2015x肺病診斷放射學(xué)院

1、1Respiratory disease 放射學(xué)院 劉林祥6222136 2支氣管擴張癥Bronchiectasis Irreversible dilatation of the bronchial branches先天性(少)Katagener綜合征免疫球旦白缺乏肺囊性纖維化后天性(多)繼發(fā)于肺結(jié)核、慢性肺炎、肺間質(zhì)纖維化、胸膜增厚好發(fā)于兩肺下葉、左舌葉和右中葉3BronchiectasisCongenital：支氣管管壁平滑肌、腺體和軟骨減少或缺如Secondary：上皮脫落、管壁炎細(xì)胞浸潤、腫脹，管壁周圍纖維組織增生Symptoms：咳嗽咯多量臭味的膿痰痰中帶血大量（百cc）咯血感染時發(fā)

2、熱4BronchiectasisCylindrical varicose cystic5Bronchography Confirm: existance of bronchiectasisClarify: subtype and extentCylindrical: 近端遠(yuǎn)端寬度相似，柱狀，或遠(yuǎn)端稍大，末端截斷，遠(yuǎn)端分支不易充盈Cystic: 重者呈葡萄串狀Varicose: 粗細(xì)不均，管腔形態(tài)不規(guī)整6BronchiectasisPlain radiograph10% may be normal肺紋理增粗、模糊，集攏和排列紊亂雙軌征，蜂窩狀陰影（0.5-3cm），液平肺不張和支氣管擴張同時存在

3、（右中葉）感染：斑片狀或大片狀實變影，邊緣模糊7支氣管擴張Multiple cystic shadows in the left lung左肺可見多個囊腔影，成蜂窩狀表現(xiàn)8支氣管擴張Plain film兩下肺紋理增粗、模糊，集攏和排列紊亂，呈蜂窩狀影，或類圓形透光區(qū)9Bronchiectasis CT features柱狀擴張：支氣管增粗，超過并行的肺動脈，管壁增厚，雙軌形或小環(huán)形囊狀擴張：肺內(nèi)多個圓形或卵圓形低密度影，壁薄，見液平面，多個病灶聚集在一起形成蜂窩狀或葡萄串樣靜脈曲張型擴張：與柱狀相似，但管壁不規(guī)則，呈蚓狀迂曲合并：炎癥；肺紋理粗亂1011121314Bronchiectasis

4、 CT features15Bronchiectasis16Bronchiectasis17氣管、支氣管異物Bronchial foreign body 多見于5歲以下兒童異物分三類植物性異物：花生米、豆籽、瓜子，多見礦物性異物：硬幣、徽章、牙托，較少見動物性異物：碎骨、碎殼、魚刺，少見18Pathology機械性阻塞雙向通氣呼氣性活瓣阻塞吸氣性活瓣阻塞完全阻塞異物引起氣道的損傷機械性化學(xué)性異物中的游離脂肪酸（如花生米、豆類）刺激氣道的粘膜，使氣管或支氣管發(fā)生一系列的病理改變，如粘膜充血、腫脹、分泌物增多、肉芽組織增生、纖維化等19Bronchial foreign body Direct s

5、ign不透X線異物：大小、形狀與部位扁形異物正位縱行影，側(cè)位圓形影，可鑒別Indirect sign縱隔擺動 (movement of mediastium)膈肌矛盾運動(paradoxical movenment )阻塞性肺氣腫(obstructive emphysema )阻塞性肺炎 (obstructive pneumonia )阻塞性肺不張 (obstructive atelectasis )20Bronchial foreign body呼氣像與吸氣像示縱隔擺動21Bronchial foreign bodyObstructive atelectasis and pneumonia

6、in right lower lober22Bronchial foreign bodyA toy whistle in the right main bronchus, with mild obstructive emphysema 2ys boy, obstructive emphysema of the right lung23Congenital Bronchial Cyst肺內(nèi)：肺囊腫?？v隔內(nèi)：縱隔支氣管囊腫支氣管發(fā)育停滯，實心索狀結(jié)構(gòu)不能成為貫通的管狀結(jié)構(gòu)，分泌的黏液不能排出，積聚膨脹而成囊壁菲薄，囊內(nèi)充滿黏液囊壁內(nèi)層為上皮，囊壁支氣管壁組織，無塵埃沉著無單獨血供，由相鄰的肺血管供

