頸部結(jié)核3課件

頸部結(jié)核3KeyWordstuberculosis[tj?,b??kj?'l??s?s]n.肺結(jié)核；結(jié)核病larynx['l?r??ks]n.[解剖]喉；喉頭thyroid['θa?r??d]n.甲狀腺；甲狀軟骨；adj.甲狀腺的；盾狀的pathogenesis[,p?θ?'d??n?s?s]n.發(fā)病機(jī)理；發(fā)病原KeyWordshaematogenous[hi:m?‘t?d?in?s]血源性的，造血的granulomasn.肉芽腫mucosa[mj?'kos?]n.[解剖]粘膜antiseptic[?nt?'sept?k]adj.防腐的，抗菌的；n.防腐劑，抗菌劑IntroductionThepurposeofthisstudyistodescribetheimagingfeaturesoftuberculousinvolvmentinthefollowingneckregions:larynx;thyroidgland;neckspaces.Thepathogenesisandimagingfindingsoftuberculousinvolvementintheneckregionwillbediscussed.簡(jiǎn)介

本研究主要描述頸區(qū)域（喉、甲狀腺、頸間間隙）結(jié)核病變的影像特征。討論頸部區(qū)域結(jié)核的發(fā)病機(jī)制和影像學(xué)表現(xiàn)。LarynxPathogenesisPrimaryinvolvementisrareandoccursbydirectinfectionofthemucosaviaaerosolizedparticles.Secondaryinvolvementoccursviaexpectorationofhighlyinfectioussputumfromthetracheo-bronchialtree,viahaematogenousspreadfromsitesotherthanlungs,orvialymphaticspread,whichisrare.喉發(fā)病機(jī)制

原發(fā)性喉結(jié)核較為罕見，主要是通過霧化微粒直接感染粘膜所致。繼發(fā)性喉結(jié)核是由來自氣管支氣管樹具有高度傳染性的痰、來源于肺組織以外其他部位結(jié)核的血源性播散、或是淋巴擴(kuò)散所引起,而淋巴播散較為罕見。ImagingfindingsCTandMRIfindingsintheacutestageincludediffusebilateralglotticthickening,withorwithoutanassociatedmass。Thecommonestfindinginthechronicstageisalocalizedlesiongranulomamimickingamass.影像表現(xiàn)

CT和MRI發(fā)現(xiàn)在急性期雙側(cè)聲襞彌漫性增厚，伴或不伴有腫塊形成。在慢性期最常見的表現(xiàn)是類似腫塊的局部肉芽腫性病變。Fig1AxialCECTofthelarynxshowsalarge,enhancing,tumourlikegranulomatousmassinpre-epiglotticspace(blackarrow)withcaseatingrightcervicallymphnode(whitearrow).圖1、喉部軸位CT圖像顯示，會(huì)厭前間隙可見體積較大、明顯強(qiáng)化、類似腫瘤的肉芽腫腫塊(黑色箭頭)和右頸部干酪樣壞死淋巴結(jié)(白色箭頭)。ThyroidPathogenesisTuberculousinvolvementofthethyroidisrareandisduetosecondaryinvolvementeitherbyhaematogenousspread,orbycontiguousspreadfromadjacentinfectedlarynxandlymphnodes.Tubercularthyroidinvolvementisrarebecausethethyroidglandisenvelopedbyatoughcapsuleprotectingitfromcontiguousspreadofinfectionandthehighiodineconcentrationwithintheglandwhichactsasanaturalantiseptic.甲狀腺發(fā)病機(jī)制

甲狀腺的結(jié)核比較罕見,甲狀腺結(jié)核主要是通過血源性播散或通過臨近感染的喉及淋巴結(jié)的直接蔓延所引起的繼發(fā)感染。原發(fā)性甲狀腺結(jié)核罕見是因?yàn)榧谞钕袤w有被膜包繞使它免于臨近感染的播散，腺體內(nèi)的高濃度碘成為天然的抗菌劑。ImagingfindingsCTdemonstratemultiple,small,focallesionsintheentireglandresemblingmiliaryTB(Fig.7).Caseatinggranulomascancauseenlargementoftheglandwithcoldabscessformationwithorwithoutsinusformation.影像表現(xiàn)

CT顯示在整個(gè)腺體中表現(xiàn)為類似粟粒狀肺結(jié)核的多發(fā)小而局灶的病變(圖7)。干酪樣肉芽腫能增大已形成冷膿腫（伴有或不伴有竇道的形成）的腺體。Figure.2Axialimageofthethyroidgland.Miliarylowdensitynodules(openarrows)intheentirethyroidgland.圖2、甲狀腺軸位圖像顯示在整個(gè)甲狀腺中多發(fā)粟粒狀的低密度結(jié)節(jié)影(空心箭頭)。NeckabscessPathogenesisSecondarylymphaticinvolvementiscommonduetoacutetubercularpharyngitis/mastoiditisorchronictuberculousinfectionofcervicalspineorcervicallymphnodes.Itcommonlyoccursintheretropharyngealspacemostlyduetoinfectionintheretropharyngealnodes.頸部膿腫發(fā)病機(jī)制

繼發(fā)性淋巴感染主要是由于急性結(jié)核性咽炎/乳突炎或慢性頸椎或頸部淋巴結(jié)結(jié)核性感染引起。它通常發(fā)生在咽后間隙，主要是由咽后淋巴結(jié)感染引起。ImagingfindingsCTandMRIshowvariable-sized,ill-defined,thick-walledmasseswithcentralnecrosisandrimenhancementfollowingcontrastmediuminjection(Fig.4).影像表現(xiàn)

CT和MRI顯示為形態(tài)多樣、邊界不清、伴有中央壞死和注射對(duì)比劑后邊緣強(qiáng)化的厚壁腫塊。（圖4）Figure3、CoronalCTimageoftheneckshowingalarge,peripherallyenhancing,centrallyliquefied,multiseptate,transpatialcoldabscess(whitearrows)withairway(whitearrowheads)andvascularmasseffect.圖3、頸部冠位CT示：體積較大、周邊強(qiáng)化、中心液化壞死、跨間隙生長(zhǎng)的冷膿腫，伴氣道(白色箭頭)和血管(白色箭頭)的占位效應(yīng)。ConclusionTuberculousinfectionaffectsmanysitesintheneck,andhasavarietyofimagingappearances,mimickingbenignandmalignantlesions.ThediagnosisofTBcanbesuggestedbasedonspeci?cimagingfeatures.Earlycom