胸部常見(jiàn)征象認(rèn)讀詳解演示文稿

胸部常見(jiàn)征象認(rèn)讀詳解演示文稿當(dāng)前第1頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)（優(yōu)選）胸部常見(jiàn)征象認(rèn)讀當(dāng)前第2頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)小葉支氣管、終末細(xì)支氣管當(dāng)前第3頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)肺動(dòng)脈pulmonaryartery

當(dāng)前第4頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)小葉間隔interlobularsepta

當(dāng)前第5頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)肺靜脈pulmonaryvein

當(dāng)前第6頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)腺泡pulmonaryacini

當(dāng)前第7頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)正常HRCT.當(dāng)前第8頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)中央肺動(dòng)脈。當(dāng)前第9頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)支氣管與相鄰肺動(dòng)脈直徑大致相等。當(dāng)前第10頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)肺動(dòng)脈常分為兩個(gè)直徑相當(dāng)?shù)姆种А?/p>

當(dāng)前第11頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)肺靜脈常分成許多細(xì)小的分支,這些分支與主支構(gòu)成直角。

當(dāng)前第12頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)葉間裂（厚度小于1mm，邊緣光滑，均一厚度）當(dāng)前第13頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)常見(jiàn)偽影雙側(cè)下肺近心臟處，肺血管脈動(dòng)偽影。低密度區(qū)，可以錯(cuò)當(dāng)作擴(kuò)大的支氣管。當(dāng)前第14頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)常見(jiàn)偽影主葉裂偽影。當(dāng)前第15頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)常見(jiàn)偽影血管雙重偽影。當(dāng)前第16頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)正常小葉間隔normalsepta

當(dāng)前第17頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)正常小葉中心動(dòng)脈當(dāng)前第18頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)正常小葉中心動(dòng)脈centrilobularartery2當(dāng)前第19頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)肺靜脈Pulmonaryveins

