七年制chest 呼吸常见病概要1.ppt

Imaging diagnosis of respirotary diseasepart 1AiPing Chen 支气管扩张bronchiectasis Clinical symptom: cough, Purulent foul-smelling sputum , emptysis, or haemoptysis. 儿童，青年多见，多见于左下叶、右中叶及右下叶。 咳嗽、咳痰、咯血 Bronchiectasis支扩 Bronchiectasis is defined as localized, irreversible dilatation of the bronchial tree. congenital or aquired --- There are several causes of bronchiectasis, postinfectious causes; congenital defects of a structure nature; chronic granulomatous infection such as tuberculosis. 无异常发现 支气管及肺间质慢性炎症引起肺纹理增多，增厚，紊乱。可呈管状、杵状、囊状蜂窝状影，或卷发状。 继发感染：呈小斑片状模糊影，常不易治愈，或于同一地方反复发作。 Bronchiectasis Pathology Damage of bronchus wall Pression of bronchus increase Circumference tissue draught 支气管壁破坏 支气管内压增加 周围组织牵拉（疤痕、肺不张等） Bronchiectasis Bronchiectasis can be divided into three morphologic types: cylindrical,saccular, mixed type.柱状、囊状或静脉曲张型。 Cylindrical bronchiectasis refers to a generalized more or less regular widening of the large bronchi. Saccular bronchietasis shows that the bronchi terminate in sac-like cavities. Bronchiectasis Bronchographic investigation is important and necessary to delineate the total extent of the disease. In the bronchogram, the cylindric bronchiectasis may be show club-shaped dilatation of the bronchi, while the saccular bronchiectasis will show saccular or cystic dilation of the affected bronchi. Bronchiectasis CT is helpful especially in the more advanced forms of bronchiectasis, cylindrical bronchiectasis causes smooth dilatation of bronchi, recognizable as “tram line” when seen in the scan plane and as the signet-ring sign in cross-section. The signet ring sign refers to the thickened and dilated bronchus, saccular bronchiectasis can be diagnosed most reliably by CT, sometime we can see air-fluid level in the dilated bronchus. HRCT：支气管壁增厚，管腔增宽。呈“轨道征”或“印戒征”。 柱状、囊状或静脉曲张型。 Question:where is the bronchiectasis? Pneumonia The causative organisms are variable:病原体多样 感染：细菌、病毒、真菌、支原体、衣原体、立克次体、寄生虫 理化性：类脂性、毒气、药物、放射线等 免疫和变态反应 Pneumonia