7、血囊腫和支氣管相通可成含氣囊腫或液氣囊腫24Congenital Bronchial Cyst多見于青少年，男性發(fā)病率高囊腫較大壓迫鄰近肺組織或縱隔，產(chǎn)生呼吸困難和發(fā)紺癥狀繼發(fā)感染：發(fā)熱、咳痰、胸痛等，癥狀可反復(fù)發(fā)作張力性囊腫如潰破，可出現(xiàn)胸悶、氣急等自發(fā)性氣胸癥狀25Congenital Bronchogenic cyst含液囊腫：類圓形，密度勻，邊緣光滑銳利，周圍肺組織清晰含氣囊腫：薄壁環(huán)狀透亮影，囊腫壁厚約1，囊壁內(nèi)外緣光滑且厚度均勻一致液氣囊腫：囊腫內(nèi)可見液平面。感染后囊壁增厚多發(fā)囊腫：密集者形如蜂窩，稱為蜂窩肺或多囊肺。囊壁薄而邊緣銳利，感染后囊壁可增厚且模糊深呼、吸氣相囊腫形態(tài)大小

8、可見改變常有胸膜增厚，肺體積減小26單發(fā)先天性支氣管囊腫27先天性支氣管囊腫28先天性支氣管囊腫29Congenital Bronchogenic cyst含液囊腫表現(xiàn)為圓形高密度影，邊界清楚銳利囊腫密度均勻，CT值為020HU。合并出血或囊內(nèi)蛋白質(zhì)含量較高，則CT值相應(yīng)增高囊腫合并感染時，肺窗上囊腫周圍可見淡薄高密度滲出性改變，而縱隔窗上難以顯示含氣囊腫在肺窗表現(xiàn)為邊界清楚的圓形低密度無肺紋理區(qū)，縱隔窗能顯示其薄壁液氣囊腫在肺窗及縱隔上均可見液氣平面影像30Congenital Bronchogenic cyst 31Congenital Bronchogenic cyst 3233慢性支氣

9、管炎Chronic bronchitis氣管、支氣管粘膜及其周圍組織慢性非特異性炎癥慢性進行性咳嗽連續(xù)兩年以上，每年連續(xù)咳嗽、咳痰3個月，并除外全身及肺部其它疾病發(fā)病率約4%，老年人多，50歲以上達(dá)15%34Chronic bronchitis支氣管粘膜杯狀細(xì)胞增生，腺體肥大，分泌物增多、粘稠，粘膜水腫、充血、上皮細(xì)胞萎縮，脫落，鱗狀上皮化生。彈力纖維破壞，管腔相對變細(xì)合并肺炎癥、肺氣腫、肺大泡，繼發(fā)肺心病咳、痰、喘，咯血少見冬季發(fā)病較多，有并發(fā)癥時癥狀加重35Chronic bronchitis兩肺紋理增多、粗、扭曲、模糊，可有雙軌征和杵狀影，網(wǎng)狀和小囊狀陰影肺氣腫時紋理減少、稀疏、纖細(xì)，肺

10、透光度不均勻或普遍增加，膈肌平直，桶狀胸，肺大泡，軍刀樣氣管兩中下肺斑片狀或?qū)嵶冴幱?，不張時體積縮小胸膜增厚，膈面胸膜粘連肺動脈增寬，肺門影增大，肺源性心臟病36Chronic bronchitis37慢性支氣管炎38慢性支氣管炎39肺隔離癥Pulmonary sequestration一部分肺與正常肺分離，且不接受肺動脈供血，而僅接受來自體循環(huán)異常血管的供血肺葉內(nèi)型肺隔離癥：隔離肺與鄰近正常肺位于同一臟層胸膜內(nèi)，供血動脈多來自降主動脈或其分支，靜脈回流多經(jīng)過肺靜脈肺葉外型肺隔離癥：有單獨的臟層胸膜包裹，90%位于左下葉后基底段，也可位于膈下或縱隔內(nèi)，供血動脈來自腹主動脈，靜脈回流通過下腔靜脈

