高分辨率肺CT详解 第二部分 HDCT.ppt

医学课件 Case 52 in a 46-year-old man with a fever and productive cough发热咳嗽 The nodule distribution is结节分布方式: (a) perilymphatic淋巴管周围分布 (b) random随机分布 (c) centrilobular小叶中心性分布 centrilobularCorrect. This patient shows a centrilobular pattern小叶中心分布. Subpleural nodules are not visible胸膜下结节未见, and some nodules are clearly related to small airways or contain a central lucency中心透亮, representing a centrilobular bronchiole小叶中心细支气管. 小叶中心透亮区 Larger areas of opacity大不透亮区, having a patchy distribution are visible in the lung bases在肺底部不均分布. These represent lobular areas of consolidation肺小叶, some containing a central air bronchogram (i.e. the centrilobular bronchiole). Diagnosis: Bacterial细菌的 bronchopneumonia支气管肺炎 with peribronchial支气管周围 and lobular areas of consolidation肺小叶. 肺小叶 Case 53 in a 57-year-old woman with progressive shortness of breath over several weeks憋气几周以上, a nonproductive 非生产性咳嗽cough, and low-grade fever低热 Multiple ill-defined lung nodules of ground-glass opacity are visible多发边界不清磨玻璃密度结节. The nodule distribution is分布方式: (a) perilymphatic淋巴管周围分布 (b) random随机分布 (c) centrilobular小叶中心性分布 centrilobularCorrect. This patient shows a centrilobular pattern小叶中心分布. Subpleural nodules are not seen胸膜下结节未见, and the most peripheral nodules外围结节 visible range可见区 from 5 to 10 mm from the pleural surface and major fissure. Overall, the nodules appear diffuse in distribution and evenly spaced弥漫均匀分布. Abnormal 异常bronchi and frank consolidation are not seen. 外围结节 Additional history revealed that the patient lived with several birds患者有养鸟史. In patients with a history of exposure, this appearance is highly suggestive of hypersensitivity pneumonitis高度暗示过敏性肺炎. Diagnosis: Hypersensitivity pneumonitis, subacute stage亚急性期, with centrilobular nodules. 过敏性肺炎 1.斑片状边缘模糊影：肺泡腔内空气被浆液渗出物取代—肺泡炎。 2.弥漫分布粟粒影：鸽子肺。 3.线、网状、粟粒状影：为间质性渗出性改变。 Case 54, in a 78-year-old man with progressive shortness of breath进行性喘憋 Multiple ill-defined lung nodules are visible许多边界不清的肺结节. The nodule distribution is分布方式: (a) perily