肺部疾病的影像診斷【雙語+圖片】

Radiology2008;246:697-722FleischnerSociety:GlossaryofTermsforThoracicImagingDavidM.Hansell,MD,FRCP,FRCR,AlexanderA.Bankier,MD,HeberMacMahon,MB,BCh,BAO,TheresaC.McLoud,MD,NestorL.Muller,MD,PhD,andJacquesRemy,MDFromtheDepartmentofRadiology,RoyalBromptonHospital,SydneyStreet,LondonSW36NP,UnitedKingdom(D.M.H.);DepartmentofRadiology,BethIsraelDeaconessMedicalCenter,Boston,Mass(A.A.B.);DepartmentofRadiology,UniversityofChicagoHospital,Chicago,Ill(H.M.);DepartmentofRadiology,MassachusettsGeneralHospital,Boston,Mass(T.C.M.);DepartmentofRadiology,VancouverGeneralHospital,Vancouver,BritishColumbia,Canada(N.L.M.);andDepartmentofRadiology,CHRUdeLille,HopitalCalmette,Lille,France(J.R.).ReceivedApril21,2007;revisionrequestedMay29;revisionreceivedJune6;acceptedAugust7;finalversionacceptedSeptember19.Addresscorrespondenceto:D.M.H.(e-mail:d.hanselISrbht.nhs.曲).ABSTRACTMembersoftheFleischnerSocietycompiledaglossaryoftermsforthoracicimagingthatreplacespreviousglossariespublishedin1984and1996forthoracicradiographyandcomputedtomography(CT),工耍p0土jyely.Theneedto憩趣撿thepreviousYW?里camefromthe/ggQ酗復上9nthatnewwordshaveemerged,othershavebecomeobsolete,andthemeaningofsometermshaschanged.Briefdescriptionsofsomediseasesareincluded,and 工jg]examples(chestradiographsandCTscans)areprovidedforthemajorityofterms.INTRODUCTIONThepresentglossaryisthethirdpreparedbymembersoftheFleischnerSocietyandreplacestheglossariesoftermsforthoracicradiology(1.)andCT(2),respectively.Theimpetustocombineandupdatethepreviousversionscamefromtherecognitionthatwiththerecentdevelopmentsinimagingnewwordshavearrived,othershavebecomeobsolete,andthemeaningofsometermshaschanged.Theintentionofthislatestglossaryisnottobeexhaustiyebuttoconcentrateonthosetermswhosemeaningmaybeproblematic.Termsandtechniquesnotusedexclusivelyinthoracicimagingarenotincluded.Twonewfeaturesaretheinclusionofbriefdescriptionsofthe“1坷空上卜應1*"￡工1上垣1pneumonias(11Ps)andpictorialexamples(chestradiographsandcomputedtomographic[CT]scans)forthemajorityofterms.ThedecisiontoincludevignettesoftheIIPs(butnototherpathologicentities)wasbasedontheperceptionthat,despitetherecentscrutinyandreclassification,theIIPsremainaconfusinggroupofdiseases.Wetrustthattheillustrationsenhance,butdonotdistractfrom,thedefinitions.Inthiscontext,thefiguresshouldberegardedasoflessimportemcethanthetext-theyaremerelyexamplesandshouldnotbetakenasrepresentingthefullrangeofpossibleimagingappearances(whichmaybefoundinthereferencesprovidedinthisglossaryorincomprehensivetextbooks).Wehopethatthisglossaryoftermswillbehelpful,anditispresentedinthespiritofthesentimentofEdwardJ.Huththat*scientificwritingcallsforprecisionasmuchinnamingthingsandconceptsasinpresentingdata*(3).ItisrighttorepeattherequestwithwhichthelastFleischnerSocietyglossaryclosed:*[U]seofwordsisinherentlycontroversialandwearepleasedtoinvitereaderstoofferimprovementstoourdefinitions*(2).GLOSSARYAcinus腺泡Anatomy.—Theacinusisastructuralunitofthelungdistaltoaterminalbronchioleandissuppliedbyfirst-orderrespiratorybronchioles;itcontainsalveolarductsandalveoli.Itisthelargestunitinwhichallairwaysparticipateingasexchangeandisapproximately6-10mmindiameter.Onesecondarypulmonarylobulecontainsbetweenthreeand25acini(4).RadiographsandCTscans.