暈征與反暈征PPT課件

暈征與反暈征 1 暈征與反暈征halosignandreversedhalosign 暈征與反暈征 2 結(jié)節(jié)與腫塊 CT表現(xiàn) 致密影 直徑 5mm稱微結(jié)節(jié) 2 3mm粟粒結(jié)節(jié) 直徑5 10mm稱小結(jié)節(jié) 10mm者統(tǒng)稱結(jié)節(jié) 一般將小于等3cm者稱為結(jié)節(jié) 大于3cm者稱為腫塊 基本概念 暈征與反暈征 3 是指肺部CT或薄層CT上 肺密度輕度增加 支氣管和血管輪廓可見 形似磨玻璃 稱磨玻璃密度影 意義 非特異 任何使肺實變 遠(yuǎn)端氣腔內(nèi)空氣含量減少而又不使肺泡全部閉塞的因素都可產(chǎn)生磨玻璃影 磨玻璃密度影 GGO 基本概念 暈征與反暈征 4 暈征 CT表現(xiàn) 在CT上肺內(nèi)結(jié)節(jié)或腫塊周圍的暈狀磨玻璃密度影 低于中央結(jié)節(jié) 但高于正常肺組織 形似日暈 暈征與反暈征 5 分類 一 出血性肺結(jié)節(jié) 一 感染性疾病中的出血性結(jié)節(jié) 毛霉菌病 念珠菌病 結(jié)核病 病毒性肺炎 侵襲性曲菌病 二 非感染性疾病中的出血性結(jié)節(jié) 韋格納肉芽腫病 Kabosi肉瘤 二 腫瘤細(xì)胞浸潤性結(jié)節(jié) 細(xì)支氣管肺泡癌 淋巴瘤 肺泡內(nèi)腫瘤生長 三 非出血性結(jié)節(jié) 肉狀瘤病 機(jī)化性肺炎 暈征與反暈征 6 暈征病因 ArchBronconeumol 2008 44 7 386 92 暈征與反暈征 7 免疫功能不全侵襲性曲霉菌 毛霉菌 念珠菌及隱球菌 一暈征 感染性疾病 真菌 暈征與反暈征 8 一暈征 感染性疾病 真菌 KuhlmanJE1985 Invasivepulmonaryaspergillosis A Computedtomography CT scanofapatientwithacutelymphoidleukemiaandneutropeniashowinganodulesurroundedbyahalointherightupperlobe withadjacentacinarinvolvement arrows B Macroscopicsagittalsliceofanotherpatient slungshowingaroundnecroticlesion asterisk surroundedbyahemorrhagichalo arrowheads correspondingtoinvasivepulmonaryaspergillosis C MicroscopicimageofthemarginofthelesiondescribedinB withvisiblepulmonarynecrosisandhemorrhage TheimagealsoshowsthehyphaeofAspergillusfumigatus arrows whichareofregularcaliber septate andbranchingatacuteangles hematoxylin eosin magnification 2 暈征與反暈征 9 中國CT和磁共振雜志2014年6月12卷3期 一暈征 感染性疾病 真菌 暈征與反暈征 10 免疫功能不全常見單純皰疹病毒 巨細(xì)胞病毒 水痘帶狀皰疹病毒及粘病毒 一暈征 感染性疾病 病毒 暈征與反暈征 11 slow resolvingbacterialpneumonia 吸收延遲性肺炎 放線菌結(jié)核分枝桿菌 一暈征 感染性疾病 細(xì)菌 暈征與反暈征 12 1 64歲男 退休 咳嗽 間斷咯血2月來診 吸煙 既往健康 痰涂片革蘭陰性菌 培養(yǎng) 卡他布蘭漢菌 2 45歲 既往心梗 吸煙 咳嗽1月間斷咯血10天 痰培養(yǎng) 流感嗜血桿菌 中國實用內(nèi)科雜志20097月29卷增刊1 一暈征 感染性疾病 細(xì)菌 暈征與反暈征 13 立克次體寄生蟲 一暈征 感染性疾病 其他 暈征與反暈征 14 腎上腺嗜鉻細(xì)胞瘤血管肉瘤轉(zhuǎn)移瘤腎細(xì)胞癌絨毛膜癌肺血管肉瘤Kaposi肉瘤 二暈征 腫瘤性疾病 出血性瘤結(jié)節(jié) 暈征與反暈征 15 Hemorrhagicmetastasisinapatientwithchoriocarcinoma 絨毛膜癌 whopresentedwithmassivehemoptysis A Computedtomographyscanofthechestshowsmultiplehemorrhagicpulmonarynoduleswithahalosignthathavecoalescedintheposteriorsegmentsoftherightlung B Macroscopiclungsliceshowingseveralroundhemorrhagiclesions C Macroscopicimageofnodulescontaininghemorrhagicareas fibrin andtumorcells hematoxylin eosin magnification 10 二暈征 腫瘤性疾病 出血性瘤結(jié)節(jié) 暈征與反暈征 16 細(xì)支氣管肺泡癌消化系 胰腺 肺腺癌淋巴瘤 二暈征 腫瘤性疾病 瘤細(xì)胞浸潤 暈征與反暈征 17 Bronchioloalveolarcarcinomainapatientwithchroniccough A Computedtomographyscanofthechestshowsnoduleswithahalosignintherightlung withsomepseudocavitation arrow Alsovisibleisaconsiderableareaofconsolidationintheleftlung B Microscopicimageshowingthickenedalveolarwalls asterisks duetoinfiltrationbytumorcells arrows ematoxylin eosin magnification 10 二暈征 腫瘤性疾病 瘤細(xì)胞浸潤 暈征與反暈征 18 Pulmonarylymphomaina73 year oldpatientwhovisitedtheemergencyservicewithdyspnea A Anaxialscanofthelowerpulmonarylobesshowsmultiplepulmonarynoduleswithahalosignandatendencytocoalesceintheposteriorsegments