医学课件高分辨率肺部CT

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HRCT扫描技术

1正常HRCT.

2中央肺动脉。

3支气管与相邻肺动脉直径大致相等。

4肺动脉常分为两个直径相当的分支。

5肺静脉常分成许多细小的分支,这些分支与主支构成直角。

6叶间裂（厚度小于1mm，边缘光滑，均一厚度）

7常见伪影双侧下肺近心脏处，肺血管脉动伪影。低密度区，可以错当作扩大的支气管。

8常见伪影主叶裂伪影。

9常见伪影血管双重伪影。

10TheSecondaryPulmonaryLobule肺小叶（直径1-2.5CM）

11小叶支气管、终末细支气管

12肺动脉pulmonaryartery

13小叶间隔interlobularsepta

14肺静脉pulmonaryvein

15腺泡pulmonaryacini

16正常小叶间隔normalsepta

17正常小叶中心动脉

18centrilobularartery2

19肺静脉Pulmonaryveins

20RETICULAROPACITIES网状结构

21肺间质病变发生于：慢性间质性肺炎、弥漫性间质纤维化、结节病、癌性淋巴管炎、结缔组织病（红斑狼疮、类风湿性关节炎、硬皮病、皮肌炎）、尘肺（矽肺、煤矽肺、石棉肺）、组织细胞病Ｘ、淋巴管平滑肌瘤病。ＣＴ：界面征、小叶间隔增厚、小叶中心结构增厚、胸膜下线、长疤痕线（扭曲肺结构）、蜂窝样改变、结节影、牵拉性支扩、磨玻璃样改变。

22网状结构reticularopacitiesF/60y乳腺癌术后，现呼吸困难。

23分析：（1）小叶间隔增厚thickeningofinterlobularsepta

24分析：（2）支气管血管周围间质增厚thickeningoftheperibronchovascularinterstitium支气管袖口症："peribronchialcuffing"

25分析：(3)斜裂增厚thickeningofthemajorfissure

26分析：（3）大结节影Largenodules

27上病例为癌性淋巴管炎。网状阴影：病理上主要为小叶间隔增厚、小叶内间隔增厚、小叶核心增厚、胸膜下线影、蜂窝肺和支气管血管周围间质增厚等改变。可见于特发性间质性肺炎、结节病、癌性淋巴管炎、特发性含铁血黄素沉积、感染性疾病等。双肺网状阴影多见与特发性间质性肺炎、结缔组织病肺浸润、结节病等。单侧以癌性淋巴管炎和放射性肺炎为主。

28测试：M/73y，咳嗽、喘憋

29

30Isseptalthickeningapredominantfinding?Isseptalthickeningapredominantfinding?(a)Yes(b)No小叶间隔增厚？

31右侧肺小叶间隔增厚。

32Aretheseptasmoothornodularinappearance?(a)Smooth.(b)Nodular小叶间隔光滑增厚还是结节状增厚？

33smooth光滑增厚

34支气管血管间质Istherethickeningoftheperibronchovascularinterstitium?(a)Yes(b)No支气管血管间质是增厚的？

35支气管袖口症peribronchialcuffing

36胸膜下间质Istherethickeningofthesubpleuralinterstitium?(a)Yes(b)No胸膜下间质是增厚的？

37斜裂增厚thickeningofthemajorfissure

38Whatisthemostlikelydiagnosis?可能的诊断？(a)Pulmonaryedema肺水肿(b)Interstitialfibrosis间质纤维化(c)Lymphangiticspreadofcarcinoma癌性淋巴管炎

39右肺门肿块，纵隔淋巴结肿大。

40PLCresultsfromhematogenousspreadtolung,withsubsequentinterstitialandlymphaticinvasion,or,asinthiscase,directlymphaticspreadoftumorfromhilarormediastinallymphnodes.癌性淋巴管炎—血性播散到肺淋巴系统。

41淋巴播散图表

4279-year-oldmanwithknownlymphoma79岁、淋巴瘤病史

43

44AreHRCTfindingsofinterlobularseptalseptalthickeningvisible?(a)Yes(b)No小叶间隔增厚？？？

45双侧光滑增厚的小叶间隔Allscansshowmarkedsmooththickeningofinterlobularseptainvolvingbothlungsinasymmetricalfashion.

46Istherethickeningoftheperibronchovascularinterstitium?(a)Yes(b)No支气管血管间质是否增厚？？？

47增厚的支气管血管间质

48Istherethickeningofthesubpleuralinterstitium?(a)Yes(b)No胸膜下间质增厚？

49斜裂增厚

50Whatisthemostlikelydiagnosis?最可能的诊断？？？(a)Pulmonaryedema(b)Interstitialfibrosis(c)Lymphangiticspreadoflymphoma

51Diagnosis:Lymphangiticspreadoflymphoma,withinterlobularseptalthickening。癌性淋巴管炎（小叶间隔增厚）

52lymphocyticinterstitialpneumonitis(LIP)淋巴间质局限性肺炎

5358-year-oldmanwithheartdisease

54DoHRCTfindingsincludeinterlobularseptalthickening?(a)Yes(b)No小叶间隔增厚？？？

55双侧小叶间隔增厚

56Istherethickeningoftheperibronchovascularinterstitium?(a)Yes(b)No支气管血管间质增厚？？？

57支气管血管间质增厚

58Istherethickeningofthesubpleuralinterstitium?(a)Yes(b)No胸膜下间质增厚？？？

59NO!!!

60Whatisthemostlikelydiagnosis?(a)Pulmonaryedema肺水肿(b)Interstitialfibrosis间质纤维化(c)Lymphangiticspreadofcarcinoma癌性淋巴管炎最可能的诊断？

61(a)Pulmonaryedema肺水肿Correct.Becauseofthehistoryofheartdisease心脏病史,characteristicabnormalities典型的异常,symmetry对称,andthepredominanceofseptalthickeningindependentlung,thisdiagnosismustbeconsidered考虑mostlikely.

62文献：间质性肺水肿（1）肺血重新分布：左心衰--肺淤血。（2）支气管周围袖口症：正常厚度约1mm—结缔组织内液体存积—增厚。X-肺纹理及肺门血管增粗、模糊.（3）肺透过度下降：液体分布到支气管血管周围、小叶间隔、小叶内支气管血管周围、肺泡间隔—透过度下降。（4）间隔线：KerleyB线—x上与肋膈角处与胸膜垂直。（5）胸膜增厚：液体—入脏层胸膜下薄层结缔组织—胸膜下结缔组织水肿--水肿位于脏层胸膜与结体组织间，不随体位移动。（６）胸腔积液：胸膜腔内液体来自壁层胸膜。

63不同原因的肺水肿（１）心源性肺水肿：左心衰（见于心梗、二尖瓣病变。（２）肾性肺水肿：急慢性肾功能衰竭，可合并尿毒症－－水钠潴留、左心衰－肺水肿－－上腔静脉、奇静脉增宽（血管蒂增宽。（3）肺微血管损伤性肺水肿：除肺水肿外，还可见出血及细胞渗出–肺血分布正常、无袖口症、间隔线。肺泡实变斑片状，肺野外为分布。毒性气体吸入、胃液吸入、药物、溺水、颅内压升高、高原性肺水肿、复张性肺水肿。

64

659.a53-year-oldwomanwithandabnormalchestradiographandmildshortness（短缺）ofbreath

66

67Isseptalthickeningpresent?(a)Yes(b)No小叶间隔增厚吗？

68增厚的小叶间隔

69Aretheseptasmoothornodularinappearance?(a)Smooth(b)Nodular小叶间隔增厚是结节状还是光滑增厚？

70小叶间隔结节状增厚

71胸膜下间质结节影

72支气管袖口症

73Possiblediagnosesinclude:(a)pulmonaryedema肺水肿(b)interstitialfibrosis间质纤维化(c)lymphangiticspreadoflymphoma(d)sarcoidosis结节病最可能的诊断？

74sarcoidosis结节病Correct.Nodularthickeningofinterlobularseptaandfissurescanbeseeninthisdiseaseandlymphangiticspreadofcarcinoma.（小叶间隔结节状改变可见于结节病、癌性淋巴管炎、尘肺）。支气管血管间质、胸膜下间质结节状改变—对结节病有特征性的诊断。

75Case10ina42-year-oldmanwithmildshortness（短缺）ofbreathforanumberofyears

76Isseptalthickeningvisible?(a)Yes(b)NoNextPage小叶间隔增厚吗？

77增厚的小叶间隔

78扭曲的肺结构

79叶间裂的扭曲

80Diagnosis:End-stagesarcoidosiswithfibrosisandinterlobularseptalthickening.结节病伴随征象：肺结构扭曲、小叶间隔结节状增厚、牵拉性支扩、蜂窝肺等。

81文献：肺间质病变界面征：支气管血管间质增厚—支气管血管束增粗、支气管袖口症；液体—边缘光滑、肿瘤或肉芽组织—结节状界面。胸膜下线：近胸膜面1cm内弧线状影—为肺纤维化征象。长疤痕线：蜂窝肺：结节影：小结节—2-5mm，肉芽、肿瘤、纤维组织。肺结构扭曲变形及牵拉支扩：磨玻璃样改变：

82Case11ina68-year-oldwomanwithrheumatoidarthritis（风湿性关节炎）andprogressive累计shortness短缺ofbreathovera2-yearperiod

83

84Thepredominantabnormalfindingonthesescansis?(a)interlobularseptalthickening小叶间隔增厚。(b)honeycombing蜂窝肺主要的异常表现？

85蜂窝肺

86部分层面小叶间隔增厚

87Whatdoeshoneycombingreflecthistologically?(a)Interstitialedema肺间质水肿(b)Interstitialinfiltration渗透bycells(c)Interstitialfibrosis蜂窝肺的组织学—肺间质纤维化的后期表现。

88Diagnosis:Rheumatoidlungdisease,withfibrosisandhoneycombing.风湿性肺疾病，肺纤维化、蜂窝肺。壁厚0.8-1MM，胸膜下3-4cm范围内或近叶裂处；早期囊腔小而少；囊壁为折叠破坏的肺泡壁及气道壁。

89

90Case12ina74-year-oldwomanwithprogressiveshortnessofbreathover6months

91Themostsignificantabnormalfindinginthisstudyis:(a)interlobularseptalthickening小叶间隔增厚(b)honeycombing蜂窝肺(c)subpleuralemphysema胸膜下肺气肿主要的异常表现？

92蜂窝肺

93Whatisthemostlikelydiagnosis?(a)Idiopathicpulmonaryfibrosis(IPF)特发性肺间质纤维化(b)Autoimmunedisease(e.g.,rheumatoidlungdisease)自身免疫性疾病(c)End-stagehypersensitivitypneumonitis过敏性肺炎(d)Asbestosis石棉肺(e)Drug-relatedlunginjury麻醉药物肺损害(f)Sarcoidosis结节病最可能的诊断？

94IPF:特发性肺间质纤维化磨玻璃密度：肺野周围—活动性肺泡炎症。网状改变：小叶间隔、小叶中心结构增厚—蜂窝状改变的前期。蜂窝状改变：胸膜下间质纤维化：胸膜下弧线状影、脏层胸膜及叶间胸膜增厚。肺气肿：小叶中心型肺气肿。肺实变：支扩：

95蜂窝肺

96牵拉性支扩

97小叶间隔增厚

98Case1386-year-oldmanwithchronicmyelogenousleukemia骨髓性的白血病,treatedusingmethotrexate化疗,nowcomplainsofshortnessofbreath气短.

99

100DoesthismanshowevidenceoffibrosisandUIP?(a)Yes(b)No显示明显的纤维化和普通间质性肺炎？？屑性间质性肺炎（DIP）、普通性间质性肺炎（UIP）。

101(a)YesCorrect.Findingsindicativeofusualinterstitialpneumonitis(UIP)visibleinthispatientinclude:honeycombing;蜂窝肺irregularfissures;叶裂扭曲irregularinterlobularseptalthickening;小叶间隔不规则增厚。tractionbronchiectasis.牵拉性支扩

102蜂窝肺

103叶裂扭曲

104不规则小叶间隔增厚

105牵拉性支扩

106Themostlikelydiagnosisis:可能的诊断？(a)idiopathicpulmonaryfibrosis(IPF)(b)lunginvolvementbyleukemia白血病肺浸润。(c)drug-relatedlunginjury化疗药物肺损害。

107(c)drug-relatedlunginjuryCorrect.Thepatternoffibrosisseeninthispatientisnonspecific,andcouldbecausedbyIPF.Therecenthistoryoftreatmentwithmethotrexatemakesdrug-relatedfibrosismostlikely.Lunginvolvementbyleukemiawouldlikelyresultinanappearancesimilartothatoflymphangiticspreadofcarcinomawithseptalthickeningbeingthepredominantfinding.IPF一可有同种表现，但患者有最近化疗史，白血病肺浸润小叶间隔增厚明显。

108

109Case14ina63-year-oldmanwithahistoryofscleroderma硬皮病andprogressiveshortnessofbreath进行性喘憋

110Findingsinclude:interlobularseptalthickening;小叶间隔增厚。tractionbronchiectasis;牵拉性支扩subpleuralhoneycombing;胸膜下蜂窝肺irregularfissures.叶裂扭曲

111小叶间隔增厚

112牵拉性支扩

113胸膜下蜂窝肺

114斜裂扭曲

115Canyoubeconfidentthatlungfibrosisispresent?(a)Yes(b)No你能确定肺纤维化存在？

116YesCorrect.Thepresenceofhoneycombingisdiagnosticoffibrosis.Tractionbronchiectasisisalsostronglysuggestiveoffibrosis.Interlobularseptalthickeningandirregularfissuresarenonspecific,andcannotbereliedupontodiagnosefibrosis.蜂窝肺、牵拉性支扩—肺纤维化存在。小叶间隔增厚、斜裂扭曲对肺纤维化的诊断意义不大。

117Diagnosis:Scleroderma,withlungfibrosis,honeycombing,andtractionbronchiectasis硬皮病—肺纤维化：蜂窝肺、牵拉性支扩。结缔组织病及肺血管炎—主要为肺间质病变。肺内实变—肺泡内渗出、肉芽肿形成、肺泡内出血、水肿。肺内多发结节—肺内血管炎、肉芽肿、肺栓塞所形成。常见于：wengner\类风湿性关节炎。肺间质病变—肺间质性肺炎、肺泡炎—间质纤维化、蜂窝肺。

118

119Case15ina61-year-oldwomanwithprogressiveshortnessofbreath进行性喘憋.