—Individualnormalaciniarenotvisible,butacinararteriescanoccasionallybeidentifiedonthin-sectionCTscans.Accumulationofpathologicmaterialinacinimaybeseenaspoorlydefinednodularopacitiesonchestradiographsandthin-sectionCTimages.(Seealsonodules,)解剖：腺泡是終末細支氣管以遠的肺結(jié)構(gòu)單位，由一級呼吸細支氣管供給。腺泡含肺泡管和肺泡，它是全部氣道都參與氣體交換的最大肺單位，直徑6?10mm。一個二次肺小葉含3?25個腺泡。X和CT表現(xiàn)：正常時見不到個別的腺泡，但在薄層CT上偶可見腺泡動脈。腺泡內(nèi)積聚病理物質(zhì)時，X線胸片和薄層CT上可見邊緣模糊的結(jié)節(jié)。acuteinterstitialpneumonia,orAIP急性肺間質(zhì)肺炎Pathology.——Thetermacuteinterstitialpneumoniaisreservedfordiffusealveolardamageofunknowncause.Theacutephaseischaracterizedbyedemaandhyalinemembraneformation.Thelaterphaseischaracterizedbyairspaceand/orinterstitialorganization(5).Thehistologicpatternisindistinguishablefromthatofacuterespiratorydistresssyndrome.病理：急性肺間質(zhì)肺炎為原因不明的彌漫肺泡損害。急性期的特征為水腫和透明膜形成，晚期的特征為氣腔和(或)間質(zhì)機化。組織學所見不能與急性呼吸窘迫綜合征鑒別。RadiographsandCTscans.—Intheacutephase,patchybilateralground-glassopacitiesareseen(6),oftenwithsomesparingofindividuallobules,producingageographicappearance;denseopacificationisseeninthedependentlung(Fig1).Intheorganizingphase,architecturaldistortion,tractionbronchiectasis,cysts,andreticularopacitiesareseen(7).急性期可見兩肺斑片狀磨玻璃影，其間個別肺小葉正常，出現(xiàn)地圖樣分布，在肺的下垂部可見致密影。在機化期可見肺結(jié)構(gòu)扭曲、牽引性支氣管擴張、囊腫和網(wǎng)影。

TransverseCTscaninapatientwithacuteinterstitialpneumonia.airbronchogram空氣支氣管征RadiographsandCTscans.—Anairbronchogramisapatternofair-filled(1ow-attenuation)bronchionabackgroundofopaque(high-attenuation)airlesslung(Fig2).Thesignimplies(a)patencyofproximalairwaysand(b)evacuationofalveolarairbymeansofabsorption(atelectasis)orreplacement(eg,pneumonia)oracombinationoftheseprocesses.Inrarecases,thedisplacementofairistheresultofmarkedinterstitialexpansion(eg,lymphoma)(8).X和CT表現(xiàn)：空氣支氣管征是一種在含氣少的致密(高衰減)肺的背景上見到含氣(低衰減)支氣管的表現(xiàn)。該征象表明：(a)近側(cè)氣道通暢；(b)肺泡內(nèi)的空氣經(jīng)吸收(肺不張)或取代(肺炎)，或兩者綜合而消失，在少見病例(如淋巴瘤)中空氣的消失是顯著的間質(zhì)膨脹的結(jié)果。TransverseCTscanshowsairbronchogramasair-filledbronchi(arrows)againstbackgroundofhigh-attenuationlung.aircrescent空氣半月征RadiographsandCTscans.―Anaircrescentisacollectionofairinacrescenticshapethatseparatesthewallofacavityfromaninnermass(Fig3).TheaircrescentsignisoftenconsideredcharacteristicofeitherAspergilluscolonizationofpreexistingcavitiesorretractionofinfarctedlunginangioinvasiveaspergillosis(9,10).However,theaircrescentsignhasalsobeenreportedinotherconditions,includingtuberculosis,Wegenergranulomatosis,intracavitaryhemorrhage,andlungcancer.(Seealsomycetoma.hemorrhage,andlungcancer.(Seealsomycetoma.)X和CT表現(xiàn)：為半月形空氣積聚，將空洞壁與洞內(nèi)腫塊分開.該征象通常被認為是曲菌移植到已有的空洞內(nèi)或在血管侵襲性曲菌病中梗死的肺收縮的結(jié)果。但該征象也見于其他情況，包括結(jié)核病、韋格肉芽腫、空洞內(nèi)出血和肺癌。Magnifiedchestradiographshowsaircrescent(arrows)adjacenttomycetoma.airtrapping空氣潴留Pathophysiology.——Airtrappingisretentionofairinthelungdistaltoanobstruction(usuallypartial).CTscans.