結節(jié)病HRCT診斷及鑒別診斷課件整理

肺結節(jié)病(Sarcoidosis)HRCT診斷及鑒別診斷肺結節(jié)病(Sarcoidosis)HRCT1概述結節(jié)病是一種未知病因的多系統(tǒng)慢性炎性疾病。病理上結節(jié)病為非干酪性肉芽腫,可累及幾乎任何器官。肺實質、縱隔和肺門淋巴結受累最為常見,占患者總數(shù)的90%,并占本病發(fā)病率和死亡率的大部分。在結節(jié)病的某些階段約90%的患者可出現(xiàn)胸部放射影像異常,估計20%演變成慢性肺疾病導致肺纖維化概述2流行病學令盡管結節(jié)病可發(fā)生于任何年齡,但一般發(fā)生于小于40歲的成人,發(fā)病高峰在20-29歲。婦女發(fā)生率略高于男性。流行病學3臨床特點最常見的臨床特點是呼吸系統(tǒng)癥狀(即咳嗽、呼吸困難、支氣管高敏感),疲勞、盜汗、體重減輕和結節(jié)性紅斑。但有50%的結節(jié)病沒有癥狀,只是偶然在胸片上發(fā)現(xiàn)異常。令肺功能檢査一般表現(xiàn)為肺活量減小和一氧化碳彌散能力減低的限制性通氣障礙。如果出現(xiàn)支氣管內結節(jié)病,就會發(fā)生阻塞性通氣障礙。在5.7%結節(jié)病例中存在氣道阻塞,被認為是預后不良的表現(xiàn)。臨床特點4病因遺傳因素:結節(jié)病可能為一種多基因遺傳病。環(huán)境與職業(yè)因素:金屬鋁、鋯、鈹,滑石粉、松樹花粉、黏土等也可能與本病的發(fā)生有關感染因素:某些病源微生物可誘發(fā)本病。但本病對激素治療反應良好,說明感染在結節(jié)病的發(fā)病中并非持續(xù)存在,否則會造成感染的擴散。因此,目前尚無法確認感染因素和結節(jié)病之間的因果關系。免疫學因素:T淋巴細胞受體(TCR)的質或量的異常與結節(jié)病的發(fā)生有關。病因5結節(jié)病HRCT診斷及鑒別診斷課件整理6結節(jié)病HRCT診斷及鑒別診斷課件整理7結節(jié)病HRCT診斷及鑒別診斷課件整理8結節(jié)病HRCT診斷及鑒別診斷課件整理9結節(jié)病HRCT診斷及鑒別診斷課件整理10結節(jié)病HRCT診斷及鑒別診斷課件整理11結節(jié)病HRCT診斷及鑒別診斷課件整理12結節(jié)病HRCT診斷及鑒別診斷課件整理13結節(jié)病HRCT診斷及鑒別診斷課件整理14結節(jié)病HRCT診斷及鑒別診斷課件整理15結節(jié)病HRCT診斷及鑒別診斷課件整理16結節(jié)病HRCT診斷及鑒別診斷課件整理17結節(jié)病HRCT診斷及鑒別診斷課件整理18結節(jié)病HRCT診斷及鑒別診斷課件整理19結節(jié)病HRCT診斷及鑒別診斷課件整理20結節(jié)病HRCT診斷及鑒別診斷課件整理21結節(jié)病HRCT診斷及鑒別診斷課件整理22結節(jié)病HRCT診斷及鑒別診斷課件整理23結節(jié)病HRCT診斷及鑒別診斷課件整理24結節(jié)病HRCT診斷及鑒別診斷課件整理25結節(jié)病HRCT診斷及鑒別診斷課件整理26結節(jié)病HRCT診斷及鑒別診斷課件整理27結節(jié)病HRCT診斷及鑒別診斷課件整理28結節(jié)病HRCT診斷及鑒別診斷課件整理29結節(jié)病HRCT診斷及鑒別診斷課件整理30結節(jié)病HRCT診斷及鑒別診斷課件整理31結節(jié)病HRCT診斷及鑒別診斷課件整理32結節(jié)病HRCT診斷及鑒別診斷課件整理33結節(jié)病HRCT診斷及鑒別診斷課件整理34結節(jié)病HRCT診斷及鑒別診斷課件整理35結節(jié)病HRCT診斷及鑒別診斷課件整理36結節(jié)病HRCT診斷及鑒別診斷