120Whichofthefollowingfindingsareshownonthisscan?上图包含症像:(a)Honeycombing蜂窝肺(b)Asubpleuralline胸膜下线(c)Aperipheralandsubpleuraldistribution外围胸膜下分布(d)Alloftheabove以上全包括

121AlloftheaboveCorrect.Smallsubpleuralcystsarepresenttypicalofmildhoneycombing.轻度的蜂窝肺Anirregularlineparallelsthepleuralsurface,termedasubpleuralline.胸膜下线

122Whichofthefollowingismostlikelyinthiscase?最符合的诊断？(a)Idiopathicpulmonaryfibrosis(IPF)特发性间质纤维化(b)Autoimmunedisease(e.g.,rheumatoidlungdisease)自身免疫性疾病(c)End-stagehypersensitivityPneumonitis过敏性肺炎(d)Asbestosis石棉肺(e)Drug-relatedlunginjury药物肺损害(f)Sarcoidosis结节病

123Idiopathicpulmonaryfibrosis(IPF)Correct.Idiopathicpulmonaryfibrosis(IPF).Intheabsenceahistorytosuggestoneofthespecificdiagnosesonthislist,IPFismostlikely.Itaccountsfor60%ofcaseshavingthisappearance.IPF在该病例无特异性，60%有该表现。

124

125Case16ina34-year-oldmanwithprogressiveshortnessofbreath喘憋

126

127Thepredominantabnormalityinthiscaseis:明显的异常表现(a)honeycombing蜂窝肺(b)intralobularinterstitialthickening小叶间质增厚

128intralobularinterstitialthickeningCorrect.Honeycombingisnotvisibleinthispatient.Afineirregularreticular不规则的网状改变patternispresentinthelungperiphery,representingintralobularinterstitialthickening.小叶间质增厚Insomepatientswithpulmonaryfibrosis,thisfindingwillpredominate.Otherfindingsoffibrosisinthispatientincludetractionbronchiectasis.牵拉性支扩Thedifferentialdiagnosisofthisappearanceisidenticalasthatforhoneycombing.

129小叶间质增厚

130牵拉性支扩

131Diagnosis:Idiopathicpulmonaryfibrosis特发性间质纤维化,withintralobularinterstitialthickening.

132

133Case17ina71-year-oldmanwithprogressiveshortnessofbreath

134

135Thepredominantabnormalityinthiscaseis:突出的表现(a)honeycombing蜂窝肺(b)intralobularinterstitialthickening小叶间质增厚

136intralobularinterstitialthickeningCorrect.Honeycombingisnotclearlyseeninthispatient.Afinebutirregularreticularpattern不规则的网状改变ispresentinthelungperiphery外围,representingintralobularinterstitialthickening小叶间质增厚.Insomepatientswithpulmonaryfibrosis,thisfindingwillpredominate.Otherfindings其他征象offibrosisinthispatientincludetractionbronchiectasis牵拉性支扩,andirregularinterlobularseptalthickening不规则小叶间隔增厚.Thedifferentialdiagnosisofthisappearanceisidenticaltothatforhoneycombing.

137小叶间质增厚

138牵拉性支扩

139不规则小叶间隔增厚

140Diagnosis:Idiopathicpulmonaryfibrosis特发性间质纤维化,withintralobularinterstitialthickening.

141

142Case18,ina55-year-oldsalamimanufacturer腊肠制造商withprogressiveshortnessofbreath

143Themostlikelydiagnosisinthiscaseis:最可能的诊断(a)Idiopathicpulmonaryfibrosis(IPF)特发性间质纤维化(b)Autoimmunedisease(e.g.,rheumatoidlungdisease)自身免疫系统疾病(c)End-stagehypersensitivitypneumonitis过敏性肺炎(d)Asbestosis石棉肺(e)Drug-relatedlunginjury药物肺损害(f)Sarcoidosis结节病

144Anydiagnosisispossible.任何诊断都是可能的。

145Case19in34-year-oldwomanwithlupuserytematosus狼疮红斑

146

147Canyoudiagnosefibrosis?能诊断纤维化？(a)Yes(b)No

148YesCorrect.HRCTobtainedinthesupineandpronepositions仰卧和俯卧位showsanumberoffindingsindicatingfibrosis指示,including:honeycombingwhichismildindegree;轻度蜂窝肺tractionbronchiectasis;牵拉性支扩intralobularinterstitialthickening;小叶间质增厚interlobularseptalthickening小叶间隔增厚;andasubpleuraldistribution.胸膜下分布

149轻度蜂窝肺

150牵拉性支扩

151小叶间质增厚

152小叶间隔增厚

153Diagnosis:Systemiclupuserythematosus（SLE系统性红斑狼疮肺部表现—肺结缔组织病,withfibrosisandhoneycombing.

154

155Case20ina65-year-oldwomanwithrheumatoidarthritis风湿性关节炎andmilddyspnea轻度呼吸困难

156Canyoudiagnosefibrosis?能诊断纤维化？(a)Yes(b)No

157Correctincluding:tractionbronchiectasis;牵拉性支扩intralobularinterstitialthickening;小叶间质增厚asubpleuralline.胸膜下线

158牵拉性支扩

159小叶间质增厚

160胸膜下线

161Diagnosis:Rheumatoidlungdisease肺结缔组织病,withmildpulmonaryfibrosis轻度肺纤维化andintralobularinterstitialthickening小叶间质增厚.

162

163Case21ina26-year-oldwomanwithmixedconnectivetissuedisease混合结缔组织病,basilarcracklesonphysicalexamination双肺底水泡音,andrestrictivediseaseonpulmonaryfunctiontests肺功能受限

164

165Canyoudiagnosefibrosis?能诊断纤维化？(a)Yes(b)No

166YesCorrect.Including:tractionbronchiectasis;牵拉性支扩intralobularinterstitialthickening小叶间质增厚;asubpleuraldistribution胸膜下分布

167牵拉性支扩

168小叶间质增厚

169Diagnosis:Mixedconnectivetissuedisease混合结缔组织病,withpulmonaryfibrosis,andintralobularinterstitialthickening

170

171Case22,ina81-year-oldmanwithsignificantoccupationalexposuretoasbestos石棉职业史

172

173Ispulmonaryfibrosispresent?肺纤维化存在？(a)Yes(b)No

174YesCorrect.Findingsoffibrosisinclude:tractionbronchiectasis;牵拉性支扩intralobularinterstitialthickening;小叶间质增厚asubpleuraldistribution.胸膜下分布irregularinterlobularseptalthickening不规则的小叶间隔增厚

175牵拉性支扩

176小叶间质增厚

177胸膜下分布

178小叶间隔增厚

179Diagnosis:石棉肺Asbestosiswithtractionbronchiectasis牵拉性支扩andintralobularinterstitialthickening小叶间质纤维化.

180纵隔窗

181pleuralthickeningandcalcification胸膜增厚、钙化椎旁区域横膈胸膜肥厚钙化

182Case24ina58-year-oldmanwithahistoryofasbestosexposure石棉史

183可见椎旁胸膜增厚、不规则线状影

184Thepleuralthickeningistypicalofasbestosexposure胸膜增厚是典型的石棉肺表现.Wouldyoudiagnoseasbestosis诊断石棉肺吗?(a)Yes(b)No

185NoCorrect.Linearopacities线状影asseeninthiscase(termedparenchymalbands肺实质带)arecommoninpatientswithpleuralthickening胸膜增厚,butarenotnecessarilyassociated不必须考虑withlungfibrosis肺纤维化.

186肺实质带parenchymalbands位于下肺部，肺内条状影；肺实质内的纤维化。

187尽管如此，结合病史，考虑Asbestosexposurewithpleuraldiseaseandparenchymalbands石棉至椎旁胸膜增厚、肺实质带。

188

189Case25ina67-year-oldmanwithahistoryofasbestosexposure石棉史

190NoCorrect.HRCTatlungwindowsshowsirregularlinearopacities不规则的线状影(“crow‘sfeet”乌鸦脚),withoutevidenceofhoneycombing无蜂窝肺,intralobularinterstitialthickening小叶间质增厚,ortractionbronchiectasis牵拉性支扩.Thisappearancedoesnotindicateasbestosis无石棉特征.Linearopacities,asseeninthiscase(parenchymalbands肺实质带)arecommoninpatientswithpleuralthickeningrelatedtoasbestosexposure,butarenotnecessarilyassociatedwithlungfibrosis不必须考虑肺纤维化.Theyrepresentfocalareasofatelectasis焦点为肺膨胀不全,associated联系withthepleuralthickening,orfocalareasofscarring焦点区疤痕.

191乌鸦脚（"crow'sfeet"),

192即尽管如此，结合病史考虑Asbestosexposurewithpleuraldiseaseandparenchymalbands。另一病例：胸膜下线椎旁胸膜增厚

193

194Case26ina56-year-oldmanwithsignificantoccupationalexposuretoasbestos石棉史

195Istherepleuralthickening胸膜增厚youwouldconsider考虑likely可能duetoasbestosexposure石棉?(a)Yes(b)No

196Yescorrect.Afocal焦点,calcifiedpleuralplaque胸膜钙斑isvisibleanteriorly,typicalofasbestosexposure石棉肺典型表现.Althoughplaquesaremorelikelyposteriorinlocation常见后胸膜,thisappearanceishighlysuggestive高度提示.

197Canadefinitediagnosisofpulmonaryfibrosisonthepronelungwindowscansbemade?肺窗能明确诊断肺纤维化吗？(a)Yes(b)No

198NoCorrect.Thereismildseptalthickening轻度间隔增厚andreticulation网状intheposteriorsubpleuralregion后胸膜下ontheright.Thisisunassociated无联系withadjacent临近pleuralthickening.Thisisaverysubtleabnormality轻微的异常whichcouldrepresenttheearlieststageofasbestosis石棉肺早期表现.However,intheabsenceofamoredefiniteabnormality明确的异常orsimilar类似findingsontheleft,itwouldbedifficult困难tomakeadefinitediagnosisoffibrosis石棉肺或肺纤维化的诊断orasbestosis.

199小叶间质增厚—轻度网状改变

200Diagnosis:Asbestosisexposure石棉肺.Possiblefibrosis可能纤维化.文献：石棉肺[1]胸膜改变：胸膜斑、弥漫性胸膜增厚、胸腔积液。[2]肺改变：弥漫性肺间质纤维化—HRCT胸膜下弧线、胸膜下点状致密影、肺实质带、蜂窝状改变、胸膜下磨玻璃表现（肺泡壁小叶间隔增厚）；圆形肺不张（支气管血管结构进入-彗星尾征）。

201

202Case27ina57-year-oldwomanwithyearsofprogressivedyspnea多年呼吸困难

203

204Ispulmonaryfibrosispresent?肺纤维化存在吗？(a)Yes(b)No

205YesCorrect.Thispatientshowsanumberof许多findingsindicativeofpulmonaryfibrosis肺纤维化征象.Theseinclude:Extensive广泛的tractionbronchiectasis牵拉性支扩involvingbothupperlobes双上叶;Irregularreticularopacities不规则的网状anddistortionoflungarchitecture肺结构扭曲associatedwithtractionbronchiectasis;andHoneycombingatthelungbases下肺蜂窝状改变。

206牵拉性支扩

207扭曲的肺结构

208蜂窝肺

209Isthedistributionofabnormalitiestypicalofidiopathicpulmonaryfibrosis?特发性间质纤维化的异常类型？(a)Yes(b)No

210NoCorrect.Withexceptionoftheposteriorhoneycombing后部蜂窝肺,thefindingsoffibrosisinthispatientlacktheperipheral不在外围,lowerlobe,andsubpleuralpredominance胸膜下ofIPF.Thesefindingsaretypical典型ofend-stagesarcoidosis.