—Airtrappingisseenonend-expirationCTscansasparenchymalareaswithlessthannormalincreaseinattenuationandlackofvolumereduction.ComparisonbetweeninspiratoryandexpiratoryCTscanscanbehelpfulwhenairtrappingissubtleordiffuse(11,12)(Fig4).Differentiationfromareasofdecreasedattenuationresultingfromhypoperfusionasaconsequenceofanocclusivevasculardisorder(eg,chronicthromboembolism)maybeproblematic(13),butotherfindingsofairwaysversusvasculardiseaseareusuallypresent.(Seealsomosaicattenuationpattern.)病理生理學：空氣潴留是指氣道阻塞(常為部分性)導致的遠處肺內(nèi)的氣體潴留CT：空氣潴留見于呼氣相末CT掃描像上，表現(xiàn)為肺實質(zhì)區(qū)的衰減較正常為少，且肺體積不縮小。當空氣潴留輕度或彌漫性時，比較吸氣相和呼氣相CT有價值。其通常難與阻塞性血管病(如慢性肺栓塞)低灌注所致的衰減減少區(qū)鑒別，但常有與血管病相對應的氣道病的其他表現(xiàn)。TransverseCTscansatendinspirationandendexpirationshowairtrapping.Airspace氣腔Anatomy.—Anairspaceisthegas-containingpartofthelung,includingtherespiratorybronchiolesbutexcludingpurelyconductingairways,suchasterminalbronchioles.RadiographsandCTscans.—Thistermisusedinconjunctionwithconsolidationtopacity,andnodulestodesignatethefillingofairspaceswiththeproductsofdisease(14).解剖：是肺的含氣部分，包括呼吸細支氣管，但不包括單純的傳導性氣道，如終末細支氣管X線和CT表現(xiàn)：氣腔一詞用于和實變、致密影、結(jié)節(jié)有關聯(lián)處，以描述由病變所致的氣腔充盈。aortopulmonarywindow主肺動脈窗Anatomy.—Theaortopulmonarywindowisthemediastinalregionboundedanteriorlybytheascendingaorta,posteriorlybythedescendingaorta,craniallybytheaorticarch,inferiorlybytheleftpulmonaryartery,mediallybytheligamentumarteriosum,andlaterallybythepleuraandleftlung(15,16).RadiographsandCTscans.—Focalconcavityintheleftmediastinalborderbelowtheaortaandabovetheleftpulmonaryarterycanbeseenonafrontalradiograph(Fig5).Itsappearancemaybemodifiedbytortuosityoftheaorta.Theaortopu1monarywindowisacommonsiteoflymphadenopathyinavarietyofinflammatoryandneoplasticdiseases.解剖：主肺動脈窗其前為升主動脈，后為降主動脈，上為主動脈弓，下為左肺動脈，內(nèi)為動脈導管韌帶，外為胸膜及左肺的縱隔內(nèi)一個區(qū)域X線和CT表現(xiàn)：在正位X線胸片上為主動脈弓下、左肺動脈上、縱隔左緣上的局部凹陷處，它的表現(xiàn)可隨主動脈扭曲而改變。主肺動脈窗內(nèi)?？梢姼鞣N炎癥和腫瘤疾病中的腫大淋巴結(jié)。Magnifiedchestradiographshowsaortopulmonarywindow.I

apicalcap肺尖帽Pathology.—Anapicalcapisacaplikelesionatthelungapex,usuallycausedbyintrapulmonaryandpleuralfibrosispullingdownextrapleuralfat(17)orpossiblybychronicischemiaresultinginhyalineplaqueformationonthevisceralpleura(18).Theprevalenceincreaseswithage.Itcanalsobeseeninhematomaresultingfromaorticruptureorinotherfluidcollectionassociatedwithinfectionortumor,eitheroutsidetheparietalpleuraorloculatedwithinthepleuralspace(19).RadiographsandCTscans.—Theusualappearanceisofhomogeneoussoft-tissueattenuationcappingtheextremelungapex(uni-orbilaterally),withasharporirregularlowerborder(Fig6).Thicknessisvariable,ranginguptoabout30mm(17).AnapicalcapoccasionallymimicsapicalconsolidationontransverseCTscans.病理：肺尖帽為肺尖部的帽狀病變，常由肺或胸膜纖維化向下牽拉胸膜外脂肪所致，也可能是慢性缺血導致的臟層胸膜透明斑形成的結(jié)果。其發(fā)生率隨年齡增大而升高。也曾見于主動脈破裂所致血腫或其他位于壁層胸膜外或胸膜腔內(nèi)的并發(fā)感染或腫瘤的積液者X線和CT：常呈密度均勻的軟組織影，覆蓋于肺尖上面(一側(cè)或兩側(cè))，下緣銳利或不規(guī)則，厚度不一，可厚達30nlm。在CT橫斷面像上肺尖帽偶可誤認為肺尖部實變。Magnifiedchestradiographshowsapicalcap(arrow).architecturaldistortion結(jié)構(gòu)扭曲Pathology.—Architecturaldistortionischaracterizedbyabnormaldisplacementofbronchi,vessels,fissures,orseptacausedbydiffuseorlocalizedlungdisease,particularlyinterstitialfibrosis.CTscans.—Lunganatomyhasadistortedappearanceandisusuallyassociatedwithpulmonaryfibrosis(Fig7)andaccompaniedbyvolumeloss.

