修翻译呼吸tb课件

呼吸系统影像诊断学ImagingdiagnosticsoftheRespiratorysystem

郑州大学第一附属医院放射科thefirstaffiliatedhospitalradiologydepartmentoftheZhengzhouUniversity

张焱ZhangYan〔四〕肺结核Pulmonarytuberculosis:1.临床特点：clinicalcharacters〔1〕病原：pathogeny人或牛结核杆菌BacillustuberculosisorBacillustuberculosisbovis〔2〕病理：pathology①结核菌侵入人体后引起的根本病理变化为:basicpathologicalchangecausedbytuberculosis渗出及增殖exudationandproliferation②机体抵抗力低下时，病变那么出现:pathologicalchangeoflowresistance干酪样坏死，液化及空洞形成caseousnecrosis,colliquationandporosis.③机体抵抗力强或经适当治疗后病灶：pathologicalchangeoflowresistanceorpost–treatment吸收absorption纤维化fibrosis钙化calcification空洞瘢痕闭合或净化空洞cavitycloseorasepsiscavity〔3〕分期:stages①进展期：progression新发现病灶，病灶扩大newlesionandexpansion病灶边界变模糊obscureborder出现空洞或空洞增大，痰结核菌阳性cavityappearanceorexpansion,spitpositive②好转期：resolvingstage病灶缩小，边界变清楚，病灶消失clarityofborderandlesseningordisppearanceoflesion空洞缩小或消失lessenordisappearofnidus痰结核菌转阴性〔连续3月，1次/月〕spitnegative(3monthscontinous,1time/month)③稳定期：stationarystage病灶无活动lesioninactivity，空洞闭合cavitycloseup，痰结核菌连续6个月阴性〔至少1次/月〕spitnegative(6monthscontinus,1time/month)如有空洞，连续1年以上阴性，属临床治愈spitnegativecontinousmorethan1yearisclinicalcureifthecavityexsist再经观察2年仍无活动，结核菌仍阴性focusinactivityformore2yearsandspitnegativecontinous如有空洞，需观察3年以上为临床痊愈clinicalcureshouldbeobservefor3yearsifthecavityexist2.影像表现：1978年全国结核病防治会议natinalconferenceforcureandprevetionoftuberculosis分为五个类型：Ⅰ型type：原发性肺结核primarypulmonarytuberculosis〔原发综合征primarysyndrome，胸内淋巴结核intrathoracicscrofula〕Ⅱ型type：

血行播散型肺结核hematogenouspulmonarytuberculosis〔急性粟粒型肺结核acutemilitarytuberculosis，亚急性或慢性血行播散型肺结核subacuteorchronichematogenouspulmonarytuberculosis〕Ⅲ型：浸润型肺结核〔含结核瘤和干酪肺炎〕exudativepulmonarytuberculosis(tuberculomaandcaseouspneumonia)Ⅳ型：慢性纤维空洞型肺结核chronicfibro-cavernouspulmonarytuberculosisⅤ型：胸膜炎型肺结核tuberculouspleurisy1998新制定中国结核病分类法：chinesegroupingoftuberculosis：Ⅰ型原发性肺结核primarypulmonarytuberculosis〔原发综合征primarysyndrome，胸内淋巴结核intrathoracicscrofula〕Ⅱ型血行播散型肺结核hematogenouspulmonarytuberculosis〔急性粟粒型肺结核acutemilitarytuberculosis，亚急性或慢性血行播散型肺结核subacuteorchronichematogenouspulmonarytuberculosis〕Ⅲ型：继发性肺结核secondarypulmonarytuberculosis〔含结核瘤tuberculoma、干酪肺炎caseouspneumonia、慢性纤维空洞型肺结核chronicfibro-cavernouspulmonarytuberculosis〕Ⅳ型：结核性胸膜炎tuberculouspleurisyⅤ型：其他肺外结核如骨结核、肾结核和结核性脑膜炎等extrapulmonarytuberculosissuchasbasaltuberculosis，nephrotuberculosisandtubercularmeningitis〔1〕原发型肺结核:〔Ⅰ型〕primarypulmonarytuberculosis①原发综合征(primarysyndrome)：典型表现呈“哑铃状或双极期〞:dumbbellorbipolarstage

A.肺野原发病灶：primarylesionoflungfeild

边界模糊的云絮状阴影，可大可小patchyshadowofobscureborderandInequalityofsizeB.肺门及纵隔淋巴结肿大：enlargementofhilarandmediastinallymphnodes