211Diagnosis:End-stagesarcoidosis结节病,withtractionbronchiectasis牵拉性支扩andhoneycombing蜂窝肺.

212DISCUSSIONInpatientswithsarcoidosis结节病,progressivefibrosisoftenleads累计纤维化常导致toperibronchovascularconglomeratemassesoffibroustissue支气管血管束聚集成纤维块,typicallymostmarkedintheupperlobes上叶显著.Bronchiandvesselsareclusteredtogetherbecauseofretraction,andbronchiappeardilated(i.e.tractionbronchiectasis);theonlyotherdiseasesthatcommonlyresultinthisappearancearesilicosis,tuberculosis,andtalcosis.Posteriordisplacementoftheupperlobebronchiindicatingvolumelossintheposteriorsegmentsoftheupperlobesisacommonearlyfinding.Honeycombingorlungcystscanbepresentinpatientswithsarcoidosis,butthisfindingislesscommonthaninotherfibroticlungdiseasessuchasidiopathicpulmonaryfibrosis.Honeycombingisusuallylimitedtopatientswithseverefibrosisandcentralconglomerationofbronchi.Thehoneycombingseeninpatientswithsarcoidosisinvolvesmainlythemiddleandupperlungzones,withrelativesparingofthelungbases.However,inanoccasionalcase,findingscanmimicIPF.

213支气管血管束聚集成纤维块

214

215

216Case28ina46-year-oldmanhistoryofshortnessofbreath喘憋andhemoptysis咳血

217

218Ispulmonaryfibrosispresent?肺纤维化？(a)Yes(b)No

219YesCorrect.Thispatientshowsanumberof许多的findingsindicativeofpulmonaryfibrosis肺纤维化征象。

220Arethefindingsweseetypicalofidiopathicpulmonaryfibrosis?能否诊断特发性间质纤维化？(a)Yes(b)No

221NoCorrect.Typicalsubpleuralhoneycombingorreticulation,withabasal,subpleural,andposteriorpredominanceisabsentI特发间质纤维化肺的外围和肺底部网状、蜂窝状，向心性减轻.Findingsoffibrosisinthispatientinclude:tractionbronchiectasis牵拉性支扩inassociationwithcentral,peribronchovascularmassesoffibroustissueshownonlungwindowsandsofttissuewindows软组织窗支气管血管束纤维块;irregularinterlobularseptalthickening;不规则小叶间隔增厚distortionoffissures;叶裂扭曲lungcystsorbullae肺大泡sometimestermed"paracicatricialemphysema;"andanupperlobepredominance,withsparingofthelungbases(Figure5).

222牵拉性支扩

223支气管血管束纤维块

224不规则的小叶间隔增厚

225叶裂扭曲

226肺大泡

227Whatisthemostlikelydiagnosis?最可能的诊断？(a)Idiopathicpulmonaryfibrosis特发性间质纤维化(b)Sarcoidosis结节病(c)Asbestosis石棉肺(d)Hypersensitivitypneumonitis过敏性肺炎(e)Tuberculosis肺结核

228SarcoidosisCorrect.Thesefindingsaretypicalofend-stagesarcoidosis.

229Animportantadditionalfinding额外的征象ispresent.Thismostlikelyrepresents可能是？:(a)anaspergilloma曲霉菌球(b)alargesarcoidgranuloma大结节肉芽肿(c)lungcancer肺癌(d)tractionbronchiectaiswithamucousplug牵拉支扩粘液栓

230

231anaspergilloma曲菌球Correct.Thisistypicalofanaspergillomaarisinginapreexisting先前存在cyst囊orcavity洞.Diagnosis:End-stagesarcoidosis,withtractionbronchiectasis牵拉性支扩andcysts,complicatedbyanaspergilloma曲菌球.

232In20-25%ofpatientswithsarcoidosis,fibrosisresultsfromhealingofgranulomas20-25%结节病纤维化来源于肉芽肿的治疗.Asfibrosisdevelops,irregularreticularopacities,includingirregularseptalthickening,oftenbecomeaprominentfeature纤维化进一步呈网状、小叶间隔增厚.Progressivefibrosisleadstoabnormalcentralconglomerationofparahilarbronchiandvessels,associatedwithmassesoffibroustissue肺门支气管血管纤维块,typicallymostmarkedintheupperlobes上叶多见.Thisfindingisfrequentlyassociatedwithbronchialdilation(i.e.tractionbronchiectasis);theonlyotherdiseasesthatcommonlyresultinthisappearancearesilicosis,tuberculosis,andtalcosis.Posteriordisplacementofthemainandupperlobebronchiindicatingvolumelossintheposteriorsegmentsoftheupperlobesiscommonlypresent.Findingsoffibrosisinpatientswithend-stagesarcoidosislackthetypicalsubpleural,posterior,lowerlobepredominanceseeninpatientswithidiopathicpulmonaryfibrosis.Acentralandupperlobepredominanceoffibrosissuggestssarcoidosis上叶中心纤维化支持结节病.

233上叶中心：支气管血管纤维块

234Hemoptysis咳血,presentinthispatient,isacommonmanifestationofmycetoma肺霉菌常见表现。

235

236Case29ina74-yearold-manwithprogressiveshortnessofbreathforoneyear喘憋一年.

237Findingsoffibrosisinthispatientinclude:纤维化包括：intralobularinterstitialthickeningresultinginirregularreticularopacities;小叶间质增厚-网状改变tractionbronchiectasis牵拉性支扩resultinginirregularreticularopacities;andinterlobularseptalthickening.不规则小叶间隔增厚

238网状改变—小叶间质增厚

239牵拉性支扩

240小叶间隔不规则增厚

241Isthedistributionofabnormaltitiesweseetypicalofidiopathicpulmonaryfibrosis?所见的异常分布为IPF？(a)Yes(b)No

242NoCorrect.Typicalsubpleuralhoneycombingorreticulation,withabasal,subpleural,andposteriorpredominanceisabsent典型的肺外围、肺底呈向心性网状、蜂窝状改变缺乏.Anupperlobepredominance上叶优势(Figure1)ispresent,withrelativesparingofthelungbases下叶少(Figure4).ThisdistributionsuggestsadiagnosisotherthanIPF不支持.Also,asupleuralpredominance,typicalofIPF,isalsolackinginthispatient(Figure1).Sarcoidosiswouldbeapossibility结节病很像.Additionalhistoryrevealedalongexposuretopetbirds长养鸟史.

243Diagnosis:End-stagehypersensitivitypneumonitiswithfibrosis过敏性肺炎伴纤维化.

244

245Case30ina59-year-oldmanwithmarkeddyspnea明显的呼吸困难

246Themostlikelydiagnosisinthispatientis:最可能的诊断？(a)idiopathicpulmonaryfibrosis特发性间质纤维化(b)autoimmunedisease自身免疫系统疾病(c)asbestosis石棉肺(d)sarcoidosis结节病

247idiopathicpulmonaryfibrosisCorrect.Idiopathicpulmonaryfibrosisismostlikelybecauseoftypicalposterior,lowerlobe,andsubpleuralhoneycombing后胸膜下、肺底蜂窝状改变.

248肺大泡、结节影

249Diagnosis:Idiopathicpulmonaryfibrosiswithhoneycombing,complicated复杂的、难解的bylungcancer.

250

251结节状阴影

252结节状影（1）腺泡结节状影：1cm以下（4-7mm），边清、梅花瓣状、无融合趋向，为肉芽肿、肿瘤、血管炎及其周围炎、渗出、出血、水肿。中上肺野-多见结核的增殖性病变、慢性炎症；弥散—细菌性真菌性肺炎、肺泡蛋白沉积症、支原体肺炎、肺出血、肺水肿。

253结节状影（2）粟粒状结节影：４ｍｍ以下，弥散分布，多由间质病变引起，见粟粒型肺结核、癌性淋巴管炎、结节病、特发性肺含铁血黄素沉着、急性细支气管炎、组织细胞病x。较大-转移瘤、肺泡癌、支气管播散型肺结核；较小—肺泡微石症。粟粒型肺结核—大小一致、分布均匀；癌性淋巴管炎—沿肺纹理分布。短期增大为癌肿所致。肿块影直径2cm以上。

254小结节影的分布（1）淋巴管周围分布：淋巴管位于支气管血管束、小叶间隔、胸膜下。见于—癌性淋巴管炎、结节病、尘肺。

255胸膜表面

256小叶间隔

257支气管血管束

258支气管血管束小叶中心

259

260小结节影的分布（2）随机分布：广泛均匀分布，一般两侧对称；又称血行分布，胸膜下不突出，在小叶间隔、小叶中心、支气管血管束、胸膜下，见于—血源性肺转移瘤、急性粟粒型肺结核。

261胸膜下不如淋巴管周围分布

262

263小结节影的分布（3）小叶中心分布：不与小叶间隔、胸膜相连，经气道吸入发生的病变。见于—过敏性肺炎、嗜酸性肉芽肿、尘肺。可见“树丫征”

264外围结节与胸膜距离5-10mm

265

266

267Case3143-year-oldwomanwithanabnormalchestradiographandcough咳嗽

268Multiplesmalllungnodules多发小结节(Figure1)arevisible.Usingthealgorithmfornodulediagnosis分布法则,whatisnoduledistributionshowninthiscase,andwhatisthedifferentialdiagnosis分布方式?(a)Perilymphatic淋巴管周围分布(b)Random随机分布(c)Centrilobular小叶中心分布

269Perilymphatic淋巴管周围分布Correct.Thispatientshowsaperilymphaticpattern.Inusingthealgorithm,wefirstidentifythepresenceofsubpleuralnodules胸膜下结节inrelationthethemajorfissureandperipheralpleuralsurfaces叶裂、外围胸膜表面.Next,wenotetheoveralldistributionofthenodules.Thenodulesarepatchy,involvingdifferentpartsofthelungtovaryingdegrees,andarespecificallyidentifiedinrelationtothesubpleuralregionsandtheperibronchovascularregions.支气管血管束Numerousnodulessurroundthecentralbronchiandvessels.Ontheleft,nodulesaresonumerous,thatanairbronchogramisvisible.Afewnodulesarevisibleinrelationtointerlobularsepta.小叶间隔

270叶裂、胸膜表面结节

271支气管血管束结节

272小叶间隔

273Whatisthemostlikelydiagnosis最可能的诊断?(a)Sarcoidosis结节病(b)Miliarytuberculosis粟粒型肺结核(c)Bronchopneumonia支气管肺炎

274SarcoidosisCorrect.Aperilympaticpatternofnodules淋巴管周围分布,withpredominanceinrelationtothefissuresandperibronchovascularregionsistypicalofsarcoidosis结节病—小结节以支气管血管束、叶裂分布为主.

275Diagnosis:Sarcoidosis,withperilymphaticnodules

276Case32,ina34-year-oldmanwithanabnormalchestradiographanddyspnea呼吸困难

277

278Multiplesmalllungnodules(Figure2)arevisiblewithconfluenceinthemostabnormallungregions.Usingthealgorithmfornodulediagnosis,whatisnoduledistributionshowninthiscase,andwhatisthedifferentialdiagnosis?小结节分布方式(a)Perilymphatic淋巴管周围分布(b)Random随机分布(c)Centrilobular小叶中心分布

279Perilymphatic淋巴管周围分布Correct.Thispatientshowsaperilymphaticpattern.Subpleuralnodules胸膜下结节arevisibleinrelationtothemajorfissureandperipheralpleuralsurfaces.Thenodulesarepatchyindistribution,involvingdifferentpartsofthelungtovaryingdegrees.Peribronchovascularnodules支气管血管束结节areclearlyseen,andnumerousnodulessurroundthecentralbronchiandvessels.Nodulesinrelationtotheinterlobularsepta小叶间隔andcentrilobular小叶中心regionsarealsoseen.

280胸膜下结节

281支气管血管束结节

282小叶间隔结节

283Whatisthemostlikelydiagnosis?最可能的诊断(a)Sarcoidosis结节病(b)Silicosis硅肺病(c)Lymphangiticspreadofcarcinoma癌性淋巴管炎

284SarcoidosisCorrect.Aperilymphaticpatternofnodules,withpredominanceinrelationtothefissuresandperibronchovascularregionsistypicalofsarcoidosis结节病以叶裂、支气管血管束分布为主.

285气管旁肿大淋巴结

286肉芽肿块Confluenceofgranulomas

287

288Case33ina48-year-oldmanwithpersistentcough持续咳嗽

289Thenoduledistributionis结节分布:(a)perilymphatic淋巴管周围(b)random随机分布(c)centrilobular小叶中心

290perilymphaticCorrect.Thispatientshowsaperilymphaticpattern.Subpleuralnodules胸膜下结节arevisibleinrelationtothemajorfissures.Thenodulesarepatchyindistribution,involvingdifferentpartsofthelungtovaryingdegrees.Peribronchovascularnodules支气管血管束结节arevisible.Nodulesinrelationtotheinterlobularseptaandcentrilobularregions小叶间隔、小叶中心arealsoseen.