當(dāng)前第20頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)肺間質(zhì)病變發(fā)生于：慢性間質(zhì)性肺炎、彌漫性間質(zhì)纖維化、結(jié)節(jié)病、癌性淋巴管炎、結(jié)締組織?。t斑狼瘡、類風(fēng)濕性關(guān)節(jié)炎、硬皮病、皮肌炎）、塵肺（矽肺、煤矽肺、石棉肺）、組織細(xì)胞?。?、淋巴管平滑肌瘤病。ＣＴ：界面征、小葉間隔增厚、小葉中心結(jié)構(gòu)增厚、胸膜下線、長(zhǎng)疤痕線（扭曲肺結(jié)構(gòu)）、蜂窩樣改變、結(jié)節(jié)影、牽拉性支擴(kuò)、磨玻璃樣改變。當(dāng)前第21頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)Case1F/60y乳腺癌術(shù)后，現(xiàn)呼吸困難。當(dāng)前第22頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)分析：（1）小葉間隔增厚當(dāng)前第23頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)分析：（2）支氣管血管周?chē)g質(zhì)增厚支氣管袖口癥：當(dāng)前第24頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)分析：(3)斜裂增厚當(dāng)前第25頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)分析：（4）大結(jié)節(jié)影當(dāng)前第26頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)網(wǎng)狀陰影：病理上主要為小葉間隔增厚、小葉內(nèi)間隔增厚、小葉核心增厚、胸膜下線影、蜂窩肺和支氣管血管周?chē)g質(zhì)增厚等改變?？梢?jiàn)于特發(fā)性間質(zhì)性肺炎、結(jié)節(jié)病、癌性淋巴管炎、特發(fā)性含鐵血黃素沉積、感染性疾病等。雙肺網(wǎng)狀陰影多見(jiàn)與特發(fā)性間質(zhì)性肺炎、結(jié)締組織病肺浸潤(rùn)、結(jié)節(jié)病等。單側(cè)以癌性淋巴管炎和放射性肺炎為主。當(dāng)前第27頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)上病例為癌性淋巴管炎。當(dāng)前第28頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)Case279歲、淋巴瘤病史當(dāng)前第29頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)當(dāng)前第30頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)小葉間隔增厚？(a)Yes(b)No當(dāng)前第31頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)雙側(cè)光滑增厚的小葉間隔當(dāng)前第32頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)支氣管血管間質(zhì)是否增厚？(a)Yes(b)No當(dāng)前第33頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)增厚的支氣管血管間質(zhì)當(dāng)前第34頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)胸膜下間質(zhì)增厚？(a)Yes(b)No當(dāng)前第35頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)斜裂增厚當(dāng)前第36頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)Whatisthemostlikelydiagnosis?最可能的診斷？？？(a)Pulmonaryedema(肺水腫）(b)Interstitialfibrosis（間質(zhì)纖維化）(c)Lymphangiticspreadoflymphoma（癌性淋巴管炎）當(dāng)前第37頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)Diagnosis:Lymphangiticspreadoflymphoma,withinterlobularseptalthickening。癌性淋巴管炎（小葉間隔增厚）當(dāng)前第38頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)lymphocyticinterstitialpneumonitis(LIP)淋巴間質(zhì)局限性肺炎當(dāng)前第39頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)Case358-year-oldmanwithheartdisease當(dāng)前第40頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)小葉間隔增厚？？？(a)Yes(b)No當(dāng)前第41頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)雙側(cè)小葉間隔增厚當(dāng)前第42頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)支氣管血管間質(zhì)增厚？？？(a)Yes(b)No當(dāng)前第43頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)支氣管血管間質(zhì)增厚當(dāng)前第44頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)Istherethickeningofthesubpleuralinterstitium?(胸膜下間質(zhì)增厚？)(a)Yes(b)No當(dāng)前第45頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)NO!!!當(dāng)前第46頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)Whatisthemostlikelydiagnosis?(最可能的診斷？)(a)Pulmonaryedema肺水腫(b)Interstitialfibrosis間質(zhì)纖維化(c)Lymphangiticspreadofcarcinoma癌性淋巴管炎當(dāng)前第47頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)(a)Pulmonaryedema肺水腫Correct.Becauseofthehistoryofheartdisease心臟病史,characteristicabnormalities典型的異常,ymmetry對(duì)稱,andthepredominanceofseptalthickeningindependentlung,thisdiagnosismustbeconsidered考慮mostlikely.當(dāng)前第48頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)文獻(xiàn)：間質(zhì)性肺水腫（1）肺血重新分布：左心衰--肺淤血。（2）支氣管周?chē)淇诎Y：正常厚度約1mm—結(jié)締組織內(nèi)液體存積—增厚。X-肺紋理及肺門(mén)血管增粗、模糊.（3）肺透過(guò)度下降：液體分布到支氣管血管周?chē)?、小葉間隔、小葉內(nèi)支氣管血管周?chē)?、肺泡間隔—透過(guò)度下降。（4）間隔線：KerleyB線—x上與肋膈角處與胸膜垂直。（5）胸膜增厚：液體—入臟層胸膜下薄層結(jié)締組織—胸膜下結(jié)締組織水腫--水腫位于臟層胸膜與結(jié)體組織間，不隨體位移動(dòng)。（６）胸腔積液：胸膜腔內(nèi)液體來(lái)自壁層胸膜。當(dāng)前第49頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)不同原因的肺水腫心源性肺水腫：左心衰（見(jiàn)于心梗、二尖瓣病變。腎性肺水腫：急慢性腎功能衰竭，可合并尿毒癥－－水鈉潴留、左心衰－肺水腫－－上腔靜脈、奇靜脈增寬。肺微血管損傷性肺水腫：除肺水腫外，還可見(jiàn)出血及細(xì)胞滲出–肺血分布正常、無(wú)袖口癥、間隔線。肺泡實(shí)變斑片狀，肺野外為分布。毒性氣體吸入、胃液吸入、藥物、溺水、顱內(nèi)壓升高、高原性肺水腫、復(fù)張性肺水腫。當(dāng)前第50頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)Case4a53-year-oldwomanwithandabnormalchestradiographandmildshortness（短缺）ofbreath（異常胸片，氣短）

當(dāng)前第51頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)當(dāng)前第52頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)Isseptalthickeningpresent?(a)Yes(b)No小葉間隔增厚嗎？當(dāng)前第53頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)增厚的小葉間隔當(dāng)前第54頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)Aretheseptasmoothornodularinappearance?(a)Smooth(b)Nodular

