肺部感染-影像学和病理.ppt

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1、肺部感染-影像学和病理Outline流行病学影像学病理学细菌性-大叶性肺炎病原菌：Streptococcuspneumoniae，CAP(35%),KlebsiellapneumoniaeLegionellapneumophila病理生理：如下图early(A)andadvanced(B)stagesoflobarpneumoniacausedbyStreptococcuspneumoniae.In(A),theairspacesarefilledwithedemafluid;onlyoccasionalneutrophilsareevident.In(B),neutro

2、philspredominate.细菌性-小叶性肺炎病原菌：StaphylococcusaureusEscherichiacoliPseudomonasaeruginosaAnaerobesHaemophilusinfluenzae病理生理：A:病原菌到达细支气管形成小叶中心结节和分枝斑片B，C:支气管周围实变，小叶或部分小叶分布，呈多中心，实变不跨国小叶间裂Acutebronchopneumonia.Lowmagnificationphotomicrographshowsseveralsmallfociofconsolidationlocatedaroundthelum

3、ensofsmallbronchioles(arrows).Chestradiographshowsareasofconsolidationintherightupperandleftlowerlobes.Thepatientwasa23-year-oldmanWithbronchopneumoniaHigh-resolutioncomputedtomography(CT)scanshowscentrilobularnodules(arrows)andlobularareasofconsolidation(arrowhead)andground-glassopacity(

4、curvedarrow).Thepatientwasa53-year-oldmanwithbronchopneumonia.并发症-肺脓肿病原菌：anaerobicbacteria，S.aureus,P.aeruginosa,andK.pneumoniaeInflammatorymasswithcentralpurulentnecrosisFrequentlycavitateSmoothorshaggyinnermarginsAir-liquidlevelscommonMaximalwallthicknessusually<15Low-attenuationcen

5、tralregionandrimenhancementonCTscan并发症-坏死性肺炎Bulgingfissuresign.Posteroanteriorchestradiographshowsdenserightupperlobeairspaceconsolidationwithdownwardbulgingoftheminorfissure.Thepatientwasa66-year-oldmanwithpneumococcalpneumonia.Necrotizingpneumonia.Chestradiograph(A)showsinhomogeneousand

6、denseconsolidationintherightlung.Computedtomography(CT)(B)imageshowsalargecavityandsloughedlungwithinthecavity(arrow).Thepatientwasa42-year-oldalcoholicmanwithnecrotizingpneumoniasecondarytoKlebsiellapneumoniaeandanaerobicorganisms.并发症-气瘤病原菌：金葡菌（儿童），PCP（免疫抑制的成人）特点：薄壁含气空洞，数天或周内扩大，可导致气胸，数周或

7、数月吸收肺脓栓来源：心内膜炎，血栓性静脉炎，静脉置管，起搏器导线。影像学特点：空洞小结节，Feedingvesselsignimage(A)showstwovesselsapparentlycoursingintoanodule(feedingvesselsign）image(B)demonstratesthattheonlyvesselinclosecontactwiththenoduleisadrainingvein(arrow).肺炎链球菌肺炎CAP的主要致病菌（40%）危险因素：高龄，慢性心肺疾病主要影像学表现：均一实