11、、奇靜脈或半奇靜脈回流到體循環(huán)。30%合并膈疝4041Pulmonary sequestration4243Pulmonary sequestration44Pulmonary sequestrationExtralobar sequestration in right lower lobe45Abnormal systemic arterial supplyOriginates within abdomen Normal venous drainage into LAextensive calcification in sequestrated segmentsystemic artery

12、enters sequestrated segment464748大葉性肺炎好發(fā)冬春季、青壯年高熱、寒戰(zhàn)、胸疼、咳嗽及鐵銹色痰充血期：起病24h內(nèi)，血管擴張、充血、滲出紅色肝變期：2-3d后，大量RBC、纖維素進入肺泡腔灰色肝變期：3-4d后，大量WBC取代RBC消散期：1w后，滲出物吸收消散，肺重新充氣49Lobar pneumonia早期：可無陽性表現(xiàn)或僅為局部肺紋理增多、模糊或較淡的絮狀模糊陰影實變期：不同范圍的均勻致密影，可見支氣管氣相消散期：大片實變影內(nèi)出現(xiàn)不規(guī)則透亮區(qū)，邊緣模糊。應(yīng)與浸潤型結(jié)核鑒別50lobar pneumonia右中上肺野大片均勻不透光區(qū)，邊緣模糊51Lobar

13、pneumonia右上肺野陰影52Lobar pneumonia53Lober pneumonia54支氣管肺炎BronchopneumoniaClinical：呼吸困難、高熱、咳嗽、咳泡沫粘液濃痰，肺部聽診可聞及濕羅音。常見于體弱、術(shù)后長期臥床或嬰幼兒Radiograph：兩中、下肺野內(nèi)中帶紋理增多、模糊及沿肺紋理分布的斑片狀模糊影。小兒患者可有肺門增大及肺氣腫55Bronchopneumonia 兩肺中下野中內(nèi)帶可見沿支氣管分布的斑片狀模糊影568y boy, S-OIV infection, 2day history of fever and cough, prominent perib

14、ronchial markings radiating from the hila into the lungs in association with hyperinflation57支氣管肺炎58間質(zhì)性肺炎Interstitial pneumoniaClinical：咳嗽、氣急、紫紺及發(fā)熱，患者常有百日咳、麻疹或流感病史Radiograph：肺紋理增多，邊緣模糊，以兩肺下野為著。肺周及兩下肺可見網(wǎng)狀及小點狀陰影。可引起肺氣腫或肺不張59Interstitial pneumonia60interstitial pneumonia61Interstitial pneumonia62間質(zhì)性肺炎6

15、3放射性肺炎Radiation pneumonia有胸部腫瘤放療史急性期：與照射野一致的大片狀陰影，邊緣較模糊，病灶內(nèi)可見到支氣管氣相慢性期：為不規(guī)則纖維條索影，肺門及周圍組織可被牽拉64放射性肺炎肺癌放療后，形成的右肺中上野纖維條索及炎性滲出65放射性肺炎Radiation pneumonitisBefore treatmentA nodule in left lung and hilar adenopathy2m after, faint opacity, radiation fibrosisRadiation pneumonitis9m after, volume loss, conso

16、lidation2m after radiation, Diffuse GGO in left lung68肺炎69Pneumonia 70Pneumonia 71Pneumonia 72SARSSevere acute respiratory syndromeA transmissible respiratory tract infection caused by coronavirus (CoV)March 12, 2003, WHO issued a global alert in response to the rapid spread of atypical pneumonia am

17、ong previously healthy adults in southern China73Clinical FeaturesRecent contact with a patient known to have SARS or of travel within 10 days to a SARS-affected areaChest radiograph shows infiltrate in the lungsLaboratory findings of SARS-CoVhigh fever (38) , 7 days after exposureDry cough, dyspnea

18、, and arthralgiaMild hypoxemia, 10%20% require intubation and mechanical ventilation 74Treatment and Clinical eNo proven therapiesBroad-spectrum antibiotics Antiviral therapy, ribavirinCorticosteroidsInterferon may be of benefit in treatmentFatality rate is 11%, 1/5 require admission to ICUA poor cl

19、inical e: increased age (60 years), male sex, and medical comorbidityElevated blood serum levels of neutrophils, creatine kinase, and lactate dehydrogenase75Radiology technologist Wear protective garments: Double gowns, double gloves, a disposable head covering, a face mask, disposable booties, and