291胸膜下结节

292支气管血管束结节

293小叶间隔结节

294小叶中心结节

295Whatisthemostlikelydiagnosis?最可能的诊断(a)Sarcoidosis结节病(b)Silicosis硅肺病(c)Lymphangiticspreadofcarcinoma癌性淋巴管炎

296SarcoidosisCorrect.Aperilymphaticpatternofnodules,withpredominanceinrelationtothefissuresandperibronchovascularregionsistypicalofsarcoidosis结节病以叶裂、支气管血管束分布为主，上叶占优势.

297

298Case34,inanasymptomatic34-year-oldmanwithanabnormalchestradiographsuggestinglymphnodeenlargement胸片提示淋巴结肿大

299纵隔窗：双侧肺门淋巴结增大

300Afewsmalllungnodulesarealsovisible.Thenoduledistributionis:少数小结节可见，分布特点？(a)perilymphatic淋巴管周围(b)random随机分布(c)centrilobular小叶中心分布

301perilymphaticCorrect.Thispatientshowsaperilymphaticpattern.Subpleuralnodules胸膜下结节arevisibleparticularlyinrelationtothemajorfissures叶裂.Thenodulesarescatteredandpatchyindistribution,andpredominateintheupperlobes结节在上叶.Someofthenodulesareperibronchovascular支气管血管束结节.

302胸膜下结节

303支气管血管束结节

304Whatisthemostlikelydiagnosis?最可能的诊断(a)Sarcoidosis结节病(b)Silicosis硅肺病(c)Lymphangiticspreadofcarcinoma癌性淋巴管炎

305SarcoidosisCorrect.Aperilymphaticpatternofnodules,withpredominanceinrelationtothefissuresandperibronchovascularregionsistypicalofsarcoidosis结节病以胸膜下、支气管血管束分布为主.Diagnosis:Sarcoidosis,mild轻度,withperilymphaticnodules淋巴管周围结节

306

307Case35infollow-upofanasymptomatic43-year-oldmanwithwithahistoryofhearttransplantationseveralyearsbefore几年前心脏移植史

308Thenoduledistributionis结节分布:(a)perilymphatic淋巴管周围分布(b)random随机分布(c)centrilobular小叶中心分布

309perilymphaticCorrect.Thispatientshowsaperilymphaticpattern.Subpleuralnodules胸膜下结节arevisibleinrelationtothemajorfissure斜裂.Thenodulesarescatteredandpatchyindistribution,andpredominateintheupperlobes.Someofthenodulesareperibronchovascular支气管血管束分布.

310胸膜下结节

311支气管血管束结节

312Themostlikelydiagnosisis:最可能的诊断(a)opportunisticinfection机遇性感染(b)post-transplantationlymphocyticdisorder移植后淋巴混乱(c)sarcoidosis结节病

313sarcoidosisCorrect.Thisappearanceistypicalofsarcoidosis.

314移植前胸部异常

315Diagnosis:Progressive前进的sarcoidosis,withperilymphaticnodules淋巴管周围分布结节

316

317Case36inanasymptomatic29-year-oldmanwithchestpainandinfiltratesonchestradiograph胸痛胸片可见渗出性病变

318

319双侧肺门淋巴结增大

320Thenoduledistributionis结节分布方式:(a)perilymphatic淋巴管周围分布(b)random随机分布(c)centrilobular小叶中心分布

321perilymphaticCorrect.Thispatientshowsaperilymphaticpattern.Subpleuralnodules胸膜下结节arevisibleinrelationtothemajorfissures叶裂.Thenodulesarescatteredandpatchyindistribution分布是分散不均的.

322胸膜下结节

323Whatisthemostlikelydiagnosis最可能的诊断?(a)Sarcoidosis结节病(b)Silicosis硅肺病(c)Lymphangiticspreadofcarcinoma癌性淋巴管炎

324SarcoidosisCorrect.Aperilympaticpatternofnodulesispresent,althoughthisappearanceissomewhatatypical淋巴管周围分布不太典型.Averypatchydistributionofnodulesiscommoninsarcoidosis结节病不均分是常见的,butthegroupingofnodulesseeninthiscaseisunusual.Whenseenonchestradiograph,thisappearanceissometimescalled“alveolarsarcoid,”类似肺泡癌althoughthenodulesarediscrete不连续andinterstitial.

325Diagnosis:Sarcoidosis,withpatchylunginvolvement不均的肺内侵润.

326

327Case37inan45-year-oldSouthAfricandiamondminerwithprogressivedyspnea南非钻石矿工进行性呼吸困难

328Thenoduledistributionis结节分布方式:(a)perilymphatic淋巴管周围分布(b)random随机分布(c)centrilobular小叶中心分布

329perilymphaticCorrect.Thispatientshowsaperilymphaticpattern.Subpleuralnodules胸膜下分布arevisibleatthelungperiphery.Thenodulesarescatteredandpatchyindistribution,andpredominateposteriorlyandintheupperlobes上叶后部占优势.Thenodulesshowsymmetricalinvolvement对称受累(Figure2,Figure3)ofbothupperlobes双上叶.

330胸膜下结节

331Whatisthemostlikelydiagnosis最可能的诊断?(a)Sarcoidosis结节病(b)Silicosis硅肺病(c)Lymphangiticspreadofcarcinoma癌性淋巴管炎

332SilicosisCorrect.Thehistorysuggestssilicosis历史支持硅肺病.Aperilympaticpatternofnodules淋巴管周围分布方式,withpredominance上叶后部胸膜下间质对称性分布为著inrelationtothesupleuralinterstitium,withasymmetrical,posterior,upperlobepredominanceisconsistentwiththisdiagnosis.

333

334Case38ina63-year-oldwomanwithbreastcancer乳癌andprogressiveshortnessofbreath进行性呼吸困难

335Thenoduledistributionis结节分布方式:(a)perilymphatic淋巴管周围分布(b)random随机分布(c)centrilobular小叶中心分布

336perilymphaticCorrect.Thispatientshowsaperilymphaticpattern.Largesubpleuralnodules胸膜下结节arevisibleinthelungperiphery肺外围.Inaddition,thenodulesarepatchyindistributionandpredominateinrelationtothickenedinterlobularsepta小叶间隔结节分布不均.

337胸膜下结节

338增厚的小叶间隔

339Whatisthemostlikelydiagnosis最可能的诊断?(a)Sarcoidosis结节病(b)Silicosis硅肺病(c)Lymphangiticspreadofcarcinoma癌性淋巴管炎

340LymphangiticspreadofcarcinomaCorrect.Thisappearanceistypicaloflymphangiticspreadofcarcinoma外观是典型的癌性淋巴管炎.Inpatientswithlymphangiticspreadoftumor,whennodulesarevisible,theyaremostoftenvisiblewithinthethickenedperibronchovascularinterstitium结节在支气管血管束内、小叶间隔内更常见andinterlobularsepta.Septalthickeningcanresultintheappearanceofa“beaded串珠状"septum.

341

342Case39ina53-year-oldmanwithknownthyroidcancer甲状腺癌andprogressiveshortnessofbreath进行性喘憋

343Thenoduledistributionis结节分布方式:(a)perilymphatic淋巴管周围分布(b)random随机分布(c)centrilobular小叶中心性分布

344perilymphaticCorrect.Thispatientshowsaperilymphaticpattern.Subpleuralnodules胸膜下结节arevisibleinrelationtotheleftmajorfissureandthelungperiphery左叶裂、肺外围.Inaddition另外,thenodulesarepatchyindistributionandarealsoseeninrelationtocentralvessels中心血管.Mediastinallymphnodeenlargement纵隔淋巴结增大isvisibleonsofttissuewindowscans.

345胸膜下结节

346中心血管

347增大淋巴结

348Whatisthemostlikelydiagnosis最可能的诊断?(a)Sarcoidosis结节病(b)Silicosis硅肺病(c)Lymphangiticspreadofcarcinoma癌性淋巴管炎

349LymphangiticspreadofcarcinomaCorrect.Thisappearanceisnonspecific非特性,butconsistentwithlymphangiticspreadofcarcinoma.Althoughthisappearancecouldalsobeseeninpatientswithsarcoidosis,thehistorysuggeststheappropriatediagnosis与结节病不好鉴别，结合病史考虑.Interlobularseptalthickening,commonwithlymphangiticspreadofcarcinomaisnotseeninthiscase.

350

351Case40ina43-year-oldmanwithAIDS,cutaneous皮肤Kaposisarcoma肉瘤(KS),andprogressiveshortnessofbreath进行性喘憋

352支气管血管束间质

353小叶中心

354小叶间隔增厚

355Thenoduledistributionis结节分布方式(a)perilymphatic淋巴管周围分布(b)random随机分布(c)centrilobular小叶中心分布

356perilymphaticCorrect.Thispatientshowsaperilymphaticpatternwithaperibronchovascularpredominance分布以支气管血管束为优势.InapatientwithAIDS,thisdistributionsuggestslunginvolvementbyKS.

357

358Case41ina44-year-oldwomanwithAIDS,fever。

359

360Thenoduledistributionis结节分布方式(a)perilymphatic淋巴管周围分布(b)random随机分布(c)centrilobular小叶中心性分布

361perilymphaticCorrect.Thispatientshowsaperilymphaticpattern.Subpleuralnodules胸膜下结节arevisibleinrelationto涉及themajorfissure叶裂.Inaddition另外,thenodulesareseeninrelationtothickenedinterlobularsepta增厚的小叶间隔可见结节状.

362胸膜下结节

363增厚的小叶间隔呈结节状

364Whatisthemostlikelydiagnosis最可能的诊断?(a)Sarcoidosis结节病(b)Silicosis硅肺病(c)Lymphangiticspreadofcarcinoma癌性淋巴管炎

365LymphangiticspreadofcarcinomaCorrect.Thisappearanceistypicaloflymphangiticspreadofcarcinoma是典型的癌性淋巴管炎.AnunusualcauseofthispatterninpatientswithAIDSislymphocyticinterstitialpneumonia淋巴间质性肺炎(LIP).

366

367Case42,ina33-year-oldmanwithshortnessofbreath呼吸短缺

368

369Large大的,ill-defined不清楚的lungnodulesarevisible,predominatinginrelationtotheperibronchovascularinterstitium支气管血管束间质.Nodulesalsoinvolvethesupleuralregion胸膜下,andlymphnodeenlargement淋巴结增大ispresent.

370支气管血管束间质

371胸膜下结节

372淋巴结增大

373Diagnosis:Lymphoma淋巴瘤arising起于fromMucosaAssociatedLymphoidTissue(MALToma粘膜相关组织的淋巴瘤),withperibronchovascularnodules.Thepresenceofperibronchovascularnodulesistypical.支气管血管束结节是典型表现。

374

375Case43inan43-year-oldmanwithfeverandcough发热咳嗽

376Thenoduledistributionis结节分布方式:(a)perilymphatic淋巴管周围分布(b)random随机分布(c)centrilobular小叶中心性分布

377randomCorrect.Thispatientshowsarandompattern.Subpleuralnodulesarevisibleperipherallyandinrelationtothemajorfissures胸膜下结节可见.Overall全面的,thenodulesappeardiffuse结节表现弥漫的,andapredominanceinrelationtoperilymphaticstructuresisnotvisible淋巴管周围是不可见的.

378胸膜下结节

379Whatisthemostlikelydiagnosis最可能的诊断?(a)Miliarytuberculosis粟粒型肺结核(b)Hematogenousmetastases血行转移瘤

380MiliarytuberculosisCorrect.Basedonhistory,infectionislikely感染是很可能的.

381

382Case44inan57-year-oldmanbeingtreated确诊治疗forbladdercancer膀胱癌

383Thenoduledistributionis结节分布方式:(a)perilymphatic淋巴管周围分布(b)random随机分布(c)centrilobular小叶中心性分布

384randomCorrect.Thispatientshowsarandompattern随机分布图案.Subpleuralnodulesarevisibleperipherally外围胸膜下结节可见andinrelationtothemajorfissures涉及叶裂.Overall全面的,thenodulesappeardiffuse结节呈弥漫性.

385胸膜下结节

386Smallnodulesappearingrandomlydistributedinrelationtostructuresofthelung肺小结节随机分布常见于：andsecondarylobuleareoftenseeninpatientswithmiliarytuberculosis粟粒型肺结核,miliaryfungalinfections粟粒状真菌感染,andhematogenousmetastases血行多发转移瘤.

387Whatisthemostlikelydiagnosis最可能的诊断?(a)MiliaryTB粟粒型肺结核(b)Miliaryfungalinfection粟粒状真菌感染(c)Hematogenousmetastases多发转移瘤

388HematogenousmetastasesCorrect.Basedonhistory依病史,hematogenousmetastasesismostlikely血行转移瘤是可能的.However,thispatientisbeingtreatedforbladdercancerbyhavingBCG,a(usually)non-pathogenicmycobacterium通常卡介苗治疗后无致病源,instilledintohisbladder.Thisrarelyresultsinhematogenousdissemination,identicalinappearanceandhistologytomiliaryTB,buteasiertotreat.

389Followingappropriateantibiotictreatment随后适当的抗生素治疗,thenodules结节haveresolved有减少.