小葉間隔增厚是結(jié)節(jié)狀還是光滑增厚？當(dāng)前第55頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)小葉間隔結(jié)節(jié)狀增厚當(dāng)前第56頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)胸膜下間質(zhì)結(jié)節(jié)影當(dāng)前第57頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)支氣管袖口癥當(dāng)前第58頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)Possiblediagnosesinclude:(a)pulmonaryedema肺水腫(b)interstitialfibrosis間質(zhì)纖維化(c)sarcoidosis結(jié)節(jié)病最可能的診斷？當(dāng)前第59頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)sarcoidosis結(jié)節(jié)病Correct.Nodularthickeningofinterlobularseptaandfissurescanbeseeninthisdiseaseandlymphangiticspreadofcarcinoma.（小葉間隔結(jié)節(jié)狀改變可見(jiàn)于結(jié)節(jié)病、癌性淋巴管炎、塵肺）。支氣管血管間質(zhì)、胸膜下間質(zhì)結(jié)節(jié)狀改變—對(duì)結(jié)節(jié)病有特征性的診斷。當(dāng)前第60頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)Case5

a42-year-oldmanwithmildshortnessofbreathforanumberofyears（氣促多年）當(dāng)前第61頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)Isseptalthickeningvisible?(a)Yes(b)No

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小葉間隔增厚嗎？當(dāng)前第62頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)增厚的小葉間隔當(dāng)前第63頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)扭曲的肺結(jié)構(gòu)當(dāng)前第64頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)葉間裂的扭曲當(dāng)前第65頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)Diagnosis:End-stagesarcoidosiswithfibrosisandinterlobularseptalthickening.結(jié)節(jié)病伴隨征象：肺結(jié)構(gòu)扭曲、小葉間隔結(jié)節(jié)狀增厚、牽拉性支擴(kuò)、蜂窩肺等。當(dāng)前第66頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)文獻(xiàn)：肺間質(zhì)病變界面征：支氣管血管間質(zhì)增厚—支氣管血管束增粗、支氣管袖口癥；液體—邊緣光滑、腫瘤或肉芽組織—結(jié)節(jié)狀界面。胸膜下線：近胸膜面1cm內(nèi)弧線狀影—為肺纖維化征象。長(zhǎng)疤痕線：蜂窩肺：結(jié)節(jié)影：小結(jié)節(jié)—2-5mm，肉芽、腫瘤、纖維組織。肺結(jié)構(gòu)扭曲變形及牽拉支擴(kuò)：磨玻璃樣改變：當(dāng)前第67頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)Case6a68-year-oldwomanwithrheumatoidarthritis（風(fēng)濕性關(guān)節(jié)炎）andprogressive累計(jì)shortness短缺ofbreathovera2-yearperiod當(dāng)前第68頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)當(dāng)前第69頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)Thepredominantabnormalfindingonthesescansis?(a)interlobularseptalthickening小葉間隔增厚。(b)honeycombing蜂窩肺主要的異常表現(xiàn)？當(dāng)前第70頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)蜂窩肺當(dāng)前第71頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)部分層面小葉間隔增厚當(dāng)前第72頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)Whatdoeshoneycombingreflecthistologically?(a)Interstitialedema肺間質(zhì)水腫(b)Interstitialinfiltration滲透bycells(c)Interstitialfibrosis蜂窩肺的組織學(xué)—肺間質(zhì)纖維化的后期表現(xiàn)。當(dāng)前第73頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)Diagnosis:Rheumatoidlungdisease,withfibrosisandhoneycombing.風(fēng)濕性肺疾病，肺纖維化、蜂窩肺。壁厚0.8-1MM，胸膜下3-4cm范圍內(nèi)或近葉裂處；早期囊腔小而少；囊壁為折疊破壞的肺泡壁及氣道壁。當(dāng)前第74頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)Case7a74-year-oldwomanwithprogressiveshortnessofbreathover6months

