肺部感染影像学和病理

肺部感染-

影像学和病理Outline流行病学影像学病理学细菌性-大叶性肺炎病原菌：Streptococcuspneumoniae，CAP(35%),

Klebsiellapneumoniae

Legionellapneumophila

病理生理：如下图early(A)andadvanced(B)stagesoflobarpneumoniacausedbyStreptococcuspneumoniae.In(A),theairspacesarefilledwithedemafluid;onlyoccasionalneutrophilsareevident.In(B),neutrophilspredominate.细菌性-小叶性肺炎病原菌：Staphylococcusaureus

Escherichiacoli

Pseudomonasaeruginosa

Anaerobes

Haemophilusinfluenzae

病理生理：

A:病原菌到达细支气管形成小叶中心结节和分枝斑片B，C:支气管周围实变，小叶或部分小叶分布，呈多中心，实变不跨国小叶间裂Acutebronchopneumonia.Lowmagnificationphotomicrographshowsseveralsmallfociofconsolidationlocatedaroundthelumensofsmallbronchioles(arrows).Chestradiographshowsareasofconsolidationintherightupperandleftlowerlobes.Thepatientwasa23-year-oldmanWithbronchopneumonia

High-resolutioncomputedtomography(CT)scanshowscentrilobularnodules(arrows)andlobularareasofconsolidation(arrowhead)andground-glassopacity(curvedarrow).Thepatientwasa53-year-oldmanwithbronchopneumonia.并发症-肺脓肿病原菌：anaerobicbacteria，S.aureus,P.aeruginosa,andK.pneumoniaeInflammatorymasswithcentralpurulentnecrosis

Frequentlycavitate

Smoothorshaggyinnermargins

Air-liquidlevelscommon

Maximalwallthicknessusually<15

Low-attenuationcentralregionandrimenhancementonCTscan并发症-坏死性肺炎Bulgingfissuresign.Posteroanteriorchestradiographshowsdenserightupperlobeairspaceconsolidationwithdownwardbulgingoftheminorfissure.Thepatientwasa66-year-oldmanwithpneumococcalpneumonia.Necrotizingpneumonia.Chestradiograph(A)showsinhomogeneousanddenseconsolidationintherightlung.Computedtomography(CT)(B)imageshowsalargecavityandsloughedlungwithinthecavity(arrow).Thepatientwasa42-year-oldalcoholicmanwithnecrotizingpneumoniasecondarytoKlebsiellapneumoniaeandanaerobicorganisms.并发症-气瘤病原菌：金葡菌（儿童），PCP（免疫抑制的成人）特点：薄壁含气空洞，数天或周内扩大，可导致气胸，数周或数月吸收肺脓栓来源：心内膜炎，血栓性静脉炎，静脉置管，起搏器导线。影像学特点：空洞小结节，Feedingvesselsignimage(A)showstwovesselsapparentlycoursingintoanodule(feedingvesselsign）image(B)demonstratesthattheonlyvesselinclosecontactwiththenoduleisadrainingvein(arrow).肺炎链球菌肺炎CAP的主要致病菌（40%）危险因素：高龄，慢性心肺疾病主要影像学表现：均一实变，毗邻脏层胸膜次要表现：小叶性肺炎（20-35%），球形实变（圆肺炎），叶间裂膨出高密度实变其他：胸腔积液（10%），同侧淋巴节肿大（CT上50%）。CT价值：明确有无空洞或积脓

