胸膜腔内液体与气体同时存在为液气胸thepleuralcavitycontainsairandfluid,itistermedhydropneumothorax（1）气胸pneumothorax：A.病因cause：脏层或壁层胸膜破裂ruptureofthevisceralpleuraorpartialpleura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ruptureofthevisceralpleuraoccuronthebasisofsubpleurallunglesions,saidspontaneouspneumothorax见于found：严重肺气肿severeemphysema胸膜下肺大泡subpleurabullae肺结核pulmonarytuberculosis肺脓肿等lungabscess胸膜裂口具活瓣作用时气体只进不出或进多出少avalveeffectofpleuralsplit可形成张力性气胸tensionpneumothoraxcanbeformed壁层胸膜破裂为壁层胸膜直接损伤破裂、体外空气进入胸腔directinjuryofpartialpleura,invitroairintothepleuralcavity如胸壁穿通伤、胸部手术及胸腔穿刺等suchaspenetratingwoundofchestwall,chestsurgeryandpleuralpuncture,etc.B.X线表现X-rayfindings：①气胸区为无肺纹理透明区alucentzoneofdevoidoflungmarking②压缩肺向肺门收缩，密度增高thelungcollapsedtothehilum,dense③肋间隙增宽，膈肌下降，纵隔对侧移位intercostalspacewiden,depressionofthediaphragm,displacementofmediastinumtotheoppositesite④气胸内有时可见致密的胸膜粘连带occasionallyvisibledensepleuraladhesionsinpneumothorax（2）液气胸hydropneumothorax：①外伤、手术后及胸腔穿刺后均可产生液气胸hydropneumothoraxaftertrauma,operationandchestpuncture②气胸下部可见均匀致密的液平面homogeneousdenseair-fluidlevelinlowerhydropneumothorax③如脏、壁层胸膜粘连，也可形成局限性或多房性液气胸pleuraladhesions,canbeformedlocalormultilocularhydropneumothorax④其余征象同气胸withtheremainingsignsofpneumothorax左侧气胸右侧液气胸3.胸膜增厚、粘连、钙化（Pleuralthickening,