晕征与反晕征(培训内容)课件

晕征与反晕征

halosign

andreversedhalosign1优选课件

结节与肿块CT表现：致密影

直径＜5mm称微结节

（2～3mm粟粒结节）

直径5～10mm称小结节

≥10mm者统称结节

一般将小于等3cm者称为结节，大于3cm者称为肿块。基本概念2优选课件是指肺部CT或薄层CT上，肺密度轻度增加，支气管和血管轮廓可见，形似磨玻璃，称磨玻璃密度影。意义——非特异，任何使肺实变、远端气腔内空气含量减少而又不使肺泡全部闭塞的因素都可产生磨玻璃影。

磨玻璃密度影（GGO）基本概念3优选课件晕征CT表现——在CT上肺内结节或肿块周围的晕状磨玻璃密度影，低于中央结节，但高于正常肺组织，形似日晕。4优选课件分类一、出血性肺结节(一)感染性疾病中的出血性结节(毛霉菌病、念珠菌病、结核病、病毒性肺炎、侵袭性曲菌病)(二)非感染性疾病中的出血性结节（韦格纳肉芽肿病，Kabosi肉瘤，）二、肿瘤细胞浸润性结节（细支气管肺泡癌，淋巴瘤、肺泡内肿瘤生长）三、非出血性结节（肉状瘤病，机化性肺炎）5优选课件晕征病因ArchBronconeumol.2008;44(7):386-926优选课件免疫功能不全侵袭性曲霉菌、毛霉菌、念珠菌及隐球菌一晕征-感染性疾病-真菌7优选课件一晕征-感染性疾病-真菌KuhlmanJE1985