當(dāng)前第75頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)Themostsignificantabnormalfindinginthisstudyis:(a)interlobularseptalthickening小葉間隔增厚(b)honeycombing蜂窩肺(c)subpleuralemphysema胸膜下肺氣腫主要的異常表現(xiàn)？當(dāng)前第76頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)蜂窩肺當(dāng)前第77頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)Whatisthemostlikelydiagnosis?(a)Idiopathicpulmonaryfibrosis(IPF)特發(fā)性肺間質(zhì)纖維化(b)Autoimmunedisease(e.g.,rheumatoidlungdisease)自身免疫性疾病(c)End-stagehypersensitivitypneumonitis過(guò)敏性肺炎(d)Asbestosis石棉肺(e)Drug-relatedlunginjury麻醉藥物肺損害(f)Sarcoidosis結(jié)節(jié)病最可能的診斷？當(dāng)前第78頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)IPF:特發(fā)性肺間質(zhì)纖維化磨玻璃密度：肺野周?chē)顒?dòng)性肺泡炎癥。網(wǎng)狀改變：小葉間隔、小葉中心結(jié)構(gòu)增厚—蜂窩狀改變的前期。蜂窩狀改變：胸膜下間質(zhì)纖維化：胸膜下弧線狀影、臟層胸膜及葉間胸膜增厚。肺氣腫：小葉中心型肺氣腫。肺實(shí)變：支擴(kuò)：當(dāng)前第79頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)蜂窩肺當(dāng)前第80頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)牽拉性支擴(kuò)當(dāng)前第81頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)小葉間隔增厚當(dāng)前第82頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)Case8

86-year-oldmanwithchronicmyelogenousleukemia骨髓性的白血病,treatedusingmethotrexate化療,nowcomplainsofshortnessofbreath氣短.當(dāng)前第83頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)當(dāng)前第84頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)DoesthismanshowevidenceoffibrosisandUIP?(a)Yes(b)No顯示明顯的纖維化和普通間質(zhì)性肺炎？？屑性間質(zhì)性肺炎（DIP）、普通性間質(zhì)性肺炎（UIP）。當(dāng)前第85頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)(a)Yes

Correct.Findingsindicativeofusualinterstitialpneumonitis(UIP)visibleinthispatientinclude:honeycombing;蜂窩肺irregularfissures;葉裂扭曲irregularinterlobularseptalthickening;小葉間隔不規(guī)則增厚。tractionbronchiectasis.牽拉性支擴(kuò)當(dāng)前第86頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)蜂窩肺當(dāng)前第87頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)葉裂扭曲當(dāng)前第88頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)不規(guī)則小葉間隔增厚當(dāng)前第89頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)牽拉性支擴(kuò)當(dāng)前第90頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)Themostlikelydiagnosisis:可能的診斷？(a)idiopathicpulmonaryfibrosis(IPF)(b)lunginvolvementbyleukemia白血病肺浸潤(rùn)。(c)drug-relatedlunginjury化療藥物肺損害。當(dāng)前第91頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)(c)drug-relatedlunginjury

Correct.Thepatternoffibrosisseeninthispatientisnonspecific,andcouldbecausedbyIPF.Therecenthistoryoftreatmentwithmethotrexatemakesdrug-relatedfibrosismostlikely.Lunginvolvementbyleukemiawouldlikelyresultinanappearancesimilartothatoflymphangiticspreadofcarcinomawithseptalthickeningbeingthepredominantfinding.IPF一可有同種表現(xiàn)，但患者有最近化療史，白血病肺浸潤(rùn)小葉間隔增厚明顯。當(dāng)前第92頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)Case9

ina63-year-oldmanwithahistoryofscleroderma硬皮病andprogressiveshortnessofbreath進(jìn)行性喘憋

當(dāng)前第93頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)Findingsinclude:

interlobularseptalthickening;小葉間隔增厚。tractionbronchiectasis;牽拉性支擴(kuò)subpleuralhoneycombing;胸膜下蜂窩肺irregularfissures.葉裂扭曲當(dāng)前第94頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)小葉間隔增厚當(dāng)前第95頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)牽拉性支擴(kuò)當(dāng)前第96頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)胸膜下蜂窩肺當(dāng)前第97頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)斜裂扭曲當(dāng)前第98頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)Canyoubeconfidentthatlungfibrosisispresent?(a)Yes(b)No你能確定肺纖維化存在？當(dāng)前第99頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)YesCorrect.Thepresenceofhoneycombingisdiagnosticoffibrosis.Tractionbronchiectasisisalsostronglysuggestiveoffibrosis.Interlobularseptalthickeningandirregularfissuresarenonspecific,andcannotbereliedupontodiagnosefibrosis.蜂窩肺、牽拉性支擴(kuò)—肺纖維化存在。小葉間隔增厚、斜裂扭曲對(duì)肺纖維化的診斷意義不大。當(dāng)前第100頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)Diagnosis:Scleroderma,withlungfibrosis,honeycombing,andtractionbronchiectasis硬皮病—肺纖維化：蜂窩肺、牽拉性支擴(kuò)。結(jié)締組織病及肺血管炎—主要為肺間質(zhì)病變。肺內(nèi)實(shí)變—肺泡內(nèi)滲出、肉芽腫形成、肺泡內(nèi)出血、水腫。肺內(nèi)多發(fā)結(jié)節(jié)—肺內(nèi)血管炎、肉芽腫、肺栓塞所形成。常見(jiàn)于：wengner\類風(fēng)濕性關(guān)節(jié)炎。肺間質(zhì)病變—肺間質(zhì)性肺炎、肺泡炎—間質(zhì)纖維化、蜂窩肺。當(dāng)前第101頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)Case10