20、protective eyewear and face shieldsPatient also was required to wear a maskAll surfaces in contact with or within 1 meter of the patient were cleaned with an antiviral agentCleaning procedure was performed twiceCT suites were not used for 3045ms after the second cleaning to allow for several air exc

21、hanges prior to the entry of the next patient 76Radiographs and HRCTA peripheral / pleural-based opacity ranging from ground-glass to consolidation Tend to occupy a sub-pleural positionIn advanced cases, widespread opacification may be ground-glass or consolidative at large areasTends to affect the

22、lower zones first and bilateralNo Calcification, cavitation, pleural effusion， lymphadenopathy77M31 health-care worker2d history of fever, chills and myalgiaAt diagnosisAfter 3d After another 4d 7825F, healthcare workerat admission7 days after4 days later79M38, healthcare workerInitial chest film at

23、 admission depicted no abnormality2nd day after: extensive ggo with interstitial thickening in left upper lobe4 days after: interval central clearing and multifocal extension of crazy paving to periphery and to other lobes80F29, 7ds after exposureA subtle focus of consolidation in right lower zone,

24、partly obscured by breast tissue5 days later, consolidation has expanded and e more dense. chest radiograph obtained 13 days after admission was normal81SARS, F7317ds after exposure, chest radiograph on was normal2ds after admission,focal consolidation in right lung8ds later, bilateral multifocal co

25、nsolidationPatient died 36ds after exposure to SARS82肺膿腫（lung abscess）高熱、胸痛、咳大量腥臭濃痰急性：肺內(nèi)厚壁空洞，內(nèi)壁不規(guī)整，外壁模糊，洞腔內(nèi)有高位液平面慢性：肺內(nèi)空洞壁變薄且光整，可一個或多個，伴周圍纖維增生和小片浸潤83lung abscess右肺厚壁空洞，內(nèi)有液平84lung abscess85Lung abscess 86金黃色葡萄球菌肺炎87肺膿腫88Lung abscess89肺結(jié)核1998年分型原發(fā)性：原發(fā)綜合征和胸內(nèi)淋巴結(jié)結(jié)核血行播散性：急性粟粒性,慢性血行播散型繼發(fā)性：浸潤型、結(jié)核球、干酪性肺炎結(jié)核性胸膜

26、炎其他肺外結(jié)核90Primary pulmonary tuberculosis左鎖骨下區(qū)見密度不均影，有纖維索條與肺門腫大的淋巴結(jié)相連91Primary pulmonary tuberculosis92Primary pulmonary tuberculosisLymphadenopathy93急性粟粒性肺結(jié)核兩肺野滿布粟粒影大小相等密度一致分布均勻94Acute military pulmonary tuberculosis兩肺從肺尖至肺底均勻分布、密度相似、大小一致的粟粒樣陰影“三均勻”95Miliary tuberculosis96chronic hematogenous dissemi

27、nated pulmonary tuberculosis病灶主要分布于兩肺上中肺野。分布不均勻，鎖骨下區(qū)病灶較多；以一側(cè)上中肺野為主病灶結(jié)節(jié)大小極不一致，粟粒、粗結(jié)節(jié)或腺泡樣結(jié)節(jié)同時混合存在97Subacute hematogenous disseminated pulmonary tuberculosis雙肺中上野散在大小不等，密度不均的粟粒結(jié)節(jié)98Subacute hematogenous disseminated pulmonary tuberculosis99Secondary pulmonary tuberculosis100結(jié)核球（邊緣鈣化）101干酪性肺炎右肺上野大片致密影，內(nèi)有

28、不均勻透亮區(qū)102慢性纖維空洞型肺結(jié)核103慢性肺結(jié)核104Tuberculosis pleuritis左側(cè)肺下野中量胸腔積液，由結(jié)核性滲出引起105Tuberculosis pleuritis右胸腔包裹性積液106Pulmonary tuberculosis107結(jié)核球108Pulmonary tuberculosis109Hematogenous disseminated pulmonary tuberculosis110肺真菌病又稱肺霉菌病，因抵抗力低下而真菌侵入引起真菌種類多，對人體能致病者只有十余種，按致病部位分為淺部真菌和深部真菌深部真菌多數(shù)可引起肺部病變。常見有曲菌、念珠菌、奴卡