課件整理37結節(jié)病HRCT診斷及鑒別診斷課件整理38結節(jié)病HRCT診斷及鑒別診斷課件整理39結節(jié)病HRCT診斷及鑒別診斷課件整理40結節(jié)病HRCT診斷及鑒別診斷課件整理41結節(jié)病HRCT診斷及鑒別診斷課件整理42結節(jié)病HRCT診斷及鑒別診斷課件整理43結節(jié)病HRCT診斷及鑒別診斷課件整理44結節(jié)病HRCT診斷及鑒別診斷課件整理45結節(jié)病HRCT診斷及鑒別診斷課件整理46結節(jié)病HRCT診斷及鑒別診斷課件整理47結節(jié)病HRCT診斷及鑒別診斷課件整理48結節(jié)病HRCT診斷及鑒別診斷課件整理49結節(jié)病HRCT診斷及鑒別診斷課件整理50結節(jié)病HRCT診斷及鑒別診斷課件整理51結節(jié)病HRCT診斷及鑒別診斷課件整理52結節(jié)病HRCT診斷及鑒別診斷課件整理53結節(jié)病HRCT診斷及鑒別診斷課件整理54結節(jié)病HRCT診斷及鑒別診斷課件整理55結節(jié)病HRCT診斷及鑒別診斷課件整理56結節(jié)病HRCT診斷及鑒別診斷課件整理57結節(jié)病HRCT診斷及鑒別診斷課件整理58結節(jié)病HRCT診斷及鑒別診斷課件整理59結節(jié)病HRCT診斷及鑒別診斷課件整理60結節(jié)病HRCT診斷及鑒別診斷課件整理61結節(jié)病HRCT診斷及鑒別診斷課件整理62結節(jié)病HRCT診斷及鑒別診斷課件整理63結節(jié)病HRCT診斷及鑒別診斷課件整理64結節(jié)病HRCT診斷及鑒別診斷課件整理65結節(jié)病HRCT診斷及鑒別診斷課件整理66結節(jié)病HRCT診斷及鑒別診斷課件整理67結節(jié)病HRCT診斷及鑒別診斷課件整理68結節(jié)病HRCT診斷及鑒別診斷課件整理69結節(jié)病HRCT診斷及鑒別診斷課件整理70結節(jié)病HRCT診斷及鑒別診斷課件整理71結節(jié)病HRCT診斷及鑒別診斷課件整理72結節(jié)病HRCT診斷及鑒別診斷課件整理73結節(jié)病HRCT診斷及鑒別診斷課件整理74結節(jié)病HRCT診斷及鑒別診斷課件整理75結節(jié)病HRCT診斷及鑒別診斷課件整理76結節(jié)病HRCT診斷及鑒別診斷課件整理77結節(jié)病HRCT診斷及鑒別診斷課件整理78結節(jié)病HRCT診斷及鑒別診斷課件整理79結節(jié)病HRCT診斷及鑒別診斷課件整理80結節(jié)病HRCT診斷及鑒別診斷課件整理81結節(jié)病HRCT診斷及鑒別診斷課件整理82結節(jié)病HRCT診斷及鑒別診斷課件整理83結節(jié)病HRCT診斷及鑒別診斷課件整理84結節(jié)病HRCT診斷及鑒別診斷課件整理85結節(jié)病HRCT診斷及鑒別診斷課件整理86結節(jié)病HRCT診斷及鑒別診斷課件整理87結節(jié)病HRCT診斷及鑒別診斷課件整理88結節(jié)病HRCT診斷及鑒別診斷課件整理89結節(jié)病HRCT診斷及鑒別診斷課件整理90結節(jié)病HRCT診斷及鑒別診斷課件整理91結節(jié)病HRCT診斷及鑒別診斷課件整理92結節(jié)病HRCT診斷及鑒別診斷課件整理93結節(jié)病HRCT診斷及鑒別診斷課件整理94結節(jié)病HRCT診斷及鑒別診斷課件整理95結節(jié)病HRCT診斷及鑒別診斷課件整理96結節(jié)病HRCT診斷及鑒別診斷課件整理97結節(jié)病HRCT診斷及鑒別診斷課件整理98結節(jié)病HRCT診斷及鑒別診斷課件整理99結節(jié)病HRCT診斷及鑒別診斷課件整理100結節(jié)病HRCT診斷及鑒別診斷課件整理101