病理：結(jié)構(gòu)扭曲是由于彌漫性或局限性肺部疾病，尤其是間質(zhì)纖維化引起的支氣管、血管、葉間裂或小葉間隔的異常移位。CT：肺解剖結(jié)構(gòu)扭曲常伴肺纖維化，并有肺容積縮小。Figure7:TransverseCTscanshowsarchitecturalFigure7:TransverseCTscanshowsarchitecturaldistortioncausedbypulmonaryfibrosis.Atelectasis肺不張Pathophysiology.—Atelectasisisreducedinflationofallorpartofthelung(20).Oneofthecommonestmechanismsisresorptionofairdistaltoairwayobstruction(eg,anendobronchialneoplasm)(21).Thesynonymcollapseisoftenusedinterchangeablywithatelectasis,particularlywhenitissevereoraccompaniedbyobviousincreaseinlungopacity.RadiographsandCTscans.——Reducedvolumeisseen,accompaniedbyincreasedopacity(chestradiograph)orattenuation(CTscan)intheaffectedpartofthelung(Fig8).Atelectasisisoftenassociatedwithabnormaldisplacementoffissures,bronchi,vessels,diaphragm,heart,ormediastinum(22).Thedistributioncanbelobar,segmental,orsubsegmental.Atelectasisisoftenqualifiedbydescriptorssuchaslinear,discoid,orplatelike.(Seealsolinearatelectasis,roundedatelectasis.)病理生理學：部分或全部肺充氣減少。最常見的機制之一為氣道阻塞，遠側(cè)空氣的吸收(如支氣管內(nèi)腫瘤)。同義詞萎陷可與肺不張交換使用，尤其在嚴重或伴有明顯的肺密度增高時X線和CT表現(xiàn)：可見肺容積縮小，伴受累肺的密度增加(X線胸片)或CT衰減值增加(CT掃描)。肺不張常伴有葉間裂、支氣管、血管、膈肌、心臟或縱隔的異常移位。可以是葉、段或亞段分布。肺不張常定量描述為線狀、盤狀或板狀肺不張。也見于線狀肺不張、圓形肺不張。TransverseCTscanshowsatelectasisofrightmiddlelobeasincreasedattenuation(arrows)adjacenttorightborderofheart.azygoesophagealrecess奇靜脈食管隱窩Anatomy.—Theazygoesophagealrecessisarightposteriormediastinalrecessintowhichtheedgeoftherightlowerlobeextends.Itislimitedsuperiorlybytheazygosarch,posteriorlybytheazygosveinandpleuraanteriortothevertebralcolumn,andmediallybytheesophagusandadjacentstructures.RadiographsandCTscans.—Onafrontalchestradiograph,therecessisseenasaverticallyorientedinterfacebetweentherightlowerlobeandtheadjacentmediastinum(themediallimitoftherecess).Superiorly,theinterfaceisseenasasmootharcwithconvexitytotheleft.Disappearanceordistortionofpartoftheinterfacesuggestsdisease(eg,subcarinallymphadenopathy).OnCTscans,therecess(Fig9)meritsattentionbecausesmalllesionslocatedintherecesswilloftenbeinvisibleonchestradiographs(23).解剖：是右后縱隔隱窩，右下葉延伸至其右緣，上界為奇靜脈弓，后為奇靜脈和脊柱前胸膜，內(nèi)側(cè)為食管和鄰近結(jié)構(gòu)X和CT表現(xiàn)：在正位X線胸片上表現(xiàn)為右下葉和鄰近縱隔（隱窩內(nèi)界）之間呈垂直方向的界面，該界面的上部表現(xiàn)為凸向左的光滑的弧形。界面的部分消失或扭曲提示有病變（如隆突下淋巴結(jié)腫大）o在CT上應高度注意該隱窩，因為隱窩內(nèi)的小病變在X線片上常見不到。TransverseCTscanshowsazygoesophagealrecess(arrows).

azygosfissure奇裂Seefissurebeadedseptumsign串珠樣隔征CTscans.—Thissignconsistsofirregularandnodularthickeningofinterlobularseptareminiscentofarowofbeads(Fig10).Itisfrequentlyseeninlymphangiticspreadofcancerandlessofteninsarcoidosis(24).該表現(xiàn)包括不規(guī)則或結(jié)節(jié)狀的小葉間隔增厚，似一串珠子。常見于癌的淋巴管播散和較少的結(jié)節(jié)病中。TransverseCTscanshowsbeadedseptumsign(arrows).Bleb肺大皰Anatomy.—Ablebisasmallgas-containingspacewithinthevisceralpleu聞臟層胸膜orin?heRUbpl991ml1包8胸膜肺,notlargerthan1cmindiameter(25).CTscans.―Ablebappearsas-thin-willedcysticairspacecontiguouswiththepleura與胸膜相連的薄壁囊性區(qū)域.Becausethearbitrary（size）distinctionbetweenablebandbullaisoflittleclinicalimportance,theuseofthistermbyradiologistsisdiscouraged.由于任意（大小）之間的氣泡和泡的區(qū)的臨床意義不大，放射專家不鼓勵使用這一術(shù)語。解剖：為一小的位于臟層胸膜內(nèi)或胸膜下肺內(nèi)的含氣間隙，直徑Siem。CT表現(xiàn)：為鄰近胸膜的薄壁囊性氣腔。由于任意以大小來區(qū)別大泡（bulla）和大皰，無臨床重要性，故不鼓勵放射診斷醫(yī)師使用該術(shù)語。Bronchiectasis支氣管擴張Pathology.―^二9/)￡卜12&±@§4§一［9_工工二0丫0工§［卜］?［Qggjjzed9rdi且Ldll0土@9rL支氣管擴張癥，是不可逆轉(zhuǎn)的局部或彌漫性擴張支氣管，usuallyresultingfromchronicinfection,proximalairwayobstruction近端氣道阻塞，orcongenitalbronchialabnormality先天性支氣管異常(26).(Seealsotractionbronchiectasis.(另見牽引支氣管擴張。))