Thereisalsobilateralpleuraleffusion somewhatgreaterontherightside Thepatientdied3weeksafteradmission B Lowmagnificationimageofpulmonarynoduleshowingmainlyperibronchovasculartumorcellinfiltrationandmarkednecrosis hematoxylin eosin magnification 4 C Ahigher magnificationimageoftheperipheryofthenoduleshowstheinfiltrationoftumorcellsalongthealveolarwalls arrows hematoxylineosin magnification 10 暈征與反暈征 19 出血性結(jié)節(jié)非出血性結(jié)節(jié) 三暈征 非感染性疾病 暈征與反暈征 20 三暈征 非感染性疾病 出血性結(jié)節(jié) 韋格納肉芽腫子宮內(nèi)膜異位癥活檢 暈征與反暈征 21 Wegenergranulomatosis A Computedtomographyscanshowing2pulmonarynodulessurroundedbyahalo arrows andanareaofconsolidationintheleftlowerlobe asterisk alsowithahalosign Thepatient whosefirstsymptomwashemoptysis alsohadrapidlyprogressingglomerulonephritis腎小球腎炎B Microscopicimageshowinginflammatoryinfiltrationofthearterialwallwithamultinucleatedgiantcell arrow andendothelialdestruction arrowheads hematoxylin eosin magnification 20 三暈征 非感染性疾病出血性結(jié)節(jié) 暈征與反暈征 22 結(jié)節(jié)病機(jī)化性肺炎閉塞性細(xì)支氣管炎嗜酸細(xì)胞肺炎肺淀粉樣變 三暈征 非感染性疾病非出血性結(jié)節(jié) 暈征與反暈征 23 反暈征 是CT肺窗 中心為磨玻璃樣密度影 周圍是高密度新月形或環(huán)形條帶 與暈征的周圍稍低密密度磨玻璃影相反 稱反暈征 Voloudakietal1996cop 暈征與反暈征 24 反暈征病因 暈征與反暈征 25 一反暈征 感染性疾病 真菌 肺曲菌接合菌屬 Zygomycetes包括根霉和毛霉 地方性真菌感染 南美芽生菌病 拉丁美洲 巴西 隱球菌早期征象 暈征與反暈征 26 Invasivepulmonaryaspergillosisina54 year oldfemalewithmultiplemyelomaandsecondaryplasmacellleukaemiawhohadundergonechemotherapy a High resolutionCTimageatthelungbaseshowsarightlower lobepulmonarynodule arrow andthereversedhalosign RHS intheleftlowerlobe curvedarrow withadjacentground glassopacities b CTimagewithmediastinalwindowsettingsshowstheperipheralconsolidationoftheRHS asterisks Noteasmallrightpleuraleffusion 暈征與反暈征 27 Pulmonaryzygomycosisina22 year oldmalewithprecursorB cellacutelymphocyticleukaemia a CTimageshowsthereversedhalosign RHS intheleftupperlobe arrows b CTscanperformed2monthslatershowsintervaldevelopmentofcavitation aircrescentsign ThepresenceofRHSinanimmunosuppressedpatientishighlysuggestiveofpulmonaryzygomycosis especiallyifthepatientisreceivingprophylaxisforaspergillosis 暈征與反暈征 28 Paracoccidioidomycosisina49 year oldmale residentofaruralareainBrazil CTimageshowsreversedhalosign RHS lesions arrows andbilateralsmallpoorlymarginatedpulmonarynodules ThepresenceofRHSinapatientfromanendemicregionforfungalinfectionshouldraiseconcernforthatspecificfungalinfection 暈征與反暈征 29 一反暈征 感染性疾病 結(jié)核 Tuberculosisina59 year oldfemale High resolutionCTimageshowsbilateralsmallcentrilobularnodules tree in budopacitiesandareasofreversedhalosign RHS NotethenodularappearanceoftheringofconsolidationoftheRHSlesions arrows whichmaybehelpfulinthedifferentiationbetweenactivegranulomatousdiseaseandcryptogenicorganisingpneumonia Thepresenceofassociatedcentrilobularnodulesandtree in budopacitiesshouldraisesuspicionoftuberculosis 暈征與反暈征 30 二反暈征 機(jī)化性肺炎 19 Organisingpneumoniaina53 year oldmalewithgraft vs