390Diagnosis:Miliary粟粒状的nontuberculousmycobacterium(BCG)肺结核,withrandomnodules随机分布结节。

391

392Case45inan53-year-oldmanwithfeverandcough发热咳嗽

393Thenoduledistributionis结节分布方式:(a)perilymphatic淋巴管周围分布(b)random随机分布(c)centrilobular小叶中心性分布

394randomCorrect.Thispatientshowsarandompattern.Subpleuralnodulesarevisibleperipherallyandinrelationtothemajorfissures肺外围、叶裂胸膜下小结节.Overall,thenodulesappeardiffuse弥漫性

395胸膜下结节

396Miliarynodulesrelatedtofungalinfection许多粟粒状结节与真菌感染有关系cannotbedistinguishedfrommiliaryTB不能与粟粒型肺结核区别.

397Diagnosis:Miliary粟粒状coccidioidomycosis球孢子菌病,withrandomnodules随机分布。

398

399Case46inan51-year-oldasymptomaticwomanwithbreastcancerwhoispostlivertransplantation乳癌肝转移

400

401Thenoduledistributionis结节分布方式:(a)perilymphatic淋巴管周围分布(b)random随机分布(c)centrilobular小叶中心性分布

402randomCorrect.Thispatientshowsarandompattern.Subpleuralnodulesarevisibleperipherallyandinrelationtothemajorfissure胸膜下（外围、叶裂）.Overall,thenodulesappeardiffuse,withaperipheralpredominance弥漫分布，外围占优势.Consideringthehistoryofbreastcancer乳癌史,metastasesarelikely多发转移.Anill-defined不清楚得opacityintherightupperlobereflectsfluidfromrecentbronchoscopywithbronchoalveolarlavage支气管镜检.

403胸膜下结节

404血行转移瘤，在外围、肺底，结节比粟粒状的大。Diagnosis:Hematogenousmetastasesfrombreastcancer血行多发转移瘤,withrandomnodules随机分布。

405

406Case47inan57-year-oldwomanwithahistoryofbreastcancer乳癌史

407Thenoduledistributionis结节分布方式:(a)perilymphatic淋巴管周围分布(b)random随机分布(c)centrilobular小叶中心性分布

408randomCorrect.Thispatientshowsarandompattern随机分布.Subpleuralnodulesarevisibleperipherallyandinrelationtothemajorfissure胸膜下结节（外围、叶裂）.Overall,thenodulesappeardiffuse弥漫性.

409胸膜下结节

410Diagnosis:Hematogenousmetastasesfrombreastcancer血行多发转移瘤,withrandomnodules随机分布.

411Case48inan63-year-oldmanwithahistoryofthyroidcancer甲状腺癌

412Thenoduledistributionis结节分布方式:(a)perilymphatic淋巴管周围分布(b)random随机分布(c)centrilobular小叶中心性分布

413randomCorrect.Thispatientshowsarandompattern随机分布.Subpleuralnodulesarevisibleperipherallyandinrelationtothemajorfissure胸膜下（外围、叶裂）.Overall,thenodulesappeardiffuse弥漫性,withaperipheralpredominance外围占优势.

414胸膜下结节

415Inthispatient该病例,interlobularseptalthickeningbothsmoothandnodular小叶间隔光滑、结节状增厚,isalsovisible可见,suggestingaperilymphaticpattern支持淋巴管周围分布.

416Diagnosis:Metastaticthyroidcarcinoma甲状腺癌,withrandomandperilymphaticnodules随机、淋巴管周围分布.

417

418Case49inan43-year-oldItalianpriest意大利牧师withanabnormalchestradiographandcough咳嗽

419Thenoduledistributionis结节分布方式:(a)perilymphatic淋巴管周围分布(b)random随机分布(c)centrilobular小叶中心性分布

420randomCorrect.Thispatientshowsarandompattern随机分布.Subpleuralnodulesarevisibleperipherallyandinrelationtothemajorfissures胸膜下结节（外围、叶裂）.Overall,thenodulesappeardiffuse弥漫性.

421胸膜下结节

422AlthoughthedifferentialdiagnosiswouldincludemiliaryTB,miliaryfungalinfection,orhematogenousmetastasesasmostlikely尽管鉴别诊断包括（结核、真菌感染粟粒状,血行转移瘤）lungbiopsyrevealedsarcoidosis病理为结节病.Diagnosis:Sarcoidosisiejie结节病,withrandomnodules随机分布。

423

424Case50,ina53-year-oldmanwithproductive生产的cough咳嗽

425Thenoduledistributionis结节分布方式:(a)perilymphatic淋巴管周围分布(b)random随机分布(c)centrilobular小叶中心性分布

426centrilobularCorrect.Thispatientshowsacentrilobularpattern小叶中心性分布.Subpleuralnodulesarenotseen胸膜下结节未见,andthemostperipheralnodules外围结节visiblerangefrom5to10mmfromthepleuralsurfaceandfissure胸膜表面、叶裂下5-10MM.Overall,thenodulesappeardiffuseanduniformindistribution弥漫均匀分布.

427外围结节（胸膜下5-10MM）

428Diagnosis:Infectious感染性的bronchiolitis细支气管炎withcentrilobularnodules小叶中心性结节.

429

430Case51ina48-year-oldmanwithcommonvariableimmunodeficiency免疫缺陷andproductive生产的cough咳嗽

431Multiple许多ill-definedlungnodules不清楚的肺结节arevisible.Thenoduledistributionis结节分布:(a)perilymphatic淋巴管周围分布(b)random随机分布(c)centrilobular小叶中心性分布

432centrilobularCorrect.Thispatientshowsacentrilobularpattern小叶中心性分布.Subpleuralnodulesarenotseen胸膜下结节未见,andthemostperipheralnodulesvisiblerangefrom5to10mmfromthepleuralsurfaceandfissure外围结节位于胸膜下5-10MM.

433胸膜下结节（胸膜下5-10MM）

434Overall,thenodulesappearpatchyindistribution分布不均,andsomeareclearlyrelatedtothick-walledbronchi增厚的支气管壁.Lucencieswithinseveralnodulesrepresentcentrilobularbronchioles小叶中心细支气管,whicharesomewhatdilated稍扩大.Diagnosis:Infectiousbronchiolitis感染性细支气管炎andbronchopneumonia支气管肺炎withcentrilobularnodules小叶中心结节.

435增厚的细支气管壁

436小叶中心细支气管

437

438Case52ina46-year-oldmanwithafeverandproductivecough发热咳嗽

439

440Thenoduledistributionis结节分布方式:(a)perilymphatic淋巴管周围分布(b)random随机分布(c)centrilobular小叶中心性分布

441centrilobularCorrect.Thispatientshowsacentrilobularpattern小叶中心分布.Subpleuralnodulesarenotvisible胸膜下结节未见,andsomenodulesareclearlyrelatedtosmallairwaysorcontainacentrallucency中心透亮,representingacentrilobularbronchiole小叶中心细支气管.

442小叶中心透亮区

443Largerareasofopacity大不透亮区,havingapatchydistributionarevisibleinthelungbases在肺底部不均分布.Theserepresentlobularareasofconsolidation肺小叶,somecontainingacentralairbronchogram(i.e.thecentrilobularbronchiole).Diagnosis:Bacterial细菌的bronchopneumonia支气管肺炎withperibronchial支气管周围andlobularareasofconsolidation肺小叶.

444肺小叶

445

446Case53ina57-year-oldwomanwithprogressiveshortnessofbreathoverseveralweeks憋气几周以上,anonproductive非生产性咳嗽cough,andlow-gradefever低热

447Multipleill-definedlungnodulesofground-glassopacityarevisible多发边界不清磨玻璃密度结节.Thenoduledistributionis分布方式:(a)perilymphatic淋巴管周围分布(b)random随机分布(c)centrilobular小叶中心性分布

448centrilobularCorrect.Thispatientshowsacentrilobularpattern小叶中心分布.Subpleuralnodulesarenotseen胸膜下结节未见,andthemostperipheralnodules外围结节visiblerange可见区from5to10mmfromthepleuralsurfaceandmajorfissure.Overall,thenodulesappeardiffuseindistributionandevenlyspaced弥漫均匀分布.Abnormal异常bronchiandfrankconsolidationarenotseen.

449外围结节

450Additionalhistoryrevealedthatthepatientlivedwithseveralbirds患者有养鸟史.Inpatientswithahistoryofexposure,thisappearanceishighlysuggestiveofhypersensitivitypneumonitis高度暗示过敏性肺炎.Diagnosis:Hypersensitivitypneumonitis,subacutestage亚急性期,withcentrilobularnodules.

451过敏性肺炎1.斑片状边缘模糊影：肺泡腔内空气被浆液渗出物取代—肺泡炎。2.弥漫分布粟粒影：鸽子肺。3.线、网状、粟粒状影：为间质性渗出性改变。

452

453Case54,ina78-year-oldmanwithprogressiveshortnessofbreath进行性喘憋

454Multipleill-definedlungnodulesarevisible许多边界不清的肺结节.Thenoduledistributionis分布方式:(a)perilymphatic淋巴管周围分布(b)random随机分布(c)centrilobular小叶中心分布

455centrilobularCorrect.Thispatientshowsacentrilobularpattern小叶中心分布.Themostperipheralnodulesarecentered5-10mmfromthepleuralsurface外围结节胸膜下5-10MM.Althoughthelargestnodulesintheposteriorlungtouchthepleuralsurface尽管后部接胸膜面,nonodulesappeartoariseatthepleuralsurface.Overall,thenodulesappeardiffuseindistributionandevenlyspaced弥漫分布均匀间隔.Noabnormalbronchiarevisible.

456Thisappearanceisnonspecific该表现无特殊性.Bronchoscopyyieldedbronchioloalveolarcarcinoma支气管镜检为肺泡癌.Diagnosis:Bronchioloalveolarcarcinoma,diffusenodularform,withcentrilobularnodules

457Bronchioloalveolarcarcinoma细支气管肺泡癌(BAC)canresultin:1)asolitarynoduleormass单发结节或肿块(40%ofpatients);2)focalordiffuseconsolidation(30%);or3)diffuseill-definednodules弥漫(30%).Whenmultiplenodulesarepresent,theymaybecentrilobular,asinthiscase,duetoendobronchialspread气道播散,ormaymimic模仿theappearanceofhematogenousmetastasis血行转移.

458

459Case55,ina35-year-oldmanwithafeverandproductive生产性的cough

460Multipleill-definedlungnodules多发边界不清的肺结节,ofvaryingsize大小不一,arevisible.Thenoduledistributionis分布方式:(a)perilymphatic淋巴管周围分布(b)random随机分布(c)centrilobular小叶中心分布

461centrilobularCorrect.Thispatientshowsacentrilobularpattern(Figure1).Subpleuralnodulesarenotvisible胸膜下结节未见.Someofthesubpleuralopacitieshaveanirregularbranchingappearance胸膜下可见树芽征.Thisappearance,mimickingabranchingtree,istermed"tree-in-bud."

462“tree-in-bud.”树芽征

463Whatisthemostlikelydiagnosis最可能的诊断?(a)Infection感染(b)Bronchioloalveolarcarcinoma细支气管肺泡癌(c)Hypersensitivitypneumonitis过敏性肺炎

464InfectionCorrect.Bronchoscopyrevealed镜检显示infection感染withHemophilusinfluenza流感.

465Diagnosis:Bacterial细菌的bronchopneumonia支气管肺炎withacentrilobularpattern小叶中心分布and“tree-in-bud.”树芽征（为细支气管内粘液栓）

466

467Case56ina53-year-oldwomanwitharightlungtransplantation肺移植foremphysema肺气肿andproductive生产性的cough咳嗽

468

469Theleftlungshowstypicalfindingsofpanlobularemphysema左肺为典型的全小叶型肺气肿.Multiplesmall,well-defined明确的centrilobularnodules小叶中心结节(Figure1)arevisibleinthetransplantedrightlung移植的右肺.Subpleuralnodulesarenotvisible胸膜下结节未见.Tree-in-budisvisibleintherightlowerlobe树芽征右下叶可见.

470左侧全小叶型肺气肿

471树芽征

472Diagnosis:Bacterial细菌的bronchopneumonia支气管肺炎withtree-in-bud.DISCUSSION：Identifyingthepresenceof“tree-in-bud”isveryimportantinthedifferentialdiagnosisofcentrilobularopacities识别树芽征在小叶中心鉴别诊断很重要,asitstronglysuggeststhepresenceofinfection暗示感染的存在.Tree-in-budismostcommonwithbacterial细菌andmycobacterial分支杆菌infections感染,butcanalsobeseenwithfungal真菌orviral滤过性毒菌infections.

473

474Case57ina58-year-oldmanwithfeverandproductive生产性的cough

475Acentrilobularpatternofnodulesisvisible,associatedwithbronchialwallthickening支气管壁厚,andmildbronchiectasis轻度支扩.Istree-in-budpresent树芽征存在?(a)Yes(b)No

476YesCorrect.Treeinbudisvisibleinmanylocations在许多的位置.