Invasivepulmonaryaspergillosis.A:Computedtomography(CT)scanofapatientwithacutelymphoidleukemiaandneutropeniashowinganodulesurroundedbyahalointherightupperlobe,withadjacentacinarinvolvement(arrows).B:Macroscopicsagittalsliceofanotherpatient’slungshowingaroundnecroticlesion(asterisk)surroundedbyahemorrhagichalo(arrowheads),correspondingtoinvasivepulmonaryaspergillosis.C:MicroscopicimageofthemarginofthelesiondescribedinB,withvisiblepulmonarynecrosisandhemorrhage.TheimagealsoshowsthehyphaeofAspergillusfumigatus(arrows),whichareofregularcaliber,septate,andbranchingatacuteangles(hematoxylin-eosin,magnification×2).8优选课件中国CT和磁共振杂志2014年6月12卷3期一晕征-感染性疾病-真菌9优选课件免疫功能不全常见单纯疱疹病毒、巨细胞病毒、水痘带状疱疹病毒及粘病毒一晕征-感染性疾病-病毒10优选课件slow-resolvingbacterialpneumonia(吸收延迟性肺炎)放线菌结核分枝杆菌一晕征-感染性疾病-细菌11优选课件1.64岁男，退休，咳嗽、间断咯血2月来诊。吸烟，既往健康，痰涂片革兰阴性菌，培养：卡他布兰汉菌；2.45岁，既往心梗，吸烟，咳嗽1月间断咯血10天，痰培养：流感嗜血杆菌中国实用内科杂志20097月29卷增刊1一晕征-感染性疾病-细菌12优选课件立克次体寄生虫一晕征-感染性疾病-其他13优选课件肾上腺嗜铬细胞瘤血管肉瘤转移瘤肾细胞癌绒毛膜癌肺血管肉瘤Kaposi肉瘤二晕征-肿瘤性疾病-出血性瘤结节14优选课件Hemorrhagicmetastasisinapatientwithchoriocarcinoma（绒毛膜癌）whopresentedwithmassivehemoptysis.A:Computedtomographyscanofthechestshowsmultiplehemorrhagicpulmonarynoduleswithahalosignthathavecoalescedintheposteriorsegmentsoftherightlung.B:Macroscopiclungsliceshowingseveralroundhemorrhagiclesions.C:Macroscopicimageofnodulescontaininghemorrhagicareas,fibrin,andtumorcells(hematoxylin-eosin,magnification×10).二晕征-肿瘤性疾病-出血性瘤结节15优选课件细支气管肺泡癌消化系、胰腺、肺腺癌淋巴瘤二晕征-肿瘤性疾病-瘤细胞浸润16优选课件Bronchioloalveolarcarcinomainapatientwithchroniccough.A:Computedtomographyscanofthechestshowsnoduleswithahalosignintherightlung,withsomepseudocavitation(arrow).Alsovisibleisaconsiderableareaofconsolidationintheleftlung.B:Microscopicimageshowingthickenedalveolarwalls(asterisks)duetoinfiltrationbytumorcells(arrows)ematoxylin-eosin,magnification×10).二晕征-肿瘤性疾病-瘤细胞浸润17优选课件Pulmonarylymphomaina73-year-oldpatientwhovisitedtheemergencyservicewithdyspnea.A:Anaxialscanofthelowerpulmonarylobesshowsmultiplepulmonarynoduleswithahalosignandatendencytocoalesceintheposteriorsegments.Thereisalsobilateralpleuraleffusion,somewhatgreaterontherightside.Thepatientdied3weeksafteradmission.B:Lowmagnificationimageofpulmonarynoduleshowingmainlyperibronchovasculartumorcellinfiltrationandmarkednecrosis(hematoxylin-eosin,magnification×4).C:Ahigher-magnificationimageoftheperipheryofthenoduleshowstheinfiltrationoftumorcellsalongthealveolarwalls(arrows)(hematoxylineosin,magnification×10).18优选课件出血性结节非出血性结节三晕征-非感染性疾病19优选课件三晕征-非感染性疾病-出血性结节韦格纳肉芽肿子宫内膜异位症活检20优选课件Wegenergranulomatosis.A:Computedtomographyscanshowing2pulmonarynodulessurroundedbyahalo(arrows)andanareaofconsolidationintheleftlowerlobe(asterisk),alsowithahalosign.Thepatient,whosefirstsymptomwashemoptysis,alsohadrapidlyprogressingglomerulonephritis肾小球肾炎B:Microscopicimageshowinginflammatoryinfiltrationofthearterialwallwithamultinucleatedgiantcell(arrow)andendothelialdestruction(arrowheads)(hematoxylin-eosin,magnification×20).三晕征-非感染性疾病出血性结节21优选课件结节病机化性肺炎闭塞性细支气管炎嗜酸细胞肺炎肺淀粉样变三晕征-非感染性疾病非出血性结节22优选课件反晕征是CT肺窗，中心为磨玻璃样密度影，周围是高密度新月形或环形条带，与晕征的周围稍低密密度磨玻璃影相反，称反晕征。Voloudakietal1996cop23优选课件反晕征病因24优选课件一反晕征-感染性疾病-真菌肺曲菌接合菌属（Zygomycetes包括根霉和毛霉）地方性真菌感染（南美芽生菌病-拉丁美洲-巴西）隐球菌早期征象25优选课件Invasivepulmonaryaspergillosisina54-year-oldfemalewithmultiplemyelomaandsecondaryplasmacellleukaemiawhohadundergonechemotherapy.(a)High-resolutionCTimageatthelungbaseshowsarightlower-lobepulmonarynodule(arrow)andthereversedhalosign(RHS)intheleftlowerlobe(curvedarrow)withadjacentground-glassopacities.(b)CTimagewithmediastinalwindowsettingsshowstheperipheralconsolidationoftheRHS(asterisks).Noteasmallrightpleuraleffusion.26优选课件Pulmonaryzygomycosisina22-year-oldmalewithprecursorB-cellacutelymphocyticleukaemia.(a)CTimageshowsthereversedhalosign(RHS)intheleftupperlobe(arrows).