hostdiseaseafterstemcelltransplantionfortreatmentofacutemyelogenousleukaemia CTscanshowsbilateralperipheralandperibronchovascularconsolidativeopacitieswiththereversedhalosign arrows Open lungbiopsyshowedorganisingpneumonia Thepatientwastreatedwithsteroidswithresolutionofthelesions 暈征與反暈征 31 二反暈征 機(jī)化性肺炎 47 yr oldfemalewasreferredtoatertiarycentre StMichael sHospital Toronto Canada forfurtherevaluationofchroniccough fever progressiveexertionaldyspnoeaandfatigue Coronalchestcomputedtomographyscanshowingmultipleareasofcentralground glassopacity surroundedbyringorcrescentic shape denseairspaceconsolidation mainlyintheleftlowerlobeandtherightupperlobe Transbronchialbiopsyshowingorganisingpneumonia 暈征與反暈征 32 三反暈征 非特異性間質(zhì)性肺炎 TheBritishJournalofRadiology May2011 A52 year oldfemalepresentedwithacoughandNewYorkHeartAssociation NYHA class2dyspnoeaof4monthsduration CTimagesshowacentralground glassopacitysurroundedbycrescentorring shapedareasofconsolidation showingthe reversedhalosign e 6daysand f 6monthsofsteroidtherapy bothshowedimprovement 暈征與反暈征 33 四反暈征 結(jié)節(jié)病 Sarcoidosisina44 year oldfemale High resolutionCTimageshowsbilateralnodularopacitieswiththereversedhalosign RHS arrows andsmallpulmonarynoduleswithpredominantperilymphaticdistribution ThepresenceoftheRHSassociatedwithnodulesinperilymphaticdistributionandmediastinalandhilarlymphadenopathy notshown shouldraisesuspicionofsarcoidosis 暈征與反暈征 34 五反暈征 肺栓塞 Acutepulmonaryembolismwithpulmonaryinfarctionina64 year oldfemale a CTimageshowsthereversedhalosigninthesuperiorsegmentoftherightlowerlobe b CTimage mediastinalwindowsettings showsaclotinthedistalrightmainpulmonaryarteryextendingtothesuperiorsegmentalbranchoftherightlowerlobepulmonaryartery c 2monthfollow upCTscanshowscavitationoftheinfarctedpulmonaryparenchyma 暈征與反暈征 35 Multifocalpulmonaryadenocarcinomaina70 year oldfemale CTimageshowsbilateralulmonarynoduleswiththereversedhalosign blackarrows andground glasspulmonarynodules whitearrows 六反暈征 腫瘤 暈征與反暈征 36 Metastaticrenalcellcarcinomaina73 year oldmale TheCTscanshowsmultiplebilaterallesionswithreversedhalosign RHS biopsyproventorepresentmetastaticrenalcellcarcinomainabackgroundoffibrosisandnecrosis Inpatientswithaknownprimarymalignancy RHSlesionsmayrepresentatypicalpresentationofmetastaticdisease Themaindifferentialdiagnosisisorganisingpneumonia whichcanberelatedtodrugtoxicityifthepatientisreceivingchemotherapy 六反暈征 腫瘤 暈征與反暈征 37 Reversedhalosign RHS followingradiofrequencyablation RFA ofapulmonaryadenocarcinomaina64 year oldfemale a CTimageshowstheadenocarcinomaintheleftlowerlobe b CTscanperformed1monthafterRFAofthetumourshowsdevelopmentoftheRHS WhenpresentshortlyafterRFA theRHSshouldnotbeconfusedwithrecurrenceofdisease 七反暈征 射頻消融術(shù)后改變 暈征與反暈征 38 放療相關(guān)肺疾病急性期腫瘤壞死炎癥反應(yīng) 肺組織壞死繼發(fā)性機(jī)化性肺炎 八反暈征 放療后改變 暈征與反暈征 39 八反暈征 放療后改變 Reversedhalosign RHS followingprotonradiationtherapyforapoorlydifferentiatedsquamous 鱗癌 cellcarcinomaina71 yearoldmale a CTimageshowsthe