29、菌、放線菌、新型隱球菌等這些真菌有的廣泛存在于自然界中，為腐物寄生菌，有的寄生于正常人體內(nèi)正常人體對真菌有較強的抵抗力，肺真菌病少見111可能引發(fā)肺真菌病的因素機體抵抗力降低口腔衛(wèi)生不佳生活和職業(yè)中接觸較多被真菌孢子污染的物質(zhì)抗生素的大量應(yīng)用，人體對抗生素敏感和不敏感的致病菌之間的相互拮抗作用產(chǎn)生紊亂，敏感者被抑制，有利于不敏感者的繁殖長期應(yīng)用激素使機體的免疫功能低下惡性腫瘤、嚴(yán)重?zé)齻虼笫中g(shù)后，免疫功能低下112感染途徑與病理變化內(nèi)源性：口腔和上呼吸道內(nèi)寄生的真菌，如放線菌和念珠菌，由于口腔衛(wèi)生不佳或身體抵抗力降低時，侵入肺部引起感染外源性：帶有真菌孢子的塵土吸入肺內(nèi)，如奴卡菌病、曲菌病和隱

30、球菌病繼發(fā)性：體內(nèi)其他部位的真菌病變經(jīng)血行或淋巴播散到肺部，或膈下病變直接侵犯蔓延到肺部病理變化：過敏、急性炎癥、化膿性病變、肉芽腫形成、空洞、纖維化和鈣化擴散方式：直接侵犯、淋巴播散和血行播散113肺真菌病影像表現(xiàn)散在性小結(jié)節(jié)：大小不一，密度均勻、邊緣較清楚的圓形陰影斑片狀影：兩肺中下部，邊緣清楚或模糊，可融合呈地圖狀肺段或肺葉實變：斑片狀影可發(fā)展融合為實變，侵犯肺段或肺葉腫塊：常多發(fā)，密度較高，內(nèi)可有多處透亮區(qū)。部分單發(fā)腫塊周圍可見暈輪樣改變，稱暈輪征真菌球：多見于曲菌病?？斩磧?nèi)邊緣光整的球形致密影，曲菌球與洞壁或腔壁之間可見新月狀空隙，為空氣半月征其他：縱隔或肺門淋巴結(jié)腫大、胸腔積液或膿

31、胸，胸膜肥厚粘連。侵犯縱隔及心包，病程長有纖維灶和鈣化灶114影像診斷與鑒別診斷肺曲菌病的曲菌球和暈輪征具特征性，其他肺真菌病影像學(xué)缺乏特征性以下幾點有助于提示肺真菌病的診斷肺部病灶存在時間長，又缺乏某些常見病的特征，且在鑒別中也無其他疾病應(yīng)有的臨床癥狀經(jīng)較長時間的動態(tài)觀察，病灶變化不大，或雖有所變化，但不符合一般炎癥、結(jié)核等病的發(fā)病規(guī)律有長期應(yīng)用大量抗生素、激素、免疫抑制劑等類藥物的病史115肺曲菌病Aspergillosis 又稱肺笰狀菌病，肺部最常見的真菌病曲菌廣泛存在于自然界，孢子在空氣中到處都有，吸入孢子不一定致病，大量吸入可引起急性氣管、支氣管炎或肺炎常寄生在人體上呼吸道，痰培養(yǎng)中

32、?？砂l(fā)現(xiàn)，很少使健康人致病慢性病病人免疫功能低下時，入侵肺發(fā)病116Microscopic features of fumigatusConidiophores with characteristic head appearance and minute sporesseptate hyphae branching at an angle of approximately 45117肺曲菌病 病理發(fā)于肺內(nèi)空洞或空腔，繁殖過程中，菌絲、纖維素、細(xì)胞碎屑及粘液混合形成曲菌球發(fā)生于支氣管者則因過敏反應(yīng)，分泌物增多，曲菌菌絲又使粘液變稠而不易排出，滯留于支氣管內(nèi)，在支氣管內(nèi)形成粘液嵌塞侵襲型為曲菌引起

