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(chēng)微結(jié)節(jié) 2 3mm粟粒結(jié)節(jié) 直徑5 10mm稱(chēng)小結(jié)節(jié) 10mm者統(tǒng)稱(chēng)結(jié)節(jié) 一般將小于等3cm者稱(chēng)為結(jié)節(jié) 大于3cm者稱(chēng)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(jiàn) 形似磨玻璃 稱(chēng)磨玻璃密度影 意義 非特異 任何使肺實(shí)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?chē)臅灎钅ゲＡ芏扔?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(lèi) 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(rùn)性結(jié)節(jié) 細(xì)支氣管肺泡癌 淋巴瘤 肺泡內(nèi)腫瘤生長(zhǎng) 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(guó)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(jiàn)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(xiàn)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(lái)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(guó)實(shí)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(chóng) 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(rùn) 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(rùn) 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?chē)歉呙芏刃略滦位颦h(huán)形條帶 與暈征的周?chē)缘兔苊芏饶ゲＡв跋喾?稱(chēng)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