ina61-year-oldwomanwithprogressiveshortnessofbreath進(jìn)行性喘憋.當(dāng)前第102頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)Whichofthefollowingfindingsareshownonthisscan?上圖包含癥像:(a)Honeycombing蜂窩肺(b)Asubpleuralline胸膜下線(c)Aperipheralandsubpleuraldistribution外圍胸膜下分布(d)Alloftheabove以上全包括當(dāng)前第103頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)Alloftheabove

Correct.Smallsubpleuralcystsarepresenttypicalofmildhoneycombing.輕度的蜂窩肺Anirregularlineparallelsthepleuralsurface,termedasubpleuralline.胸膜下線當(dāng)前第104頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)Whichofthefollowingismostlikelyinthiscase?最符合的診斷？(a)Idiopathicpulmonaryfibrosis(IPF)特發(fā)性間質(zhì)纖維化(b)Autoimmunedisease(e.g.,rheumatoidlungdisease)自身免疫性疾病(c)End-stagehypersensitivityPneumonitis過(guò)敏性肺炎(d)Asbestosis石棉肺(e)Drug-relatedlunginjury藥物肺損害(f)Sarcoidosis結(jié)節(jié)病當(dāng)前第105頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)Idiopathicpulmonaryfibrosis(IPF)

Correct.Idiopathicpulmonaryfibrosis(IPF).Intheabsenceahistorytosuggestoneofthespecificdiagnosesonthislist,IPFismostlikely.Itaccountsfor60%ofcaseshavingthisappearance.IPF在該病例無(wú)特異性，60%有該表現(xiàn)。當(dāng)前第106頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)Case11a34-year-oldmanwithprogressiveshortnessofbreath喘憋當(dāng)前第107頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)當(dāng)前第108頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)Thepredominantabnormalityinthiscaseis:明顯的異常表現(xiàn)(a)honeycombing蜂窩肺(b)intralobularinterstitialthickening小葉間質(zhì)增厚當(dāng)前第109頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)intralobularinterstitialthickening

Correct.Honeycombingisnotvisibleinthispatient.Afineirregularreticular不規(guī)則的網(wǎng)狀改變patternispresentinthelungperiphery,representingintralobularinterstitialthickening.小葉間質(zhì)增厚Insomepatientswithpulmonaryfibrosis,thisfindingwillpredominate.Otherfindingsoffibrosisinthispatientincludetractionbronchiectasis.牽拉性支擴(kuò)Thedifferentialdiagnosisofthisappearanceisidenticalasthatforhoneycombing.當(dāng)前第110頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)小葉間質(zhì)增厚當(dāng)前第111頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)牽拉性支擴(kuò)當(dāng)前第112頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)Diagnosis:Idiopathicpulmonaryfibrosis特發(fā)性間質(zhì)纖維化,withintralobularinterstitialthickening.當(dāng)前第113頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)Case12a71-year-oldmanwithprogressiveshortnessofbreath當(dāng)前第114頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)當(dāng)前第115頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)Thepredominantabnormalityinthiscaseis:突出的表現(xiàn)(a)honeycombing蜂窩肺(b)intralobularinterstitialthickening小葉間質(zhì)增厚當(dāng)前第116頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)intralobularinterstitialthickening