LobarpneumoniaduetostreptococcuspneumoniaRoundpneumoniaduetoStreptococcuspneumoniaeBronchiolitisandbronchopneumoniaduetoStreptococcuspneumoniaeExtensivebilateralpneumoniaduetoStreptococcuspneumoniae葡萄球菌肺炎肺脓肿Coccalcoloniesaredenselysurroundedbyneutrophils(HE).StrongbasophiliaofthebacteriainH&EpreparationindicatesGrampositivityIncidentalterminalaspirationofMRSAcoloniesintothelung,leadingtoaculture-positiveresult(HE).MorphologicstudycaneasilydistinguishMRSA-inducedinfectionfromthecarrierstateofMRSAwithoutprovokingclinicalmanifestation.S.aureusbronchopneumonia,ischaracterizedhistologicallybypredominantlyperibronchiolarinflammationBronchopneumoniaduetoStaphylococcusaureus.Chestradiographshowsbilateralpoorlydefinednodularopacitiesandpatchyareasofconsolidation.Alsonotedisacentralvenousline.Thepatientwasa70-year-oldmanwithMRSApneumonia.EmpyemaduetoStaphylococcusaureus.Thepatientwasa44-year-oldmanandanintravenousdruguser.Hehadnoradiologicevidenceofsepticembolism.SepticembolismduetoStaphylococcusaureus.Thepatientwasa43-year-oldmanwithpositivebloodculturesforStaphylococcusaureus.克雷白肺炎CAP占1%-5%，HAP占15%危险因素：嗜酒，慢性支气管肺病，ICU病人常见影像学表现：CAP:均一大叶实变(右肺上叶多见）HAP:多中心单侧（60%），双侧（40%）实变（小叶性肺炎）其他常见发现叶间裂膨出（30%），胸腔积液（60-70%），肺脓肿，脓胸CT价值：明确空腔或脓肿AutopsiedlungwithseverepneumoniainapatientwithdegenerativeneuronalDisorder。Numerouslargeandlongpathogensaredispersedwithintheedematousalveolarspace.Thepathogensarenotphagocytizedbyneutrophils(HE,lowpower).LobarpneumoniaduetoKlebsiellapneumoniae.Thepatientwasa73-year-oldwomanwithK.pneumoniaepneumonia.Klebsiellapneumoniaepneumoniaandabscessformation。Thepatientwasa53-year-oldman.C,D(3dayslater)大肠埃希氏菌肺炎CAP(4%),HAP的5-20%危险因素：操劳过度病人常见影像学表现：多中心单侧或双侧实变（支气管肺炎），下叶为主其他表现：胸腔积液

BronchopneumoniaduetoEscherichiacoli.Chestradiographshowspoorlydefinednodularopacities(arrows)intherightupperlobeandsmallbilateralfociofconsolidation.铜绿假单胞菌肺炎HAP占20%危险因素：COPD,机械通气，抗生素运用，囊型纤维化定植菌常见影像学表现：小叶性肺炎，所有肺叶受累，CT提示小叶中心结节和tree-in-bud其他常见表现：肺脓肿（20%），胸腔积液（60%）左上，右上:Perivascularcuffing征，左下：美兰细菌染色。右下：痰图片染色（胶质铁染色）痰染色左：胶质铁染色右：革兰染色SeverepneumoniaduetoPseudomonas.流感嗜血杆菌肺炎5-20%的CAP病原菌危险因素：COPD,嗜酒，高龄常见影像学表现：小叶性肺炎（50-60%）大叶性肺炎（30-40%）非常见表现：CT示小结节和树芽征，圆肺炎，空洞（不超过15%），胸腔积液（50%）图左：NeonatalpneumoniacausedbyHaemophilusinfluenzaeinfection图右：阳性痰涂片BronchiolitisandbronchopneumoniaduetoHaemophilusinfluenza.Thepatientwasa50-year-oldmanwithH.influenzapneumonia.军团菌肺炎2-5%CAP危险因素：高龄，男性，肿瘤或器官移植主要影像学表现：大叶性肺炎，进展至多叶受累少见表现：球形实变（圆肺炎），单个或多个结节或者肿块样实变并发症：空洞（免疫抑制病人），肺门淋巴结肿大(免疫抑制病人），胸腔积液（35-60%）Fatalhospital-acquiredpneumoniaseeninaprematureinfant。left）Thelungismassivelyinfiltratedbymacrophages(HE)right）Numerousshortrodsareseeninthecytoplasmofalveolarmacrophages痰涂片希门尼斯染色，巨噬细胞胞浆可见军团菌LobarpneumoniaduetoLegionellapneumophila.Thepatientwasa77-year-oldmanwithlegionellapneumonia.

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