結節(jié)病HRCT診斷及鑒別診斷課件整理102結節(jié)病HRCT診斷及鑒別診斷課件整理103結節(jié)病HRCT診斷及鑒別診斷課件整理104結節(jié)病HRCT診斷及鑒別診斷課件整理105結節(jié)病HRCT診斷及鑒別診斷課件整理106結節(jié)病HRCT診斷及鑒別診斷課件整理107結節(jié)病HRCT診斷及鑒別診斷課件整理108結節(jié)病HRCT診斷及鑒別診斷課件整理109結節(jié)病HRCT診斷及鑒別診斷課件整理110結節(jié)病HRCT診斷及鑒別診斷課件整理111結節(jié)病HRCT診斷及鑒別診斷課件整理112結節(jié)病HRCT診斷及鑒別診斷課件整理113結節(jié)病HRCT診斷及鑒別診斷課件整理114結節(jié)病HRCT診斷及鑒別診斷課件整理115結節(jié)病HRCT診斷及鑒別診斷課件整理116結節(jié)病HRCT診斷及鑒別診斷課件整理117結節(jié)病HRCT診斷及鑒別診斷課件整理118結節(jié)病HRCT診斷及鑒別診斷課件整理119結節(jié)病HRCT診斷及鑒別診斷課件整理120結節(jié)病HRCT診斷及鑒別診斷課件整理121結節(jié)病HRCT診斷及鑒別診斷課件整理122結節(jié)病HRCT診斷及鑒別診斷課件整理123結節(jié)病HRCT診斷及鑒別診斷課件整理124結節(jié)病HRCT診斷及鑒別診斷課件整理125結節(jié)病HRCT診斷及鑒別診斷課件整理126結節(jié)病HRCT診斷及鑒別診斷課件整理127結節(jié)病HRCT診斷及鑒別診斷課件整理128結節(jié)病HRCT診斷及鑒別診斷課件整理129結節(jié)病HRCT診斷及鑒別診斷課件整理130結節(jié)病HRCT診斷及鑒別診斷課件整理131結節(jié)病HRCT診斷及鑒別診斷課件整理132結節(jié)病HRCT診斷及鑒別診斷課件整理133結節(jié)病HRCT診斷及鑒別診斷課件整理134結節(jié)病HRCT診斷及鑒別診斷課件整理135結節(jié)病HRCT診斷及鑒別診斷課件整理136結節(jié)病HRCT診斷及鑒別診斷課件整理137結節(jié)病HRCT診斷及鑒別診斷課件整理138結節(jié)病HRCT診斷及鑒別診斷課件整理139結節(jié)病HRCT診斷及鑒別診斷課件整理140結節(jié)病HRCT診斷及鑒別診斷課件整理141結節(jié)病HRCT診斷及鑒別診斷課件整理142結節(jié)病HRCT診斷及鑒別診斷課件整理143結節(jié)病HRCT診斷及鑒別診斷課件整理144結節(jié)病HRCT診斷及鑒別診斷課件整理145結節(jié)病HRCT診斷及鑒別診斷課件整理146結節(jié)病HRCT診斷及鑒別診斷課件整理147肺結節(jié)病(Sarcoidosis)HRCT診斷及鑒別診斷肺結節(jié)病(Sarcoidosis)HRCT148概述結節(jié)病是一種未知病因的多系統(tǒng)慢性炎性疾病。病理上結節(jié)病為非干酪性肉芽腫,可累及幾乎任何器官。肺實質、縱隔和肺門淋巴結受累最為常見,占患者總數(shù)的90%,并占本病發(fā)病率和死亡率的大部分。在結節(jié)病的某些階段約90%的患者可出現(xiàn)胸部放射影像異常,估計20%演變成慢性肺疾病導致肺纖維化概述149流行病學令盡管結節(jié)病可發(fā)生于任何年齡,但一般發(fā)生于小于40歲的成人,發(fā)病高峰在20-29歲。婦女發(fā)生率略高于男性。流行病學150臨床特點最常見的臨床特點是呼吸系統(tǒng)癥狀(即咳嗽、呼吸困難、支氣管高敏感),疲勞、盜汗、體重減輕和結節(jié)性紅斑。