33、的肺部炎癥、化膿及肉芽腫性病變，病變范圍較廣泛118肺曲菌病 臨床與吸入曲菌量有關(guān)，也與機體對曲菌發(fā)生的變態(tài)反應(yīng)有關(guān)無癥狀有的起病急，有發(fā)熱、咳嗽、咳痰、咯血等癥狀，酷似急性肺炎有的起病緩慢，有低熱、夜間盜汗、咳嗽、咳膿痰帶血，病情時好時壞，頗似肺結(jié)核119X線表現(xiàn)曲菌球:肺空洞內(nèi)類圓形致密影，密度均勻，邊緣光整Mycetomas: a solid, round or oval mass with soft-tissue opacity within a lung cavity小于空洞內(nèi)腔，位置可變，且總處于近地位曲菌球與空洞壁間可見新月形空隙，空氣半月征Separated from the

34、wall of cavity by an airspace of variable size and shape, resulting in the air crescent signMoves with the patient changes position侵襲型: 一側(cè)或兩側(cè)肺野單發(fā)或多發(fā)斑片狀影，也可為肺葉或肺段的實變影，病灶壞死可形成膿腫，少數(shù)見空洞120CT表現(xiàn)薄壁空洞或空腔內(nèi)孤立球形灶，邊緣光滑銳利，大小不等，常見空氣半月征曲菌球處于近地位，軟組織密度，無強化Thickening of cavity wall and adjacent pleura10% of mycetomas

35、 resolve spontaneously支氣管粘液嵌塞表現(xiàn)為柱狀致密影侵襲型曲菌病，早期出現(xiàn)結(jié)節(jié)或腫塊狀實變，周圍見暈輪征，病灶周圍環(huán)繞較低密度GGO區(qū)域，似暈輪，出血所致小葉性實變或小葉融合性影，多發(fā)球形病灶伴空洞形成及肺門淋巴結(jié)腫大 121Bilateral aspergillomasM71, with residual tuberculosis122Aspergilloma in a pulmonary cavityM43change in the positionA fumigates at bronchoscopy123Parasites（寄生蟲?。㎡rganisms obtai

36、n nourishment and shelter from other organismsHost may either be unaffected or suffer harmful consequencesVary widely in size and complexity, from relatively simple unicellular protozoans (amebae) to more complex multicellular organisms ( worms, flukes) Distributed worldwide, a higher prevalence in

37、developing countries, inadequate sanitation124Hydatid Disease（包蟲?。┓伟x病（棘球蚴?。?，為細(xì)粒棘球絳蟲或多房棘球絳蟲之幼蟲感染所致，在人體寄生的棘球蚴病稱為包蟲囊腫A worldwide zoonosis produced by the larval stage of the Echinococcus tapewormTwo main types of hydatid disease are caused by E granulosus and E multilocularisCommonly in great grazing

38、regions of the worldMediterranean region, Africa, South America, the Middle East, Australia, and New Zealand傳染源多為狗，寄生于狗腸內(nèi)的細(xì)粒棘球絳蟲蟲卵隨糞便排出污染牲畜皮毛、水源及牧草等，病人多因食入污染的食物或水而感染，蟲卵也可經(jīng)呼吸道吸入而發(fā)生感染125Geographic distribution of hydatid diseaseTransmitted by means of the dog-sheep cycle (solid red areas)Transmitted b

39、y means of alternative life cycles in carnivores as wolves and foxes serve as definitive hosts and goats, camels, and horses serve as intermediate hosts (red stripes )126Life Cycle of E granulosusDefinitive host is a dog (or other carnivore)Adult worm lives in proximal small bowel of the definitive

40、host, attached by hooklets to the mucosaEggs are released into intestine and excreted in fecesSheep are common intermediate hosts. They ingest the ovum while grazing on contaminated groundOvum loses its protective chitinous layer as it is digested in the duodenumReleased hexacanth embryo, or oncosph

41、ere, passes through the intestinal wall into the portal circulation and develops into a cyst within the liver127Life Cycle of E granulosusWhen the definitive host eats the viscera of the intermediate host, the cycle is completedHumans may e intermediate hosts through contact with a definitive host (

