肺真菌病的影像診斷-2

肺真菌病的影像診斷

ImagingDiagnosisofPulmonaryMycoses彭文鴻解放軍第306醫(yī)院呼吸內(nèi)科小葉中心性結(jié)節(jié)

Centrilobularnodule小葉中心性結(jié)節(jié)分布廣泛，酷似隨機(jī)分布的表現(xiàn)，但不累及胸膜面和小葉間隔。Centrilobularnodulesareusuallyofsimilarsizeandspacedatregulardistancesfromeachother.Ifthenodulesareeachatthecenterofalobule,theinternodulardistancewillbeapproximately1-2.5cm.Attheperipherytheyoccur5-10mmfromthepleuralsurface(1/2thediameterofalobule).Theyusuallyrepresentlinearperibronchiolarorbronchiolardensitiescutincross-section.淋巴管周圍性結(jié)節(jié)

（Perilymphaticnodules）淋巴管周圍結(jié)節(jié)主要在肺門旁的支氣管血管周圍區(qū)、小葉中心區(qū)和與小葉間隔和胸膜面有關(guān)。Groundglass,consolidation磨玻璃影Groundglassopacity肺密度模糊增加，但不掩蓋其內(nèi)部的肺血管。提示為活動(dòng)性或急性病變。PCP馬賽克衰減（Mosaicattenuation）Theterm‘mosaicattenuation’isusedtodescribedensitydifferencesbetweenaffectedandnon-affectedlungareas.

Therearepatchyareasofblackandwhitelung.

馬賽克灌注，肺灌注的區(qū)域性差異，導(dǎo)致吸氣時(shí)HRCT上可見肺衰減的差異。反映了血管阻塞或通氣異常，多見于氣道疾病透亮區(qū)的血管特征性地表現(xiàn)為較致密肺內(nèi)的血管細(xì)小。呼氣HRCT在由氣道疾病中導(dǎo)致的馬賽克灌注診斷上的價(jià)值。馬賽克衰減（Mosaicattenuation）AirwayinvasiveaspergillosisMosaicattenuationPCPinAIDS實(shí)變影Consolidation肺衰減增加并掩蓋了該區(qū)域內(nèi)的肺血管，可見支氣管空氣征。completeopacificationofthisarea.Whenthebronchiremainaerated,theyareseenasbranchinglucenciescalledair-bronchograms,whicharepresentinthisimage.Thisimagerepresentsinfectiouspneumonia,whichislimitedbythemajorfissure,resultinginasharpborder.Theadvancinganteromedialmarginshowsground-glassopacity(seelater).實(shí)變影Consolidation支氣管肺活檢證實(shí)為曲霉性支氣管炎和肺炎樹芽征（TreeinBud）樹芽征（TreeinBud）擴(kuò)大的小葉中心細(xì)支氣管，管腔內(nèi)為黏液、液體或膿液所嵌塞，常伴細(xì)支氣管炎癥。Hypodensesign

(在實(shí)變及結(jié)節(jié)出現(xiàn)中心性低