477Diagnosis:Bronchiectasis支扩,bacterialbronchitisandbronchiolitis细菌性支气管炎、细支气管炎,with"tree-in-bud."DISCUSSION：Tree-in-budisoftenvisibleinpatientswithchronicairwaysdisease树芽征在慢性气道阻塞常见,particularly独特的bronchiectasis支扩,wheninfectionispresent感染存在.Inthispatient,treeinbudisassociatedwithbronchiectasis与支扩是关联的.

478

479Case58ina28-year-oldwomanwithcoughandnightsweats盗汗

480

481Severalnodularopacitiesarevisibleintherightupperlobe上叶多个结节,withfocal焦点cavitation空洞andseveralareasof“tree-in-bud.”Theappearanceoftree-in-budstronglysuggestsendobronchialinfection末细支气管.Thisappearanceinassociationwithafocalapicalopacitysuggests上叶支持TB.

482树芽征

483空洞

484Diagnosis:Activetuberculosis活动肺结核withendobronchialspreadand"tree-in-bud"DISCUSSION：Inapatientwithtuberculosis,thepresenceoftreeinbudindicatesactive树芽征存在指示活动diseaseandendobronchialspreadofinfection末细支气管播散、感染.

485

486Case59ina35-year-oldmanwithcoughandnightsweats盗汗

487Multiplelargenodularopacitiesarevisibleintheupperlobes上叶多发结节,withareasofcavitation空洞形成,multipleclustersandrosettesofcentrilobularnodules小叶中心结节呈梅花瓣状presentingendobronchialspreadofinfection末细支气管播散、感染,andseveralareasof"tree-in-bud."

488空洞

489梅花瓣状

490树芽征

491Diagnosis:Activetuberculosis活动结核withendobronchialspread气道播散and"tree-in-bud"

492

493Case60ina78-year-oldwomanwithcoughandhemoptysis咳嗽咳血

494

495树芽征

496大的边界不清的结节

497Whatisthemostlikelydiagnosisinthispatient最可能的诊断?(a)Bacterialbronchopneumonia细菌性支气管肺炎(b)Tuberculosis结核(c)Infectionwithatypicalmycobacteria非典型的分支杆菌感染

498InfectionwithatypicalmycobacteriaCorrect.Inanelderlywoman年老的女人,thiscombinationoffindingscouldbeseenwithanyofthesediseases,butismostsuggestiveofatypicalmycobacterialinfection更支持非典型分支杆菌感染.

499Diagnosis:Mycobacterium分支杆菌avium-intracellularecomplex(MAC)infectionwithtree-in-bud。分支杆菌广泛存在自然界。

500

501Case61ina73-year-oldwomanwithcough

502支扩

503大边界不清的结节

504树芽征

505Whatisthemostlikelydiagnosisinthispatient最可能的诊断?(a)Bacterialbronchopneumonia细菌性支气管肺炎(b)Tuberculosis肺结核(c)Infectionwithatypicalmycobacteria非典型分支杆菌感染

506InfectionwithatypicalmycobacteriaCorrect.Inanelderlywoman,thecombinationofbronchiectasis,nodules,andtree-in-budishighlysuggestiveofMACinfection支扩、结节、树芽征高度暗示分支杆菌感染。

507Case62ina35-year-oldmanwithleukemia白血病

508Onthelungwindowscan,alungnoduleissurroundedbyahaloofground-glassopacity磨玻璃晕征.Thisistermedthe“halosign晕征”.Onthesofttissuewindowscan,low-attenuationnecrosisisvisibleinthecentralportionofthenodule结节中心可见坏死.

509晕征

510坏死

511Diagnosis:Invasive入侵的aspergillosis曲霉病withthe“halosign晕征"

512

513Case63ina28-year-oldmanwithleukemia白血病andtreatedaspergillosis曲霉病治疗

514不规则的空洞

515结节影像

516Diagnosis:Invasiveaspergillosis曲霉病withinfarction坏死andair-crescentsign新月征

517Case64ina31-year-oldwomanwithanabnormalchestradiograph异常胸部表现.

518Diagnosis:Wegener‘sgranulomatosiswithmultiplenodules韦格纳肉芽肿DISCUSSION：Largelungnodulescanbeassociatedwithavarietyoflungdiseases,andinmostinstances,theirappearanceisnonspecific无特殊性.Thedifferentialdiagnosis鉴别诊断includesmetatstatictumor转移瘤,infectious感染orinflammatorylesions炎性损害,infarctions肉芽肿病,nodulesofWegener‘sgranulomatosis,sarcoidosis结节病,andfibroticmasses纤维块asarecommoninsarcoidosisorsilicosis在结节病、硅肺病.

519

520INCREASEDOPACITY肺不透明性增加

521Case65ina35-year-oldwomanwhohasahistoryofasthma哮喘史,progressiveshortnessofbreath进行性喘憋

522DoestheprincipalabnormalityvisibleonCTrepresentconsolidationorground-glassopacity首要异常是实变还是磨玻璃改变?(a)Consolidation实变(b)Ground-glassopacity磨玻璃密度

523ConsolidationCorrect.HRCTshowspatchyareasofconsolidationinthelungperiphery肺外围不均的实变.Notethatvesselsarenotvisiblewithintheareasofincreasedopacity密度增高影内肺血管影像未见.Someareasofgroundglassopacityarealsovisible一些磨玻璃区是可见的.

524实变

525Diagnosis:Chroniceosinophilicpneumonia慢性嗜伊红肺炎,presentingwithconsolidation呈现实变。

526

527Case66ina43-year-oldwomanwithalow-gradefever低热,progressiveshortnessofbreath气短

528肺外围实变影

529Therewasamarkedeosinophiliaintheperipheralblood外围血嗜伊红细胞增多.Themostlikelydiagnosisis最可能的诊断:(a)BOOP机化性肺炎(b)pneumonia肺炎(c)hypersensitivitypneumonitis过敏性肺炎(d)eosinophilicpneumonia嗜伊红肺炎

530eosinophilicpneumoniaCorrect.Diagnosis:Chroniceosinophilicpneumonia慢性嗜伊红肺炎,presentingwithconsolidation呈现实变.

531

532Case67ina56-year-oldwomanwithalow-gradefever低热,progressiveshortnessofbreathover2months喘憋2月以上。

533HRCTshowspatchyareasofconsolidationinthelungperipheryandintheperibronchovascularregion肺外围、支气管血管束周围片状实变影.Notethatvesselsarenotvisiblewithintheareasofincreasedopacity在其内血管影不见.Atamorecephaladlevel,patchyconsolidationandground-glassopacity磨玻璃影arevisible.

534实变、磨玻璃影

535Whatisthemostlikelydiagnosis可能的诊断?(a)Pneumonia肺炎(b)Eosinophilicpneumonia嗜伊红肺炎(c)BOOP机化性肺炎

536BOOPCorrect.Thedifferentialdiagnosis鉴别诊断includesanumberofinfectiousandnoninfectiousdiseases包括许多感染、非感染疾病.Inpatientswithsubacuteorchronicsymptoms在亚急性、慢性,pneumoniaislesslikely肺炎少见,andthemostlikelydiagnosesincludebronchiolitisobliteransorganizingpneumonia(BOOP)更多的诊断是机化性肺炎,eosinophilicpneumonia嗜伊红肺炎,bronchioloalveolarcarcinoma细支气管肺泡癌andlymphoma淋巴瘤,interstitialpneumonia间质性肺炎,andalveolarproteinosis肺泡蛋白沉积症.Biopsyrevealed病理是BOOP.

537Diagnosis:Bronchiolitisobliteransorganizingpneumonia(BOOP),presentingwithconsolidationandground-glassopacity出现实变、磨玻璃密度.

538TheHRCTfindingsinpatientswithBOOPinclude机化性肺炎:1)patchyconsolidation片状实变(seenin80%ofcases)orground-glassopacity磨玻璃影(in60%ofcases),oftenwithasubpleural胸膜下and/orperibronchialdistribution支气管周围;and2)smallill-definednodules小结节(30-50%ofcases)whichmaybeperibronchialorperibronchiolar.Findingsmaycloselymimicthoseseeninpatientswitheosinophilicpneumonia与嗜伊红肺炎近似.

539Case6847-year-oldwomanwith6weekshistoryofalow-gradefever低热6周,nonproductivecough,andmalaiseishen不舒服

540HRCTshowsill-definednodularareasofconsolidation边界不清实变结节intheperibronchovascularregions在支气管束周围.Air-filledbronchicanbeidentifiedwithinsomeoftheseopacities支气管可见.Thisappearancemimicstheperibronchovascularnodulessometimesseeninpatientswithsarcoidosis类似（支气管血管束结节）在结节病可见,butnotethat,unlikesarcoidosis,nosubpleuralnodulesarevisibleinthiscase但该病无胸膜下结节.Additionalhistoryrevealedarecentupperrespiratoryinfection另外最近有上呼吸道感染.Biopsyshowed病理是BOOP.

541边界不清的实变影

542Diagnosis:Bronchiolitisobliteransorganizingpneumonia(BOOP)resultingfromrespiratoryinfection因呼吸道感染发生,presentingwithconsolidation呈现实变.

543Case6953-year-oldmanwithahistoryofunresolvedrespiratoryinfection未治愈的感染,low-gradefever低热,andnonproductivecough咳嗽

544HRCTshowsilldefinednodularareasofground-glassopacityinthelungperiphery肺外围磨玻璃密度.

545Diagnosis:Bronchiolitisobliteransorganizingpneumonia(BOOP)resultingfromrespiratoryinfection因呼吸感染所致,presentingwithcentrilobularnodules呈现小叶中心结节.

546Case70na15-year-oldboywitharecenthistoryofhemoptysis近日咳血史.

547DoesHRCTshowconsolidationorground-glassopacity实变还是磨玻璃密度?(a)Consolidation实变(b)Ground-glassopacity磨玻璃密度

548Ground-glassopacityCorrect.HRCTshowsanill-definedincreaseinlungopacity,butpulmonaryvesselsremainvisiblewithintheabnormallungregions在异常区肺纹理可见.Thisappearanceistermedground-glassopacity.术语：磨玻璃密度。

549磨玻璃密度

550Whatisthemostlikelydiagnosis最可能的诊断?(a)Viralpneumonia病毒性肺炎(b)Pulmonaryhemorrhage肺出血(c)Pulmonaryedema肺水肿(d)Hypersensitivitypneumonitis过敏性肺炎

551PulmonaryhemorrhageCorrect.Alargenumberofdiseasescanbeassociatedwithground-glassopacity.Themostcommoncausesofground-glassopacity磨玻璃密度包括includehypersensitivitypneumonitis过敏性肺炎,pneumonia肺炎(particularlyatypicalpneumoniascausedbypneumocystiscarinii,virus,andmycoplasma),pulmonaryedema肺水肿orhemorrhage出血,alveolarproteinosis肺泡蛋白沉积症,acuteinterstitialpneumonia急性间质性肺炎orothercausesofdiffusealveolardamage(ARDS),orinterstitialpneumonia(DIPorUIP).Inthispatient,thehistoryofhemoptysissuggestspulmonaryhemorrhage咳血史支持肺出血.

552Case71ina46-year-oldwomanwithahistoryofprogressiveshortnessofbreath喘憋,low-gradefever低热,andnonproductivecough咳嗽

553HRCTshowsilldefinedpatchyareasofground-glassopacity片状磨玻璃密度区.Bronchilook“tooblack”comparedtolungparenchyma,representingairbronchograms支气管相对肺实质“较黑”.

554Whatitthemostlikelydiagnosis最可能的诊断?(a)Viralpneumonia病毒性肺炎(b)Pulmonaryhemorrhage肺出血(c)Pulmonaryedema肺水肿(d)Hypersensitivitypneumonitis过敏性肺炎

555HypersensitivitypneumonitisCorrect.Theexposuretomoldsmakes模型铸造hypersensitivitypneumonitismostlikely过敏性肺炎更像。

556Diagnosis:Hypersensitivitypneumonitis过敏性肺炎,presentingwithground-glassopacity呈现磨玻璃密度.

557DISCUSSIONHypersensitivitypneumonitis过敏性肺炎(HP)isanallergiclungdisease过敏性肺疾患causedbytheinhalationofantigenscontainedinavarietyoforganicdusts吸入多种抗原的灰尘.Farmer‘slung农民肺,whichisthebest-knownHPsyndrome,resultsfromtheinhalationoffungalorganisms吸入真菌有机体(thermophilicactinomycetes)thatgrowinmoisthay潮湿的干草多见.HRCTisusuallyperformedinthesubacutestageofdisease,weekstomonthsfollowingfirstexposuretotheantigen.Typicalfindingsincludepatchyground-glassopacity典型表现：磨玻璃密度(80%)andsmallill-definedcentrilobularnodulesofground-glassopacity小边界不清的小叶中心结节(80%).Patchylobularlucency小叶透亮区andairtrapping空气潴留mayalsobeseen,andischaracteristicofhypersensitivitypneumonitis,reflectingthepresenceofbronchiolitis细支气管炎是过敏性肺炎典型表现.