RadiographsandCTscans.-Morphologiccriteriaonthin-sectionCTscans形態(tài)上標準的薄層CT掃描includebronchialdilatationwithrespecttotheaccompanyingpulmonaryartery包括就伴隨肺動脈擴張支氣管(signetringsign戒號)，lackoftaperingofbronchi逐漸變細的支氣管,andidentificationofbronchiwithin1cmofthepleuralsurface(27)(Fig11).Bronchiectasismaybeglassifigd空cyliKrig，varicose,orgystig根據(jù)受影響的支氣管外觀，支氣管擴張癥可分為圓柱，靜脈曲張，或囊隹 Itisoftenaccompaniedbybronchialwallthickening,mucoidimpaction粘液嵌塞，andsmall-airwaysabnormalities(27-29).(Seealsosignetringsign.)病理：為不可恢復的局限性或彌漫性支氣管擴大，常由慢性感染、近側(cè)氣道阻塞或先天支氣管異常所致。也見于牽引性支氣管擴張X和CT表現(xiàn)：薄層CT的形態(tài)學標準包括與其伴行的肺動脈相比支氣管擴大(印戒征)、支氣管不變細及胸膜面下工cm內(nèi)可見支氣管。根據(jù)擴張支氣管的表現(xiàn)可分為柱狀、靜脈曲張狀和囊狀支氣管擴張。支氣管擴張常伴有支氣管管壁增厚、黏液嵌塞和小氣道異常。也見于印戒征。TransverseCTscanshowsvaricosebronchiectasis.橫向靜脈曲張的CT掃描顯示支氣管擴Bronchiole細支氣管Anatomy.—Bronchiolesarenon-cartilage軟骨-containingairways.Terminalbronchiolesare她0ffdjw扭1璉th?PU工旦!y￡9。如￡及。&曳邛或縣；終端支氣管是純粹進行氣管最遠端theygiverisetorespiratorybronchioles呼吸細支氣管，fromwhichthealveoli肺泡ariseandpermitgasexchange.Respiratorybronchiolesbranchintomultiplealveolarducts呼吸細支氣管分支成多肺泡導管.RadiographsandCTscans.—Bronchiolesarenotidentifiableinhealthyindividuals支氣管在健康的人無法識另1J,becausethebronchiolarwallsaretoothin(4).Ininflammatorysmall-airwaysdisease炎性小呼吸道疾病，however,thickenedorplugged堵塞bronchiolesmaybeseenasanodularpatternonachestradiographorasatree-in-budpatternonCTscans.解剖：細支氣管為不含軟骨的氣道。終末細支氣管是最遠端的單純傳導性氣道，它們發(fā)出呼吸細支氣管，呼吸細支氣管分支成多個肺泡管、肺泡囊、肺泡而進行氣體交換X線和CT表現(xiàn)：健康人的細支氣管因管壁太薄而見不到，但在感染性小氣道病變中，因管壁增厚或管腔內(nèi)嵌塞而容易見到。其在X線胸片上呈結(jié)節(jié)影，CT上表現(xiàn)為樹芽征。Bronchiolectasia細支氣管擴張Pathology.—Bronchiolectasisisdefinedasdilatationofbronchioles被定義為支氣管擴張.Itiscausedbyinflammatoryairwaysdisease(potentiallyreversible)or,morefrequently,fibrosis.它是由疾病引起的呼吸道炎癥(可能逆轉(zhuǎn))，或更頻繁，纖維化。CTscans.—"Whendilatedbronchiolesarefilledwithexudateandarethickwald當擴張支氣管充滿滲出物，并厚壁，theyarevisibleasatree-in-budpattern可看見樹中芽方式orascentrilobularnodules小葉結(jié)節(jié)(魚,黑).Intraction牽引bronchiolectasis,[hediiMedbronchioles擴張支氣管areseenassmall,cystic,tubularairspaces,associatedwithCTfindingsoffibrosis化的CT表現(xiàn)相關(Fig12).(Seealsotractionbronchiectasisandtractionbronchiolectasis,tree-in-budpattern.)病理：細支氣管擴張定義為細支氣管擴大，是由感染性氣道疾病(有潛在的可逆性)或更常見的肺纖維化所致。CT表現(xiàn)：當擴大的細支氣管腔被滲出物充盈和管壁增厚時，表現(xiàn)為樹芽征或小葉中心性結(jié)節(jié)。在牽引性細支氣管擴張中，擴大細支氣管表現(xiàn)為小的囊狀、管狀氣腔，并伴有纖維化的CT表現(xiàn)。也見于牽引性支氣管擴張、細支氣管擴張和樹芽征。TransverseCTscanshows

bronchiolectasiswithinfibroticlung(arrow).Bronchiolitis細支氣管炎Pathology.—Bronchiolitisisbronchiolarinflammationofvariouscauses(33).CTscans.—Thisdirectsignofbronchiolarinflammation(eg,infectiouscause)ismostoftenseenasthetree-in-budpattern,centrilobularnodules,andbronchiolarwallthickeningonCTscans.(Seealsosmall-airwaysdisease,tree-in-budpattern.)病理：為各種原因所致的細支氣管炎癥。