Correct.Honeycombingisnotclearlyseeninthispatient.Afinebutirregularreticularpattern不規(guī)則的網(wǎng)狀改變ispresentinthelungperiphery外圍,representingintralobularinterstitialthickening小葉間質(zhì)增厚.Insomepatientswithpulmonaryfibrosis,thisfindingwillpredominate.Otherfindings其他征象offibrosisinthispatientincludetractionbronchiectasis牽拉性支擴(kuò),andirregularinterlobularseptalthickening不規(guī)則小葉間隔增厚.Thedifferentialdiagnosisofthisappearanceisidenticaltothatforhoneycombing.當(dāng)前第117頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)小葉間質(zhì)增厚當(dāng)前第118頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)牽拉性支擴(kuò)當(dāng)前第119頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)不規(guī)則小葉間隔增厚當(dāng)前第120頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)Diagnosis:Idiopathicpulmonaryfibrosis特發(fā)性間質(zhì)纖維化,withintralobularinterstitialthickening.當(dāng)前第121頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)Case1334-year-oldwomanwithlupuserytematosus狼瘡紅斑當(dāng)前第122頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)當(dāng)前第123頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)Canyoudiagnosefibrosis?能診斷纖維化？(a)Yes(b)No

當(dāng)前第124頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)Yes

Correct.HRCTobtainedinthesupineandpronepositions仰臥和俯臥位showsanumberoffindingsindicatingfibrosis指示,including:honeycombingwhichismildindegree;輕度蜂窩肺tractionbronchiectasis;牽拉性支擴(kuò)intralobularinterstitialthickening;小葉間質(zhì)增厚interlobularseptalthickening小葉間隔增厚;andasubpleuraldistribution.胸膜下分布當(dāng)前第125頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)輕度蜂窩肺當(dāng)前第126頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)牽拉性支擴(kuò)當(dāng)前第127頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)小葉間質(zhì)增厚當(dāng)前第128頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)小葉間隔增厚當(dāng)前第129頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)Diagnosis:Systemiclupuserythematosus（SLE系統(tǒng)性紅斑狼瘡肺部表現(xiàn)—肺結(jié)締組織病,withfibrosisandhoneycombing.當(dāng)前第130頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)Case14

a65-year-oldwomanwithrheumatoidarthritis風(fēng)濕性關(guān)節(jié)炎andmilddyspnea

輕度呼吸困難當(dāng)前第131頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)Canyoudiagnosefibrosis?能診斷纖維化？(a)Yes(b)No當(dāng)前第132頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)Correctincluding:tractionbronchiectasis;牽拉性支擴(kuò)intralobularinterstitialthickening;小葉間質(zhì)增厚asubpleuralline.胸膜下線當(dāng)前第133頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)牽拉性支擴(kuò)當(dāng)前第134頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)小葉間質(zhì)增厚當(dāng)前第135頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)胸膜下線當(dāng)前第136頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)Diagnosis:Rheumatoidlungdisease肺結(jié)締組織病,withmildpulmonaryfibrosis輕度肺纖維化andintralobularinterstitialthickening小葉間質(zhì)增厚.當(dāng)前第137頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)Case15a26-year-oldwomanwithmixedconnectivetissuedisease混合結(jié)締組織病,basilarcracklesonphysicalexamination雙肺底水泡音,andrestrictivediseaseonpulmonaryfunctiontests

肺功能受限當(dāng)前第138頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)當(dāng)前第139頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)Canyoudiagnosefibrosis?能診斷纖維化？(a)Yes(b)No當(dāng)前第140頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)Yes

Correct.Including:tractionbronchiectasis;牽拉性支擴(kuò)intralobularinterstitialthickening小葉間質(zhì)增厚;asubpleuraldistribution胸膜下分布當(dāng)前第141頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)牽拉性支擴(kuò)當(dāng)前第142頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)小葉間質(zhì)增厚當(dāng)前第143頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)Diagnosis:Mixedconnectivetissuedisease混合結(jié)締組織病,withpulmonaryfibrosis,andintralobularinterstitialthickening當(dāng)前第144頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)Case16a81-year-oldmanwithsignificantoccupationalexposuretoasbestos石棉職業(yè)史當(dāng)前第145頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)當(dāng)前第146頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)Ispulmonaryfibrosispresent?肺纖維化存在？(a)Yes(b)No當(dāng)前第147頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)Yes