(b)CTscanperformed2monthslatershowsintervaldevelopmentofcavitation(aircrescentsign).ThepresenceofRHSinanimmunosuppressedpatientishighlysuggestiveofpulmonaryzygomycosis,especiallyifthepatientisreceivingprophylaxisforaspergillosis.27优选课件Paracoccidioidomycosisina49-year-oldmale,residentofaruralareainBrazil.CTimageshowsreversedhalosign(RHS)lesions(arrows)andbilateralsmallpoorlymarginatedpulmonarynodules.ThepresenceofRHSinapatientfromanendemicregionforfungalinfectionshouldraiseconcernforthatspecificfungalinfection.28优选课件一反晕征-感染性疾病-结核Tuberculosisina59-year-oldfemale.High-resolutionCTimageshowsbilateralsmallcentrilobularnodules,tree-in-budopacitiesandareasofreversedhalosign(RHS).NotethenodularappearanceoftheringofconsolidationoftheRHSlesions(arrows),whichmaybehelpfulinthedifferentiationbetweenactivegranulomatousdiseaseandcryptogenicorganisingpneumonia.Thepresenceofassociatedcentrilobularnodulesandtree-in-budopacitiesshouldraisesuspicionoftuberculosis.29优选课件二反晕征-机化性肺炎（19%）Organisingpneumoniaina53-year-oldmalewithgraft-vs-hostdiseaseafterstemcelltransplantionfortreatmentofacutemyelogenousleukaemia.CTscanshowsbilateralperipheralandperibronchovascularconsolidativeopacitieswiththereversedhalosign(arrows).Open-lungbiopsyshowedorganisingpneumonia.Thepatientwastreatedwithsteroidswithresolutionofthelesions.30优选课件二反晕征-机化性肺炎47-yr-oldfemalewasreferredtoatertiarycentre(StMichael’sHospital,Toronto,Canada)forfurtherevaluationofchroniccough,fever,progressiveexertionaldyspnoeaandfatigue.Coronalchestcomputedtomographyscanshowingmultipleareasofcentralground-glassopacity,surroundedbyringorcrescentic-shape,denseairspaceconsolidation,mainlyintheleftlowerlobeandtherightupperlobe.Transbronchialbiopsyshowingorganisingpneumonia31优选课件三反晕征-非特异性间质性肺炎TheBritishJournalofRadiology,May2011A52-year-oldfemalepresentedwithacoughandNewYorkHeartAssociation(NYHA)class2dyspnoeaof4monthsduration，CTimagesshowacentralground-glassopacitysurroundedbycrescentorring-shapedareasofconsolidation,showingthe‘‘reversedhalosign’’.(e)6daysand(f)6monthsofsteroidtherapy,bothshowedimprovement.32优选课件四反晕征-结节病Sarcoidosisina44-year-oldfemale.High-resolutionCTimageshowsbilateralnodularopacitieswiththereversedhalosign(RHS)(arrows)andsmallpulmonarynoduleswithpredominantperilymphaticdistribution.ThepresenceoftheRHSassociatedwithnodulesinperilymphaticdistributionandmediastinalandhilarlymphadenopathy(notshown)shouldraisesuspicionofsarcoidosis.33优选课件五反晕征-肺栓塞Acutepulmonaryembolismwithpulmonaryinfarctionina64-year-oldfemale.(a)CTimageshowsthereversedhalosigninthesuperiorsegmentoftherightlowerlobe.(b)CTimage(mediastinalwindowsettings)showsaclotinthedistalrightmainpulmonaryarteryextendingtothesuperiorsegmentalbranchoftherightlowerlobepulmonaryartery.(c)2monthfollow-upCTscanshowscavitationoftheinfarctedpulmonaryparenchyma.34优选课件Multifocalpulmonaryadenocarcinomaina70-year-oldfemale.CTimageshowsbilateralulmonarynoduleswiththereversedhalosign(blackarrows)andground-glasspulmonarynodules(whitearrows).六反晕征-肿瘤35优选课件Metastaticrenalcellcarcinomaina73-year-oldmale.TheCTscanshowsmultiplebilaterallesionswithreversedhalosign(RHS),biopsyproventorepresentmetastaticrenalcellcarcinomainabackgroundoffibrosisandnecrosis.Inpatientswithaknownprimarymalignancy,RHSlesionsmayrepresentatypicalpresentationofmetastaticdisease.Themaindifferentialdiagnosisisorganisingpneumonia,whichcanberelatedtodrugtoxicityifthepatientisreceivingchemotherapy.六反晕征-肿瘤36优选课件Reversedhalosign(RHS)followingradiofrequencyablation(RFA)ofapulmonaryadenocarcinomaina64-year-oldfemale.(a)CTimageshowstheadenocarcinomaintheleftlowerlobe.(b)CTscanperformed1monthafterRFAofthetumourshowsdevelopmentoftheRHS.WhenpresentshortlyafterRFA,theRHSshouldnotbeconfusedwithrecurrenceofdisease.七反晕征-射频消融术后改变37优选课件放疗相关肺疾病急性期肿瘤坏死炎症反应，肺组织坏死继发性机化性肺炎八反晕征-放疗后改变38优选课件八反晕征-放疗后改变Reversedhalosign(RHS)followingprotonradiationtherapyforapoorlydifferentiatedsquamous（鳞癌）cellcarcinomaina71-yearoldmale.(a)CTimageshowstheprimary