558小叶透亮区

559常规CT检查均为吸气相；呼气时肺内的含气量明显减少，正常肺野的透光度应均匀或阶梯性降低；合并小气道管腔狭窄或闭塞时，相应肺泡内的气体不能呼出而呈片状低密度，称之为空气潴留征。所以呼气相CT主要判断有无小气道的病变，一定程度上反应了肺的局部通气功能。

560低密度病变：提示肺内含气量过多、肺结构破坏、肺内潜在腔隙扩大以及纤维化等。根据有无囊壁分为：（1）有壁低密度病变或含气囊腔：常见病变为肺囊肿、支气管扩张、蜂窝肺、肺淋巴管平滑肌瘤病等。（2）无壁低密度病变或含气囊腔：主要见于肺气肿、肺大泡、空气潴留征和马赛克灌注。

561Case72in57-year-oldwomanwithexposuretobirdsaspets接触鸟史,progressiveshortnessofbreath喘憋,low-gradefever低热,andnonproductivecough咳嗽

562HRCTshowsilldefinedpatchyareasofground-glassopacity边界不清的磨玻璃密度影.Focalareasoflucency病灶区域的透亮区,representingairtrappingarealsovisible表现空气潴留.

563磨玻璃密度

564空气潴留

565闭塞性细支气管炎：局部空气潴留、通气不良、反射性低灌注，马赛克灌注--在这种情况下，血液再分配到通气正常区—补丁状或地图状，病变区（低密度区）内血管管径减小，并有支气管异常；正常区（高密度区）内血管管径正常或变大，而磨玻璃密度肺动脉大小正常。

566Themostlikelydiagnosisis最可能的诊断:(a)viralpneumonia病毒性肺炎(b)pulmonaryhemorrhage肺出血(c)pulmonaryedema肺水肿(d)hypersensitivitypneumonitis过敏性肺炎

567hypersensitivitypneumonitis过敏性肺炎Correct.Theexposuretobirdsmakeshypersensitivitypneumonitismostlikely与鸟有关.Theappearanceofground-glassopacitywithfocallucentregionsistypical磨玻璃密度伴透亮区（空气潴留）.

568Diagnosis:Hypersensitivitypneumonitis过敏性肺炎,presentingwithground-glassopacityandairtrapping呈现磨玻璃密度和空气潴留.

569DISCUSSIONThecombinationofpatchyground-glassopacityandpatchylucencyduetoairtrappingishighlysuggestiveofhypersensitivitypneumonitis补钉状磨玻璃密度、透亮区支持过敏性肺炎.Thiscombinationreflectslunginfiltration(ground-glassopacity磨玻璃密度反映肺感染),andbronchiolitis细支气管炎(patchylucencyduetoairtrapping空气潴留地图状透亮区),commoninthisdisease.Thisvariegatedappearancehasbeenlikenedtothatofasausage多样变化比作腊肠,so-called“headcheese猪头肉冻征",madefromvariouspartsoftheheadofahog.Thevariegatedappearanceoflungseenwiththeheadcheesesignindicatesthepresenceofground-glassopacityinassociationwithnormallungattenuationandareasoflowattenuationduetoairtrapping.Itisstronglysuggestiveofhypersensitivitypneumonitis.

570猪头肉冻征

571Case73ina56-year-oldwomanwithchroniccough慢性咳嗽,whosesymptomsbegan开始在atatimeshewasburningmoldywoodinthefireplace燃烧发霉的木头

572HRCTshowssomepatchyareasofconsolidationintherightupperlobe右肺上叶补钉状实变,butthepredominantabnormality突出的异常ispatchyandgeographicground-glassopacity,补钉状、地图状磨玻璃密度andsomelobularregionsoflucency小叶透亮区.Inviewingthesequenceofimages,theabnormalitieshaveanupperlobepredominance上叶优势,andthelungbases(Figure4)arerelativelyspared.

573实变

574磨玻璃密度

575小叶透亮区

576Thecombinationofground-glassopacity实变的磨玻璃密度,normallung,andareasoflucency透亮区suggestswhatdiagnosis支持什么诊断?(a)BOOP机化性肺炎(b)Hypersensitivitypneumonitis过敏性肺炎(c)Alveolarproteinosis肺泡蛋白沉积症

577Hypersensitivitypneumonitis过敏性肺炎Correct.Thisisanotherexampleofthehead-cheesesign猪头肉冻征,afindingstronglysuggestingthediagnosisofhypersensitivitypneumonitis强烈支持过敏性肺炎.Openlungbiopsywasperformed.

578Case74ina42-year-oldHIVpositive艾自病毒manfeverandshortnessofbreath发热、喘憋

579

580Themostlikelydiagnosisis最可能的诊断:(a)viralpneumonia病毒性肺炎(b)pneumocystispneumonia卡氏肺孢子虫肺炎(c)pulmonaryhemorrhage肺出血(d)pulmonaryedema肺水肿(e)hypersensitivitypneumonitis过敏性肺炎

581pneumocystispneumoniapcp肺炎Correct.HRCTshowsextensiveregionsofground-glassopacity,广泛磨玻璃密度involving包括theupperlobesdiffusely上叶弥漫,andthelowerlobesinapatchy下叶补钉状andgeographicfashion地图状.Inviewingthesequenceofimages,theabnormalitieshaveanupperlobeandparahilarpredominance上叶肺门、优势.Thedifferentialdiagnosisofthisappearanceisextensive,butwiththehistoryofAIDSandfever,Pneumocystiscariniipneumonia(PCP)mustbestronglyconsidered,andappropriatediagnostictestsperformed鉴别诊断是广泛的，结核病史可考虑pcp.

582Case75ina54-year-oldwomanwithlymphoma淋巴瘤beingtreatedwithchemotherapy在化疗.Symptoms症状includefever发热,cough咳嗽,andshortnessofbreath喘憋

583

584HRCTshowspatchyareasofground-glassopacityintheupperlobes上叶磨玻璃密度补丁状区域.Manyoftheopacitiesappearlobularorcentrilobular不透明表现小叶或小叶中心,andinterlobularseptalthickeningisalsoclearlyseen小叶间隔增厚可见.Atlowerlevels,theareasofground-glassopacityappeargeographic下叶磨玻璃密度表现地图状(Figure5)andatleastoneareaofconsolidation至少一个区域实变(Figure4)ispresent.Anirregularnoduleisalsoseen,butunrelated不规则结节可见但无关.Thenodulerepresentedanaspergillusinfection为曲霉菌感染.

585小叶或小叶中心性（上叶补丁状不透明区）

586小叶间隔增厚

587地图状磨玻璃密度

588不规则结节—霉菌感染

589Themostlikelydiagnosisis最可能的诊断:(a)viralpneumonia病毒性肺炎(b)pneumocystispneumonia卡氏囊虫肺炎(c)pulmonaryhemorrhage肺出血(d)pulmonaryedema肺水肿(e)hypersensitivitypneumonitis过敏性肺炎

590Adefinitediagnosiscannotbemade明确诊断是困难的.Inapatientwithlymphomaonchemotherapy淋巴瘤化疗,Iwouldconsidereachoftheseispossible所诉每一诊断都是可能的.BronchoscopyrevealedPneumocystiscariniipneumonia镜检为(PCP).

591Diagnosis:Pneumocystiscariniipneumonia(PCP),presentingwithground-glassopacity磨玻璃密度andseptalthickening小叶间隔增厚.Pneumocystiscariniipneumonia(PCP)mayoccurinanyimmunosuppressedpatient间质性浆细胞肺炎可以发生在任何免疫抑制患者.

592Case76ina48-year-oldmanwithahistoryofsubstanceabuse身体滥用,cough,fever,andshortnessofbreath

593

594HRCTshowspatchyareasofground-glassopacityintheupperlobes上叶磨玻璃密度(Figure1).Interlobularseptalthickening磨玻璃区可见小叶间隔增厚isalsovisibleinrelationtotheareasofground-glassopacity.Atalowerlevel下部,afocalareaofconsolidationispresent可见实变病灶(Figure4).

595上叶磨玻璃密度

596小叶间隔增厚

597下叶实变灶

598Themostlikelydiagnosisis最可能的诊断:(a)viralpneumonia病毒性肺炎(b)pneumocystispneumonia卡氏囊虫肺炎(c)pulmonaryhemorrhage肺出血(d)pulmonaryedema肺水肿(e)hypersensitivitypneumonitis过敏性肺炎

599AdefinitediagnosiscannotbemadebasedontheHRCTappearance不能明确诊断.Inthisclinicalsetting,eachoftheseispossible每一病例是可能的.Bronchoscopyandculturerevealedaviralpneumonia(CMV)镜检示病毒性肺炎.

600Diagnosis:Viralpneumonia巨细胞病毒性肺炎(cytomegalovirus),presentingwithground-glassopacity磨玻璃密度andseptalthickening间隔增厚.

601Case77ina60-year-oldwomanwithahistoryofrecentpneumonia最近肺炎史,cough咳嗽,lowgradefever低热

602HRCTshowspatchyandgeographicareasofground-glassopacityintheupperlobes地图状、补丁状磨玻璃密度增高影,withlobularareasoflucencyalsovisible小叶透亮区.Patchyground-glassopacityandconsolidationarevisibleatotherlevels补丁状磨玻璃密度和实变在其它区域可见.Thisappearanceisnonspecific表现无特殊性.

603磨玻璃密度

604小叶透亮区

605实变

606Diagnosis:Mycoplasmapneumonia支原体肺炎,presentingwithground-glassopacityandpatchyairtrapping呈现磨玻璃密度、补丁状空气潴留.Thecombinationofpatchyground-glassopacity磨玻璃密度的实变andpatchylucencyduetoairtrapping补丁状空气潴留(i.e.the“headcheesesign”)ishighlysuggestiveofhypersensitivitypneumonitis支持过敏性肺炎,butcanbeseeninotherdiseasesassociated但在其他疾病亦可见withlunginfiltration肺感染andbronchiolitis细支气管炎,including包括sarcoidosis结节病andatypicalinfections非典型感染.

607Case78ina47-year-oldwomanwithahistoryoflymphoma淋巴瘤史andsymptomsofcough,malaise不舒服,andfever

608HRCTshowspatchyandsomewhatnodularareasofground-glassopacityintherightmiddlelobe右中叶可见磨玻璃密度区.Interlobularseptalthickening小叶间隔增厚isalsovisibleinrelationtotheareasofground-glassopacity.Atalowerlevel,thelingula舌段有类似异常showssimilarabnormalities.

609中叶补丁状磨玻璃密度影

610小叶间隔增厚

611舌段的类似异常

612Diagnosis:Viralpneumonia病毒性肺炎,presentingwithground-glassopacity磨玻璃密度andseptalthickening间隔增厚.

613Case79ina57-year-oldwomanwithahistoryoflymphoma淋巴瘤史,failedchemotherapyinduction失败的化疗,andshortnessofbreath气短

614HRCTshowspatchyareasofground-glassopacity补丁状磨玻璃密度影.Interlobularseptalthickening小叶间隔增厚isalsovisible,asismildthickeningofthefissures叶裂轻度增厚.

615磨玻璃密度影

616小叶间隔增厚

617叶裂轻度增厚

618Themostlikelydiagnosisis最可能的诊断:(a)viralpneumonia病毒性肺炎(b)pneumocystispneumonia卡氏肺囊虫肺炎(c)pulmonaryhemorrhage肺出血(d)pulmonaryedema肺水肿(e)BOOP机化性肺炎

619Inapatientwiththishistory,eachofthesediagnosesispossible上诉诊断都可能.Sheimprovedfollowingdiuresis.利尿后减轻Diagnosis:Pulmonaryedema肺水肿duetofluidoverload,presentingwithground-glassopacityandseptalthickening.磨玻璃密度、小叶间隔增厚。

620Case80ina46-year-oldwomanwithahistoryofbilaterallungtransplantation双肺移植史andrapidly迅速进行性喘憋progressingshortnessofbreath

621HRCTshowspatchyareasofground-glassopacitywithastrikingperipheralandsubpleuralpredominance磨玻璃影外围胸膜下为优势.Consideringherhistoryofimmunosuppression考虑肺移植史,infectionmustbeconsidered感染必须被考虑.However,noinfectionswerefoundatbronchoscopy不能气管镜.Thepatientprogressivelyworsenedandeventuallydied患者严重死亡.Autopsyshowedlungcongestion尸检肺充血andpulmonaryedema肺水肿secondarytopulmonaryveno-occlusivedisease.

622以胸膜下为主的磨玻璃影

623Diagnosis:Pulmonaryedema肺水肿secondarytopulmonaryveno-occlusivedisease肺静脉闭塞,occurringasacomplicationoflungtransplantation因肺移植,presentingwithground-glassopacity呈现磨玻璃影.

624Case81ina42-year-oldmanwithahistoryofleukemia白血病andhemoptysis咳血

625HRCTshowspatchyareasofground-glassopacity磨玻璃密度(Figure1).Afinereticularpattern明显的网状(Figure2)issuperimposed在磨玻璃影上ontheground-glassopacity.Thisappearanceisconsistentwithpulmonaryhemorrhage与肺出血是一致的,suspectedfromthehistory支持病史.