但有50%的結節(jié)病沒有癥狀,只是偶然在胸片上發(fā)現(xiàn)異常。令肺功能檢査一般表現(xiàn)為肺活量減小和一氧化碳彌散能力減低的限制性通氣障礙。如果出現(xiàn)支氣管內結節(jié)病,就會發(fā)生阻塞性通氣障礙。在5.7%結節(jié)病例中存在氣道阻塞,被認為是預后不良的表現(xiàn)。臨床特點151病因遺傳因素:結節(jié)病可能為一種多基因遺傳病。環(huán)境與職業(yè)因素:金屬鋁、鋯、鈹,滑石粉、松樹花粉、黏土等也可能與本病的發(fā)生有關感染因素:某些病源微生物可誘發(fā)本病。但本病對激素治療反應良好,說明感染在結節(jié)病的發(fā)病中并非持續(xù)存在,否則會造成感染的擴散。因此,目前尚無法確認感染因素和結節(jié)病之間的因果關系。免疫學因素:T淋巴細胞受體(TCR)的質或量的異常與結節(jié)病的發(fā)生有關。病因152結節(jié)病HRCT診斷及鑒別診斷課件整理153結節(jié)病HRCT診斷及鑒別診斷課件整理154結節(jié)病HRCT診斷及鑒別診斷課件整理155結節(jié)病HRCT診斷及鑒別診斷課件整理156結節(jié)病HRCT診斷及鑒別診斷課件整理157結節(jié)病HRCT診斷及鑒別診斷課件整理158結節(jié)病HRCT診斷及鑒別診斷課件整理159結節(jié)病HRCT診斷及鑒別診斷課件整理160結節(jié)病HRCT診斷及鑒別診斷課件整理161結節(jié)病HRCT診斷及鑒別診斷課件整理162結節(jié)病HRCT診斷及鑒別診斷課件整理163結節(jié)病HRCT診斷及鑒別診斷課件整理164結節(jié)病HRCT診斷及鑒別診斷課件整理165結節(jié)病HRCT診斷及鑒別診斷課件整理166結節(jié)病HRCT診斷及鑒別診斷課件整理167結節(jié)病HRCT診斷及鑒別診斷課件整理168結節(jié)病HRCT診斷及鑒別診斷課件整理169結節(jié)病HRCT診斷及鑒別診斷課件整理170結節(jié)病HRCT診斷及鑒別診斷課件整理171結節(jié)病HRCT診斷及鑒別診斷課件整理172結節(jié)病HRCT診斷及鑒別診斷課件整理173結節(jié)病HRCT診斷及鑒別診斷課件整理174結節(jié)病HRCT診斷及鑒別診斷課件整理175結節(jié)病HRCT診斷及鑒別診斷課件整理176結節(jié)病HRCT診斷及鑒別診斷課件整理177結節(jié)病HRCT診斷及鑒別診斷課件整理178結節(jié)病HRCT診斷及鑒別診斷課件整理179結節(jié)病HRCT診斷及鑒別診斷課件整理180結節(jié)病HRCT診斷及鑒別診斷課件整理181結節(jié)病HRCT診斷及鑒別診斷課件整理182結節(jié)病HRCT診斷及鑒別診斷課件整理183結節(jié)病HRCT診斷及鑒別診斷課件整理184結節(jié)病HRCT診斷及鑒別診斷課件整理185結節(jié)病HRCT診斷及鑒別診斷課件整理186結節(jié)病HRCT診斷及鑒別診斷課件整理187結節(jié)病HRCT診斷及鑒別診斷課件整理188結節(jié)病HRCT診斷及鑒別診斷課件整理189結節(jié)病HRCT診斷及鑒別診斷課件整理190結節(jié)病HRCT診斷及鑒別診斷課件整理191結節(jié)病HRCT診斷及鑒別診斷課件整理192結節(jié)病HRCT診斷及鑒別診斷課件整理193結節(jié)病HRCT診斷及鑒別診斷課件整理194結節(jié)病HRCT診斷及鑒別診斷課件整理195結節(jié)病HRCT診斷及鑒別診斷課件整理196結節(jié)病HRCT診斷及鑒別診斷課件整理197結節(jié)病HRCT診斷及鑒別診斷課件整理198結節(jié)病HRCT診斷及鑒別