边界清晰或模糊、圆或分叶状块影

the

borderisclearorobscureandthelesionisrotateorsublobe

C.淋巴管炎：angialymphitis

连接淋巴结和原发灶之间索条状影thestreakshadowisconnectionoflymphnodesandprimarylesion②胸内淋巴结结核(tuberculosisofintrathoraciclymphonodes)：原发病灶吸收absorptionofprimarylesion但淋巴结核因干酪化而愈合缓慢，slowcicatrizationofscrofulabecauseofcaseation

故只有淋巴结炎adenolymphitis典型表现:classicalcharacters肺门或纵隔有圆或椭圆结节状阴影，单个或多个singleormultiplenodositasrotateorellipselesionofhilusoflungormediastinal

边界清晰者clearborder

：肿瘤型tumortype

边界模糊者obscureboder：炎症型Inflammatorytype

原发综合征肺结核胸内淋巴结肺结核

primarysyndrometuberculosisofintrathoraciclymphonodes〔2〕血行播散型肺结核hematogenouspulmonarytuberculosis〔Ⅱ型〕①急性粟粒型肺结核〔acutemiliarytuberculosis〕：结核菌一次大量进入肺循环massofBacillustuberculosiscomeintopulmonarycircuIation所以肺部病变广泛，临床病症较重pulmonarylesioniswideandclinicalsymptomissevere1.病变早期：earlystage

只见肺呈磨玻璃样groundglasspulmonary2.发病10天大约后：10daysafteronste

见1.5~2mm大小的粟粒状影miliarylesion大小一致，分布均匀，密度相似normalsize,densityandequalityofdistribution正常肺纹理看不清normallungmarkingcannotbeobserved3.治疗后数月内吸收absorptionafterseveralmonths’treatment恶化那么融合，出现空洞amalgamationfordegenerationandcavitypresent②亚急性或慢性血行播散型肺结核:〔又称慢性播散型肺结核，chronicdisseminatedpulmonarytuberculosis〕：结核菌少量，屡次进入肺循环fewBacillustuberculosiscomeintopulmonarycirculationtimeaftertime病症较轻slightsymptom典型表现:classicalcharacters为结节状病灶nodositaslesion主要分布在两肺上、中部mediansuperiorlung〔少数可单侧〕大小不一，分布不均，密度不一致，呈多种性质病灶abnormalsize,densityandasymmetryofdistributionandmultinature急性粟粒型肺结核亚急性、慢性血行播散型

肺结核〔3〕浸润型肺结核〔infiltrativepulmonarytuberculosis〕:为继发性肺结核，最常见secondpulmonarytuberculosisandbestcommonX线表现有三种形式：①常见表现：好发于两肺或一侧肺的锁骨上、下区regionesofsupraclavicularorinfraclavicula

可以呈多种性质multinature，多种形态multianatomy，多个小叶性病灶multilesionofsublobe病灶边界模糊obscureborder病灶可融合成大片或出现空洞lesionmergeortogethercavitypresent②结核瘤〔球〕tuberculoma：系干酪样结核病变被纤维组织包绕而成caseastionoftuberculosiscircumfusedbyfibroustissue一般为圆或椭圆形致密影rotateorellipsehighdensitylesion大小2~3cm多数轮廓光滑outlineissmooth病灶内可有钙化或小空洞calcificationorsmallcavityinthelesion病灶周围常有卫星病灶satellitearoundthelesion③干酪性肺炎caseouspneumonia

：机体抵抗力差，对结核菌高度过敏而形成，分大叶性和小叶性Lowresistanceandhypersensitivetotuberculosis.Divideintolobarandlobularpneumonia.大叶性呈肺段或大叶实变阴影，内有无壁空洞，其余部位可有播散病灶Lobarpneumoniaishighdensitylesionofsegmentorlobarandcavitywithoutwallinit.Disseminatuslesionsinotherregions.小叶性病灶呈小片状阴影，常与大叶性病灶同时存在Lobularlesionislobularshadowandcoexistwithlobarlesion

浸润型肺结核

常见表现结核球浸润型肺结核〔干酪性肺炎〕

平片断层片〔4〕慢性纤维空洞型肺结核〔Ⅳ型〕Chronicfibrocavitarypulmonarytuberculosis①为各型结核恶化、好转与稳定交替开展而来的晚期肺结核Latepulmonarytuberculosisbydegeneration,improvementandstabilizationofallt