CT表現(xiàn)：細支氣管炎癥（即感染性）的直接征象中最常見的是樹芽征、小葉中心性結(jié)節(jié)和細支氣管管壁增厚。Bronchocele支氣管囊腫Pathology.―Abronchoceleisbronchialdilatationduetoretainedsecretions(mucoidimpaction)usuallycausedbyproximalobstruction,eithercongenital(eg,bronchialatresia)oracquired(eg,obstructingcancer)(34).RadiographsandCTscans.—AbronchoceleisatubularorbranchingY-orV-shapedstructurethatmayresembleaglovedfinger(Fig13).TheCTattenuationofthemucusisgenerallythatofsofttissuebutmaybemodifiedbyitscomposition(eg,high-attenuationmaterialinallergicbronchopu1monaryaspergillosis).Inthecaseofbronchialatresia,thesurroundinglungmaybeofdecreasedattenuationbecauseofreducedventilationand,thus,perfusion.病理學表現(xiàn)：支氣管內(nèi)因先天性疾病(如支氣管閉鎖)或獲得性疾病(如阻塞性癌)造成近端支氣管阻塞，分泌物存留(黏液嵌塞)而使支氣管擴大X線和CT表現(xiàn)：支氣管囊腫為管狀或Y形、V形的分支狀結(jié)構(gòu)，類似指套。黏液的CI衰減值一般同軟組織，但可因成分(如過敏性支氣管肺曲菌病中的高衰減物質(zhì))而改變。在支氣管閉鎖病例中，因通氣、灌注減少而使周圍肺衰減值減低OCoronalCTscanshowsbronchocele(arrow).Bronchocentric支氣管中心性CTscans.—Thisdescriptorisappliedtodiseasethatisconspicuouslycenteredonmacroscopicbronchovascularbundles(Fig14).Examplesofdiseaseswithabronchocentricdistributionincludesarcoidosis(35),Kaposisarcoma(36),andorganizingpneumonia(37).該術(shù)語用于在肉眼上顯著以支氣管血管束為中心的病變。支氣管中心性分布的疾病包括結(jié)節(jié)病、Kaposi肉瘤和機化性肺炎。

TransverseCTscanshowsconsolidationwithbronchocentricdistribution.Broncholith支氣管結(jié)石Pathology.—Abroncholith,acalcifiedperibronchiallymphnodethaterodesintoanadjacentbronchus,ismostoftentheconsequenceofHistopiasmaortuberculousinfection.RadiographsandCTscans.—Theimagingappearanceisofasmallcalcificfocusinorimmediatelyadjacenttoanairway(Fig15),mostfrequentlytherightmiddlelobebronchus.BroncholithsarereadilyidentifiedonCTscans(38).Distalobstructivechangesmayincludeatelectasis,mucoidimpaction,andbronchiectasis.病理學表現(xiàn)：支氣管結(jié)石為鈣化的支氣管周圍淋巴結(jié)侵蝕并進入鄰近的支氣管管腔內(nèi)，最常發(fā)生于組織胞漿菌或結(jié)核感染后X線和CT表現(xiàn)：影像表現(xiàn)為在氣道內(nèi)或直接在氣道旁見到小鈣化灶。最常見于右中葉支氣管。氣道阻塞遠側(cè)有肺不張、黏液嵌塞和支氣管擴張。該病在CT上容易確診。TransverseCTscanshowsabroncholith(arrows).Bulla大泡Pathology.—Anairspacemeasuringmorethan1cm-usuallyseveralcentimeters-indiameter,sharplydemarcatedbyathinwallthatisnogreaterthan1mminthickness.Abullaisusuallyaccompaniedbyemphysematouschangesintheadjacentlung.(Seealsobullousemphysema.)

RadiographsandCTscans.—Abullaappearsasaroundedfocallucencyorareaofdecreasedattenuation,1cmormoreindiameter,boundedbyathinwall(Fig16).Multiplebullaeareoftenpresentandareassociatedwithothersignsofpulmonaryemphysema(centrilobularandparaseptal).病理學表現(xiàn)：直徑＞lcm,常為數(shù)厘米的氣腔，壁薄，厚度Slmm,邊緣銳利。鄰近肺常有肺氣腫。也見于大泡性肺氣腫leftlowerlungzone.X線和CT表現(xiàn)：大泡表現(xiàn)為圓形局限性透光影或低衰減區(qū)，直徑Nlcm,圍以薄壁。大泡常為多個，并常伴有其他肺氣腫征象(小葉中心型或間隔旁型肺氣腫)。leftlowerlungzone.CoronalCTscanshowslargebullainbullousemphysema大泡性肺氣腫Pathology.—Bullousemphysemaisbullousdestructionofthelungparenchyma,usuallyonabackgroundofparaseptalorpanacinaremphysema.(Seealsoemphysema,bulla.)病理學表現(xiàn)：大泡性肺氣腫是肺實質(zhì)的大泡性破壞，常有間隔旁型肺氣腫或全小葉型肺氣腫的背景。也見于肺氣腫、大泡。Cavity空洞RadiographsandCTscans.