42、usually a domesticated dog) or ingestion of contaminated water or vegetablesOnce in the human liver, cysts grow to 1 cm during the first 6 months and 23 cm annually thereafter, depending on host tissue resistance128發(fā)病過程棘球蚴蟲卵在十二指腸內(nèi)孵化為六鉤蚴，進入腸壁的毛細(xì)血管，并經(jīng)門脈至肝臟，再經(jīng)肝靜脈、下腔靜脈、右心、肺動脈到達(dá)肺六鉤蚴周圍有大單核細(xì)胞和嗜酸性粒細(xì)胞浸潤，并逐漸長

43、成棘球蚴的囊狀體，可形成巨大囊腫包蟲囊腫壁分兩層，外層為角質(zhì)層，較堅韌，起保護和營養(yǎng)胚層的作用；內(nèi)層為胚層（或稱為生發(fā)層），能分泌液體，具有繁殖作用，液體內(nèi)有毛鉤和頭節(jié)，頭節(jié)脫落則形成子囊囊腫破裂，囊液溢出，頭節(jié)可在鄰近形成新的囊腫肺包蟲囊腫可破入支氣管及繼發(fā)感染129Life cycle (dog-sheep cycle) of E granulosusDiagram shows the most prevalent life cycle of E granulosus, in which a dog and sheep serve as the definitive and interme

44、diate hosts, respectively 130Hydatid Disease in humansOnce the parasite passes through the intestinal wall to reach the portal venous system or lymphatic system, the liver acts as the first line of defense and is therefore the most frequently involved organliver in 75%, lung in 15%, other in 10%The

45、lungs are the second most frequent site of hematogenous spread in adults and probably the most common site in children131Hematogenous DisseminationCompressible organs such as the lung or brain facilitate the growth of the cystMost cysts are acquired in childhood, remain asymptomatic for a long perio

46、d of time, and are later diagnosed incidentally at chest radiographyCysts are multiple in 30% of cases, bilateral in 20%, and located in the lower lobes in 60%Calcification in pulmonary cysts is rare132Hydatid cyst has three layersOuter pericyst, composed of modified host cells that form a dense and

47、 fibrous protective zoneMiddle laminated membrane, which is acellular and allows the passage of nutrientsInner germinal layer, where the scolices (the larval stage of the parasite) and the laminated membrane are producedMiddle laminated membrane and the germinal layer form the true wall of the cyst1

48、33癥狀較小的包蟲囊腫可無癥狀咳嗽、咯血、胸痛及發(fā)熱，Coughing, hemoptysis, and chest painRupture into the pleural cavity may occur, 破入胸腔引起氣胸和胸腔積液破入支氣管時咳出大量囊液嗜酸性粒細(xì)胞增多皮試及血清學(xué)試驗有助診斷134X線單發(fā)或多發(fā)的圓形或類圓形影，110cm密度均勻，囊狀，邊緣光滑清楚，可環(huán)形鈣化外囊破裂，并與支氣管相通，少量氣體進入內(nèi)外囊之間，在囊腫上部形成新月形透亮影內(nèi)外囊同時破裂，并與支氣管相通，部分囊內(nèi)的內(nèi)容物咳出，空氣進入囊內(nèi)形成氣液平面內(nèi)外囊同時破裂后，若內(nèi)囊塌陷，漂浮于液平面上形成凹凸不平

49、的形態(tài)，稱為“水上浮蓮”征肺表面的囊腫破裂可形成氣胸或液氣胸135Pulmonary hydatid cystWell-defined mass, round, oval, polycyclicAir collection appears as a thin, radiolucent crescent in upper part of cyst and is known as the crescent sign or meniscus signAs air continues to enter this space, the two layers separate completely and

50、 the cyst shrinks and ruptures, allowing the passage of air into the endocystAn air-fluid level inside the endocyst and air between the pericyst and the endocyst with an onion peel appearance constitute the Cumbo sign136Pulmonary hydatid cystPartial expectoration of the cyst fluid and scolices, the

51、cyst empties and the collapsed membranes be seen inside the cyst (serpent sign)Completely collapsed, the crumpled endocyst floats freely in the cyst fluid (water lily sign) Fluid is entirely evacuated by expectoration, the remaining solid components will fall to the most dependent part of the cavity