Correct.Findingsoffibrosisinclude:tractionbronchiectasis;牽拉性支擴(kuò)intralobularinterstitialthickening;小葉間質(zhì)增厚asubpleuraldistribution.胸膜下分布irregularinterlobularseptalthickening不規(guī)則的小葉間隔增厚當(dāng)前第148頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)牽拉性支擴(kuò)當(dāng)前第149頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)小葉間質(zhì)增厚當(dāng)前第150頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)胸膜下分布當(dāng)前第151頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)小葉間隔增厚當(dāng)前第152頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)Diagnosis:石棉肺Asbestosiswithtractionbronchiectasis牽拉性支擴(kuò)andintralobularinterstitialthickening小葉間質(zhì)纖維化.當(dāng)前第153頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)縱隔窗當(dāng)前第154頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)pleuralthickeningandcalcification胸膜增厚、鈣化椎旁區(qū)域橫膈胸膜肥厚鈣化當(dāng)前第155頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)Case17a58-year-oldmanwithahistoryofasbestosexposure石棉史

當(dāng)前第156頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)可見(jiàn)椎旁胸膜增厚、不規(guī)則線狀影當(dāng)前第157頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)Thepleuralthickeningistypicalofasbestosexposure胸膜增厚是典型的石棉肺表現(xiàn).Wouldyoudiagnoseasbestosis診斷石棉肺嗎?(a)Yes(b)No當(dāng)前第158頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)No

Correct.Linearopacities線狀影asseeninthiscase(termedparenchymalbands肺實(shí)質(zhì)帶)arecommoninpatientswithpleuralthickening胸膜增厚,butarenotnecessarilyassociated不必須考慮withlungfibrosis肺纖維化.當(dāng)前第159頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)肺實(shí)質(zhì)帶parenchymalbands位于下肺部，肺內(nèi)條狀影；肺實(shí)質(zhì)內(nèi)的纖維化。當(dāng)前第160頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)盡管如此，結(jié)合病史，考慮Asbestosexposurewithpleuraldiseaseandparenchymalbands石棉至椎旁胸膜增厚、肺實(shí)質(zhì)帶。當(dāng)前第161頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)Case18a67-year-oldmanwithahistoryofasbestosexposure石棉史當(dāng)前第162頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)No

Correct.HRCTatlungwindowsshowsirregularlinearopacities不規(guī)則的線狀影(“crow‘sfeet”烏鴉腳),withoutevidenceofhoneycombing無(wú)蜂窩肺,intralobularinterstitialthickening小葉間質(zhì)增厚,ortractionbronchiectasis牽拉性支擴(kuò).Thisappearancedoesnotindicateasbestosis無(wú)石棉特征.Linearopacities,asseeninthiscase(parenchymalbands肺實(shí)質(zhì)帶)arecommoninpatientswithpleuralthickeningrelatedtoasbestosexposure,butarenotnecessarilyassociatedwithlungfibrosis不必須考慮肺纖維化.Theyrepresentfocalareasofatelectasis焦點(diǎn)為肺膨脹不全,associated聯(lián)系withthepleuralthickening,orfocalareasofscarring焦點(diǎn)區(qū)疤痕.當(dāng)前第163頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)烏鴉腳（"crow'sfeet"),當(dāng)前第164頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)即盡管如此，結(jié)合病史考慮Asbestosexposurewithpleuraldiseaseandparenchymalbands。另一病例：胸膜下線椎旁胸膜增厚當(dāng)前第165頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)Case19a56-year-oldmanwithsignificantoccupationalexposuretoasbestos石棉史當(dāng)前第166頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)Istherepleuralthickening胸膜增厚youwouldconsider考慮likely可能duetoasbestosexposure石棉?(a)Yes(b)No當(dāng)前第167頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)Yes

correct.Afocal焦點(diǎn),calcifiedpleuralplaque胸膜鈣斑isvisibleanteriorly,typicalofasbestosexposure石棉肺典型表現(xiàn).Althoughplaquesaremorelikelyposteriorinlocation常見(jiàn)后胸膜,thisappearanceishighlysuggestive高度提示.當(dāng)前第168頁(yè)\共有181頁(yè)\編于星期四\9點(diǎn)Canadefinitediagnosisofpulmonaryfibrosisonthepronelungwindowscansbemade?肺窗能明確診斷肺