—Acavityisagas-filledspace,seenasalucencyorow-attenuationarea,withinpulmonaryconsolidation,amass,oranodule(Fig17).Inthecaseofcavitatingconsolidation,theoriginalconsolidationmayresolveandleaveonlyathinwall.Acavityisusuallyproducedbytheexpulsionordrainageofanecroticpartofthelesionviathebronchialtree.Itsometimescontainsafluidlevel.Cavityisnotasynonymforabscess,X線和CT：空洞為一充盈氣體的腔，表現(xiàn)為肺實變、腫塊或結(jié)節(jié)內(nèi)的透光區(qū)或低衰減區(qū)。在空洞性實變病例中，原來的實變可吸收而僅遺留薄壁?？斩闯椴∽兊膲乃啦糠纸?jīng)支氣管樹排出或引流而致。有時含有液平。空洞不是膿腫同義詞。Centrilobular小葉中心性Anatomy.―Centrilobulardescribestheregionofthebronchiolovascularcoreofasecondarypulmonarylobule(4,39,40).Thistermisalsousedbypathologiststodescribethelocationoflesionsbeyondtheterminalbronchiolethatcenteronrespiratorybronchiolesorevenalveolarducts.CTscans.-Asmalldotlikeorlinearopacityinthecenterofanormalsecondarypulmonarylobule,mostobviouswithin1cmofapleuralsurface,representstheintralobularartery(approximately1mmindiameter)(41).Centrilobularabnormalitiesinclude(a)nodules,(b)atree-in-budpatternindicatingsmall-airwaysdisease,(c)increasedvisibilityofcentrilobularstructuresduetothickeningorinfiltrationoftheadjacentinterstitium,or(d)abnormalareasoflowattenuationcausedbycentrilobularemphysema(4).(Seealsolobularcorestructures.)解剖學：該術(shù)語描述的是二次肺小葉的細支氣管血管核心區(qū)。病理學家也使用該術(shù)語描述位于終末細支氣管以遠的、以呼吸細支氣管，甚至肺泡管為中心的病變CT表現(xiàn)：在正常二次肺小葉中心的小點狀或線狀致密影，在胸膜面下1cm內(nèi)最明顯，代表小葉內(nèi)動脈(直徑約為1mm)。小葉中心性異常包括：①多個結(jié)節(jié)；②表明為小氣道病變的樹芽征；③小葉中心性結(jié)構(gòu)由于鄰近的間質(zhì)增厚或浸潤而可見性增加；④由小葉中心型肺氣腫而致的異常低衰減區(qū)。也見于小葉核心結(jié)構(gòu)。centrilobularemphysema小葉中心型肺氣腫Pathology.―Centrilobularemphysemaischaracterizedbydestroyedcentrilobularalveolarwallsandenlargementofrespiratorybronchiolesandassociatedalveoli(42,43).Thisisthecommonestformofemphysemaincigarettesmokers.CTscans.—CTfindingsarecentrilobularareasofdecreasedattenuation,usuallywithoutvisiblewalls,ofnonuniformdistributionandpredominantlylocatedinupperlungzones(44)(Fig18).Thetermcentriacinaremphysemaissynonymous.(Seealsoemphysema.)以小葉中心性肺泡壁破壞，呼吸支氣管和肺泡增大為特征，為吸煙者最常見的肺氣腫類型。表現(xiàn)為小葉中心區(qū)密度減低，常無可見的壁，分布不均勻，主要位于上葉。小葉中心型肺氣腫與腺泡中心型肺氣腫是同義詞。也見于肺氣腫。

TransverseCTscanshowscentrilobularemphysema.Collapse萎陷Seeatelectasis肺不張Consolidation肺實變Pathology.―Consolidationreferstoanexudateorotherproductofdiseasethatreplacesalveolarair,renderingthelungsolid(asininfectivepneumonia).RadiographsandCTscans.―Consolidationappearsasahomogeneousincreaseinpulmonaryparenchymalattenuationthatobscuresthemarginsofvesselsandairwaywalls(45)(Fig19).Anairbronchogrammaybepresent.Theattenuationcharacteristicsofconsolidatedlungareonlyrarelyhelpfulindifferentialdiagnosis(eg,decreasedattenuationinlipoidpneumonia[46]andincreasedinamiodaronetoxicity[47]).病理學表現(xiàn)：實變涉及病變的滲出或其他產(chǎn)物取代了肺泡內(nèi)的空氣使肺實化（如在感染性肺炎中）。X線和CT表現(xiàn)：實變表現(xiàn)為肺實質(zhì)衰減均勻增加，掩蓋了其內(nèi)的血管和氣道壁的邊緣，可有空氣支氣管征。實變肺的衰減特征對鑒別診斷幫助不大（如，類脂性肺炎中的衰減減低，在乙胺碘吠酮中毒時的衰減增加）。TransverseCTscanshowsmultifocalconsolidation.crazy-pavingpattern碎石路征CTscans.—Thispatternappearsasthickenedinterlobularseptaandintralobularlinessuperimposedonabackgroundofground-glassopacity(Fig20),resemblingirregularlyshapedpavingstones.Thecrazy-pavingpatternisoftensharplydemarcatedfrommorenormallungandmayhaveageographicoutline.Itwasoriginallyreportedinpatientswithalveolarproteinosis(48)andisalsoencounteredinotherdiffuselungdiseases(49)thataffectboththeinterstitial

