哈医大三院《医学影像学》真菌病和原因不明肺疾病2012ppt课件.ppt

肺隐球菌感染 术后病理：隐球菌感染。病理结果出来后再详细询问病史，才知道患者因“盆腔炎”不规则服用消炎药达3月之久 新型隐球菌肺炎 广泛肺实变影 孤立小空洞 Fig. 5 A 71-year-old woman admitted with cough and fever. (a) Plain and post-contrasted CT in the mediastinal window shows a round-like nodule, measuring 2.2 2.5 cm, located in the left hilum and showing marked ring enhancement. (b) CT in the lung window of the same patient showed multiple nodules scattered in the adjacent field (white arrow head). (c) H&E stain (400) of a biopsy specimen obtained by bronchoscopy-guided transbronchial lung biopsy from the hilar node showed a granuloma with numerous intracellular organisms of C. neoformans (black arrow) 诊断与鉴别诊断 缺乏特征性，与其他感染性病变难以鉴别，但若病人脑部出现脑和脑和脑膜症状，提示本病 若痰中查到新型隐球菌的厚壁孢子，有助于诊断 特发性肺间质纤维化 结节病 韦格肉芽肿 ? 第十一节 原因不明性肺疾病 一、特发性肺间质纤维化 原因不明的弥漫性、非感染性、纤维性肺泡炎，近年认为系免疫性疾病，可能与遗传有关。 临床：多见于中年，起病隐匿，主要症状为进行性呼吸困难和干咳，进展速度因人而异，最终出现缺氧和肺心病。 第十一节 原因不明性肺疾病 病理 肺泡内皮细胞和基底膜损害 蛋白样物质渗出，透明膜形成 ，淋巴、单核细胞渗出 肺泡内皮再生 间隔增宽，机化、纤维化 第十一节 原因不明性肺疾病 X线影像表现 早期：无异常或中下野细小网状影 一定阶段：不对称网状、条索状及结节状阴影 晚期：结节阴影增大，广泛厚壁囊状影 第十一节 原因不明性肺疾病 CT影像表现 第十一节 原因不明性肺疾病 7种征象 Figures 4, 5. (4) IPF in a 64-year-old man. (a) High-resolution CT image obtained at presentation shows reticular opacities, honeycombing (arrowhead), and focal ground-glass opacity (thick arrow). Moderate traction bronchiectasis is present (thin arrow). These findings are consistent with the UIP pattern. (b) Follow-up CT image obtained 12 months later shows marked progression of the honeycombing (arrowheads) and traction bronchiectasis (arrows). (5) IPF in a 67-year-old man. (a) High-resolution CT image shows areas of relatively unaffected lung parenchyma with only ground-glass opacity (arrow) next to fibrotic areas with honeycombing and traction bronchiectasis (arrowhead), an appearance typical of UIP. (b) Coronal CT image shows an obvious apicobasal gradient of the lung alterations 1.磨玻璃样影及实变影：两下肺后外基底段小叶状、斑片状；病理上为肺间质水肿、呼吸性细支气管和肺泡腔内渗出及巨噬细胞聚集 2.线状影：与胸膜面垂直，长约2.0cm，代表小叶间隔增厚 2.胸膜下弧线状影：与胸膜平行的5～10cm；病理上为细支气管周围的纤维化及肺泡塌陷 3.蜂窝状影 第十一节 原因不明性肺疾病 多发环状