52、 (mass within a cavity) 137CT囊腫1cm以下時，邊緣模糊的片狀影2cm，輪廓清楚的類圓形囊性影，分葉狀。邊緣光整，密度均勻，液體密度囊壁薄厚不一，囊腫與胸膜或縱隔相鄰處變平囊腫衰老呈不規(guī)則狀，形似實質(zhì)性腫瘤，但密度仍較低合并感染時邊緣模糊，類似肺膿腫破裂形成支氣管瘺，咳出部分囊液且空氣進入囊內(nèi)后出現(xiàn)氣液面破入支氣管后，若外囊有細(xì)小裂口而內(nèi)囊未破，可有少量氣體進入內(nèi)外囊之間，呈現(xiàn)新月形或鐮刀狀氣體影空氣進入外囊，內(nèi)囊塌陷并漂浮于液面，“水上浮蓮征”138Pulmonary hydatid cystM3A well-circumscribed, masslike les

53、ion with a polycyclic configuration in the left lower lobeObliteration of the left costophrenic angle 139Open lung cystsA child with fever, cough, and expectoration Left lateral decubitus positionA large cavitary lesion with an air-fluid level in the inferior left lungAir between pericyst and lamina

54、ted membrane of the cyst 140A child with previous episodes of cough and expectorationLateral chest radiographAn intracystic serpentine structure representing collapsed membranes141Open lung cystM20left lateral decubitus positionA cavitary in the right upper lobe with solid contents that have settled

55、 in dependent part of cavitysolid component is detached, crumpled endocyst 142Pulmonary hydatid disease, E granulosusM43, A large cyst in the right lower lungF32, A hypoattenuating crescent sign (meniscus sign)143Polycystic echinococcosisM25Multiple peripheral round areas of soft-tissue opacity144Po

56、lycystic echinococcosisClearly defined capsule with a relatively hypoattenuating centerE vogeli was identified at pathologic analysis as the etiologic agent145Polycystic echinococcosis of the chest wall from E vogeliM13Cystic thickening of the pleura with chest wall involvement 146肺吸蟲病肺吸蟲囊蚴經(jīng)消化道而感染人體

57、，肺吸蟲囊蚴寄生在中間宿主石蟹及喇蛄等體內(nèi)，當(dāng)生食或食入未煮熟的石蟹、喇蛄而感染后，肺吸蟲幼蟲在腸道內(nèi)脫囊后穿過腸壁進入腹腔，12周后經(jīng)膈進入胸腔及肺而引起感染肺吸蟲在肺內(nèi)由幼蟲發(fā)育為成蟲，在蟲體周圍肺組織充血并發(fā)生炎性反應(yīng)。蟲體在肺內(nèi)可隨意穿行，形成隧道樣腔隙或囊腫。增生的纖維組織包裹蟲體則形成囊腫樣病變，當(dāng)囊腫樣病變內(nèi)的成蟲死亡或脫落后病變可吸收或縮小，也可發(fā)生纖維化或鈣化147Paragonimiasis（肺吸蟲?。〤aused by the trematode Paragonimus westermani or other Paragonimus species through the

58、 ingestion of raw or partially cooked freshwater crabs or crayfish infected with the metacercariaThe main endemic areas are east Asia, Southeast Asia, Latin America (primarily Peru), and Africa (primarily Nigeria)148Geographic distribution of Paragonimus species149Life cycle of Paragonimus species15

59、0ParagonimiasisThe lung is the target organFever, chest pain, respiratory symptoms such as chronic cough and hemoptysisConfirmed by detecting parasite eggs in the sputum, pleural fluid, or fecesLarvae often be found at bronchial brushingIntradermal and serologic tests are also available151臨床表現(xiàn)咳嗽、咳痰、咯血、胸痛、氣短等呼吸道癥狀，咳果醬樣粘痰為特征性表現(xiàn)疲乏及體重減輕，如無混合感染也可不發(fā)熱痰中可找到肺吸蟲蟲卵、嗜酸性粒細(xì)胞和夏科雷登結(jié)晶 152X線肺內(nèi)浸潤影，1-3cm，邊緣模糊，密度低，為肺吸蟲引起的肺內(nèi)出血及組織破壞，中下肺多見浸潤陰影內(nèi)見單發(fā)或多發(fā)囊狀透明區(qū)，多位