andairspacecompartments,suchaslipoidpneumonia(50).為在磨玻璃影背景上重疊有增厚的小葉間隔和小葉內(nèi)線，類似不規(guī)則的碎石路。碎石路征區(qū)常與較正常的肺區(qū)分界清楚，呈地圖樣輪廓。該征最先報道于肺泡蛋白沉著癥中，也見于同時累及間質(zhì)和氣腔的彌漫性肺病，如類脂質(zhì)肺炎。TransverseCTscanshowscrazy-pavingpattern.cryptogenicorganizingpneumonia,orCOP隱原性機化性肺炎Seeorganizingpneumonia.Cyst肺囊腫Pathology.—Acystisanyroundcircumscribedspacethatissurroundedbyanepithelialorfibrouswallofvariablethickness(51).RadiographsandCTscans.—Acystappearsasaroundparenchymallucencyorlow-attenuatingareawithawell-definedinterfacewithnormallung.Cystshavevariablewallthicknessbutareusuallythin-walled(<2mm)andoccurwithoutassociatedpulmonaryemphysema(Fig21).Cystsinthelungusuallycontainairbutoccasionallycontainfluidorsolidmaterial.Thetermisoftenusedtodescribeenlargedthin-walledairspacesinpatientswithlymphangioleiomyomatosis(52)orLangerhanscellhistiocytosis(53);thicker-walledhoneycombcystsareseeninpatientswithend-stagefibrosis(54).(Seealsobleb,bulla,honeycombing,pneumatocele.)病理學表現(xiàn)：囊腫是任何圓形的空腔，周圍環(huán)繞以不同厚度的上皮或纖維性壁。X和CT表現(xiàn)：表現(xiàn)為圓形的實質(zhì)透光區(qū)或低衰減區(qū)，與正常肺分界清楚，囊壁厚度不等，常為薄壁(V2mm),不伴有肺氣腫。肺囊腫內(nèi)常含空氣，但偶含液體或?qū)嶓w物質(zhì)。囊腫常用于描述淋巴管平滑肌瘤病或朗格漢斯細胞組織細胞增生癥病例中增大的薄壁氣腔，在終末期纖維化病例中可見厚壁的蜂窩囊腫。也見于大皰、大泡、蜂窩、肺氣囊。

desquamativeinterstitialpneumonia,orDIP脫屑性間質(zhì)性肺炎Pathology.—Histologically,DIPischaracterizedbythewidespreadaccumulationofanexcessofmacrophagesinthedistalairspaces.Themacrophagesareuniformlydistributed,unlikeinrespiratorybronchiolitis-interstitiallungdisease,inwhichthediseaseisconspicuouslybronchiolocentric.Interstitialinvolvementisminimal.MostcasesofDIParerelatedtocigarettesmoking,butafewareidiopathicorassociatedwithrareinbornerrorsofmetabolism(5).RadiographsandCTscans.―Ground-glassopacityisthedominantabnormalityandtendstohaveabasalandperipheraldistribution(Fig22).Microcysticorhoneycombchangesintheareaofground-glassopacityareseeninsomecases(55).病理：組織學上，DIP的特征是遠側(cè)氣腔內(nèi)過量巨噬細胞的廣泛積聚，巨噬細胞分布均勻，間質(zhì)受累輕。這與呼吸細支氣管炎一間質(zhì)性肺病不同，后者的病變明顯地以細支氣管為中心。大多數(shù)DIP病例與吸煙有關，但少數(shù)為特發(fā)性或伴有先天性代謝缺陷。X和CT表現(xiàn)：磨玻璃影為其主要異常，傾向肺周圍部和基底部分布，在有些病例的磨玻璃肺區(qū)中可見微囊腫或蜂窩。TransverseCTscaninapatientwithdesquamativeinterstitialpneumonia.diffusealveolardamage,orDAD彌漫性肺泡損傷Seeacuteinterstitialpneumonia.Emphysema肺氣腫Pathology.—Emphysemaischaracterizedby cr]%旦diWt旦1tQ永久遠端擴大空域theterminalbronchiole終末細支氣管withdestructionofalveolarwalls肺泡壁破壞(42,43).Absenceof"obviousfibrosis*washistoricallyregardedasan旦期工工強乳cri圾理9n額夕卜的標準_(位)，butthevalidity有效性ofthatcriterionhasbeenquestioned質(zhì)疑becausesomeinterstitialfibrosismaybepresentinemphysemasecondarytocigarettesmoking(56,57).Emphysemaisusuallyclassifiedintermsofthepartoftheacinus腺泡predominantlyaffected:proximal近端(centriacinar,morecommonlytermed稱為centrilobular,emphysema小葉，肺氣腫)，distal遠端肺氣腫(paraseptalemphysema),orwholeacinus(panacinaror,lesscommonly,panlobularemphysema).CTscans.—TheCTappearanceofemphysemaconsistsoffocalareasorregionsoflowattenuation,usuallywithoutvisiblewalls(58).Inthecaseofpanacinaremphysema,dWS工螃Mattenuation diffUWW降低衰減更加分散.(Seealsobullous大皰emphysema,centrilobular<|、葉emphysema,pan