診斷課件整理199結節(jié)病HRCT診斷及鑒別診斷課件整理200結節(jié)病HRCT診斷及鑒別診斷課件整理201結節(jié)病HRCT診斷及鑒別診斷課件整理202結節(jié)病HRCT診斷及鑒別診斷課件整理203結節(jié)病HRCT診斷及鑒別診斷課件整理204結節(jié)病HRCT診斷及鑒別診斷課件整理205結節(jié)病HRCT診斷及鑒別診斷課件整理206結節(jié)病HRCT診斷及鑒別診斷課件整理207結節(jié)病HRCT診斷及鑒別診斷課件整理208結節(jié)病HRCT診斷及鑒別診斷課件整理209結節(jié)病HRCT診斷及鑒別診斷課件整理210結節(jié)病HRCT診斷及鑒別診斷課件整理211結節(jié)病HRCT診斷及鑒別診斷課件整理212結節(jié)病HRCT診斷及鑒別診斷課件整理213結節(jié)病HRCT診斷及鑒別診斷課件整理214結節(jié)病HRCT診斷及鑒別診斷課件整理215結節(jié)病HRCT診斷及鑒別診斷課件整理216結節(jié)病HRCT診斷及鑒別診斷課件整理217結節(jié)病HRCT診斷及鑒別診斷課件整理218結節(jié)病HRCT診斷及鑒別診斷課件整理219結節(jié)病HRCT診斷及鑒別診斷課件整理220結節(jié)病HRCT診斷及鑒別診斷課件整理221結節(jié)病HRCT診斷及鑒別診斷課件整理222結節(jié)病HRCT診斷及鑒別診斷課件整理223結節(jié)病HRCT診斷及鑒別診斷課件整理224結節(jié)病HRCT診斷及鑒別診斷課件整理225結節(jié)病HRCT診斷及鑒別診斷課件整理226結節(jié)病HRCT診斷及鑒別診斷課件整理227結節(jié)病HRCT診斷及鑒別診斷課件整理228結節(jié)病HRCT診斷及鑒別診斷課件整理229結節(jié)病HRCT診斷及鑒別診斷課件整理230結節(jié)病HRCT診斷及鑒別診斷課件整理231結節(jié)病HRCT診斷及鑒別診斷課件整理232結節(jié)病HRCT診斷及鑒別診斷課件整理233結節(jié)病HRCT診斷及鑒別診斷課件整理234結節(jié)病HRCT診斷及鑒別診斷課件整理235結節(jié)病HRCT診斷及鑒別診斷課件整理236結節(jié)病HRCT診斷及鑒別診斷課件整理237結節(jié)病HRCT診斷及鑒別診斷課件整理238結節(jié)病HRCT診斷及鑒別診斷課件整理239結節(jié)病HRCT診斷及鑒別診斷課件整理240結節(jié)病HRCT診斷及鑒別診斷課件整理241結節(jié)病HRCT診斷及鑒別診斷課件整理242結節(jié)病HRCT診斷及鑒別診斷課件整理243結節(jié)病HRCT診斷及鑒別診斷課件整理244結節(jié)病HRCT診斷及鑒別診斷課件整理245結節(jié)病HRCT診斷及鑒別診斷課件整理246結節(jié)病HRCT診斷及鑒別診斷課件整理247結節(jié)病HRCT診斷及鑒別診斷課件整理248結節(jié)病HRCT診斷及鑒別診斷課件整理249結節(jié)病HRCT診斷及鑒別診斷課件整理250結節(jié)病HRCT診斷及鑒別診斷課件整理251結節(jié)病HRCT診斷及鑒別診斷課件整理252結節(jié)病HRCT診斷及鑒別診斷課件整理253結節(jié)病HRCT診斷及鑒別診斷課件整理254結節(jié)病HRCT診斷及鑒別診斷課件整理255結節(jié)病HRCT診斷及鑒別診斷課件整理256結節(jié)病HRCT診斷及鑒別診斷課件整理257結節(jié)病HRCT診斷及鑒別診斷課件整理258結節(jié)病HRCT診斷及鑒別診斷課件整理259結節(jié)病HRCT診斷及鑒別診斷課件整理260結節(jié)病HRC