626Diagnosis:Pulmonaryhemorrhage肺出血esecondarytoleukemia白血病,presentingwithground-glassopacity呈现磨玻璃密度影。DISCUSSION讨论Pulmonaryhemorrhagemayresultfromanticoagulation,leukemiawithlowplateletcounts(asinthiscase)白血病血小板减少,Goodpasture‘ssyndrome,orothercausesofvasculitis其他脉管炎.Regardlessofitscause,HRCTshowspatchyordiffuse,ground-glassopacityorconsolidation不管原因：表现补丁状、弥漫的磨玻璃影或实变影.Reticularopacitiesorinterlobularseptalthickeningmaybesuperimposed可以有网状改变.

627Goodpasture'ssyndrome,

628Case82ina29-year-oldwomanwithahistoryofsystemiclupuserythematosus系统性红斑狼疮andshortnessofbreath喘憋

629Diagnosis:Activeinterstitialpneumonia急性间质性肺炎secondarytosystemiclupuserythematosus红斑狼疮,presentingwithground-glassopacity磨玻璃密度影.

630Case83ina19-year-oldwomanwithnewlydiagnosedsystemicerythematosusandhemoptysis系统红斑狼疮

631

632Themostlikelydiagnosisis最可能的诊断:(a)viralpneumonia病毒性肺炎(b)pneumocystispneumonia卡氏费囊虫肺炎(c)pulmonaryedema肺水肿(d)pulmonaryhemorrhage肺出血(e)lupuspneumonitis狼疮肺炎

633EachofthesecouldexplaintheHRCTfindings每一个都能解释.Thehistoryofhemoptysissuggestspulmonaryhemorrhage据历史诊断肺出血。

634Case84ina59-year-oldwomanwithahistoryofnon-productivecoughandprogressiveshortnessofbreathofseveralmonthsduration咳嗽喘憋持续几个月

635HRCTshowsareasofground-glassopacitywithaperipheralandsubpleuralpredominance胸膜下磨玻璃影.Therearesomeassociatedreticularopacities网状改变.Thesubpleuraldistributionoftheseopacitiesissuggestiveofidiopathicpulmonaryfibrosisorothercauseofusualinterstitialpneumonia使人想到间质性纤维化(UIP).

636胸膜下磨玻璃影、网状改变

637Doyouthinkthispatienthasactivedisease是急性疾病吗?(a)Yes(b)No

638YesCorrect.Thepredominanceofground-glassopacitysuggestsactivedisease磨玻璃密度支持急性疾病.Openlungbiopsyshowedanactiveidiopathicinterstitialpneumonitis病理：急性先天性间质性肺炎.Subsequenttreatmentshowsasignificantreductioninground-glassopacity治疗磨玻璃密度减少,althoughsomereticularopacitiespersist尽管网状存在,likelyduetomildfibrosis很可能轻度纤维化.

639治疗后：磨玻璃密度减少，网状改变

640Diagnosis:Activeinterstitialpneumonia急性间质性肺炎,idiopathicpulmonaryfibrosis先天性肺纤维化,presentingwithground-glassopacityandseptalthickening呈现磨玻璃密度、间隔增厚.

641非特异性间质纤维化：蜂窝肺广泛

642Case85ina71-year-oldmanwithdrycoughandprogressiveshortnessofbreath干咳喘憋

643HRCTinthepronepositionshowspatchyground-glassopacityintheposteriorsubpleurallung后胸膜下磨玻璃密度(Figure1).Thisdistributionistypicalofidiopathicpulmonaryfibrosis分布是典型的IPF.

644Doyouthinkthispatienthasactivedisease患者有急性疾患吗?(a)Yes(b)No

645NoCorrect.Inadditiontotheground-glassopacity除磨玻璃密度外,tractionbronchiectasis牵拉支扩andreticularopacitiesarevisible网状改变可见.Thepresenceoftractionbronchiectasispredictsthepresenceoffibrosisratherthanactivedisease牵拉支扩存在说明纤维化胜于急性疾患.

646牵拉支扩

647Diagnosis:Idiopathicpulmonaryfibrosis(IPF)withfibrosis先天性间质纤维化,presentingwithground-glassopacityandtractionbronchiectasis呈现磨玻璃密度、牵拉性支扩.

648Case86ina45-year-oldwomanwithahistoryofcigarettesmoking吸烟史andprogressiveshortnessofbreath喘憋

649Doyouthinkthatactivediseaseispresent急性疾患存在吗?(a)Yes(b)NoThisappearanceisnonspecific表现是非典型的.

650YesCorrect.Thediseaseislikelyactive疾病很可能是急性的.Thereisnoevidenceoffibrosis没有明显的纤维化.Openlungbiopsywasperformed.

651Diagnosis:Desquamativeinterstitialpneumonia间质性肺炎,presentingwithground-glassopacity呈现磨玻璃密度.

652Case87ina61-year-oldmanwithahistoryofprogressiveshortnessofbreathofseveralmonthsduration喘憋持续几个月

653Atalowerlevel,thereissomeincreaseinreticularopacities下肺有网状改变(Figure2)inassociationwiththegroundglassopacity磨玻璃密度中.Nohoneycombingispresent无蜂窝状改变.

654Doyouthinkthatactivediseaseispresent急性疾患存在吗?(a)Yes(b)No

655YesCorrect.Thisislikelyactivedisease急性疾患可能存在.Althoughabnormalreticulationispresent尽管有网状,thereisnoevidenceofhoneycombing无蜂窝肺.Openlungbiopsywasperformed病理证实.

656Diagnosis:Nonspecificinterstitialpneumonia非特定的间质性肺炎,presentingwithground-glassopacityandreticulation呈现磨玻璃密度、网状改变.

657先天性间质纤维化：胸膜下蜂窝肺

658Thesefivetypeswere间质性肺炎五种类型:usualinterstitialpneumonia普通的间质性肺炎(UIP);desquamativeinterstitialpneumonia脱屑的间质性肺炎(DIP);lymphocyticinterstitialpneumonia淋巴间质性肺炎(LIP);giant-cellinterstitialpneumonia巨细胞间质性肺炎(GIP);andbronchiolitiswithinterstitialpneumonia细支气管炎间质性肺炎(BIP).

659DIP,formerlythoughtofasanearlystageofUIP从前作为uip的早期,isnowconsideredtobeadistinctentity现为独特疾患,ratherrare,andusuallyrelatedtosmoking吸烟的.Ittypicallyshowsgroundglassopacity典型是磨玻璃密度.

660LIPisuncommon少见,beingseenmainlyinpatientswithdysproteinemia,autoimmunedisease自身免疫性疾患,particularlySjogren‘ssyndrome,andpatientswithAIDS.LIPmaybea“pre-lymphomatous”condition,exceptinpatientswithAIDS.Itoftenpresentswithnoduleshavingaperilymphaticdistribution结节淋巴管周围分布.

661Case8842-year-oldsandblasterwithahistoryofcoughandmildbutprogressiveshortnessofbreathofseveralmonthsduration喷沙喘憋持续几个月

662HRCTinthesupinepositionshowspatchyandgeographicareasofground-glassopacity(Figure1)involvingtheleftlungmorethantheright地图状、补丁状磨玻璃密度影左肺为主.Withinareasofground-glassopacity,thereisobviousInterlobularseptalthickening期内可见小叶间隔增厚.Thecombinationofgeographicground-glassinterlobularseptalthickeninghasbeentermed“crazypaving碎石路征"becauseofitresemblancetopavingstonesinanEnglishgarden.

663小叶间隔增厚

664Themostlikelydiagnosisis最可能的诊断:(a)viralpneumonia病毒性肺炎(b)pneumocystispneumoniaPCP(c)pulmonaryedema肺水肿(d)interstitialpneumonia间质性肺炎(e)alveolarproteinosis肺泡蛋白沉积症

665alveolarproteinosis肺泡蛋白沉积症Correct.Thisappearanceisnonspecific表现无特殊性,butinapatientwiththeappearanceofcrazypaving碎石路征andsilicaexposure职业史,alveolarproteinosisismostlikely该病很向.Openlungbiopsywasperformed病理证实.

666Case89Asymptomatic63-year-oldwoman无症状的

667小叶间隔增厚

668Themostlikelydiagnosisis最可能的诊断:(a)aspirationduetoesophagealdysfunction食道功能紊乱(b)alveolarproteinosis肺泡蛋白沉积症(c)edema水肿(d)pneumocysticpneumoniaPCP

669alveolarproteinosis肺泡蛋白沉积症Correct.Thefindings表现andabsenceofsymptoms缺乏症状aretypical是典型的。Althoughthesymptomsofalveolarproteinosis尽管肺泡蛋白沉积症include包括nonproductivecough咳嗽,fever发热,andmilddyspnea轻微呼吸困难onexertion,theyareusuallymild,andpatientsmaybequiteasymptomatic很轻微可以无症状.

670Case9037-year-oldKorean韩国manwhoregularlyconsumedsharkliveroilasahealthtonic沙鱼肝油补品,whopresentedwithcoughandprogressiveshortnessofbreath咳嗽喘憋

671HRCTinthesupinepositionshowspatchyareasofground-glassopacity补丁状磨玻璃影(Figure1).Insomeareastheopacitiesarelobularindistribution一些区域呈小叶性表现.Thereissomeconfluence(Figure3)intheleftlowerlobe左下肺有融合.

672小叶性分布的磨玻璃影

673Diagnosis:Exogenouslipoidpneumonia外因的类脂性肺炎,presentingwithground-glassopacity呈现磨玻璃密度.

674Case91ina35-year-oldmanwitha2-monthhistoryofprogressiveradiographicabnormalitiesx线异常andshortnessofbreath气短

675HRCTinthesupinepositionshowspatchyareasofground-glassopacity补丁状磨玻璃密度影(Figure1).Insomeareas,smallnodulesmaybevisible小结节可见.Transbronchialbiopsywasperformed病理证实.

676小结节

677Diagnosis:Sarcoidosis结节病,presentingwithground-glassopacity呈现磨玻璃密度.

678Case92ina35-year-oldmanwithprogressivebutmildshortnessofbreath轻微的呼吸短缺

679Themostlikelydiagnosisis最可能的诊断:(a)calcifiedmiliaryTB粟粒状钙化结核(b)alveolarmicrolithiasis肺泡微石症(c)metastaticcalcification转移钙化(d)thyroidmetastases甲状腺转移

680alveolarmicrolithiasisCorrect.

681Case93ina60-year-oldmanwithchronicrenalfailure慢性肾衰

682HRCTshownusingalungwindowshowsill-definednoduleshavingalobulardistribution边缘不请结节小叶分布.Thesehaveadistinctupperlobepredominance上叶优势.Onasoft-tissuewindowscaninanareaoflungcollapse,lungparenchymaisseentobedenselycalcified肺实质钙化.Alsonotecalcificationofsofttissuesofthechestwall胸壁.Radionuclidebonescan(Figure6)showsmarkeduptakeoftheisotopeinthelung同位素显著.

683边界不清的小叶结节

684肺实质钙化

685胸壁钙化

686同位素

687Case94ina65-year-oldmanwithleftlungtransplantationforamyloidosis左肺因淀粉样变性移植

688HRCTshownusingalungwindowshowssmallandlargenodulesdiffuselyinvolvingtherightlung小、大结节右肺广泛分布.Onasoft-tissuewindowscans,thereisdensecalcification高密度钙化oftheseopacities.Alsonotethepresenceofstentsinthedistaltrachea气管分叉andleftmainbronchus左主支气管,fortreatmentofbronchialnarrowing治疗支气管狭窄,atleastpartiallyrelatedtoamyloidinfiltrationoftheairwaywall气道壁与淀粉渗透有关。

689大小结节

690钙化

691Diagnosis:Pulmonaryamyloidosis肺淀粉样变性病,withlungcalcification肺钙化。

692

693DecreasedLungOpacityandCysticLesion肺透过度减低、囊性病变

694Case95ina64-year-oldmanwithprogressiveshortnessofbreathofayear‘sduration持续一年的气短.Pulmonaryfunctiontestsshowrestrictivedisease肺功能测试限制性疾患

695Themostlikelydiagnosisis最可能的诊断:(a)honeycombingduetoidiopathicpulmonaryfibrosis蜂窝肺—先天性肺纤维化(b)cysticlungdisease囊性肺疾患(c)emphysema肺气肿

696honeycombingduetoidiopathicpulmonaryfibrosis蜂窝肺--IPFCorrect.HRCTshowsirregularreticularopacitiesinthelungperipheryandlungbases下肺外围网状改变,associatedwithhoneycombing蜂窝肺andtractionbronchiectasis牵拉支扩.Thisappearanceisindicativeofpulmonaryfibrosis说明肺纤维化,andthemostlikelydiagnosiswouldbeidiopathicpulmonaryfibrosis最可能的诊断IPF.Inadditiontothefindingsoffibrosis,numerousair-filledlungcysts肺气囊arevisible,primarilyintheleftlung主要在左肺.

697蜂窝肺

698牵拉性支扩

699肺气囊(肺大泡）

700Case96ina35-year-oldwomanwithadenomasebaceum皮脂腺瘤,shortnessofbreath气短,obstructiononpulmonaryfunctiontests,andlowdiffusingcapacity低容量

701

702HRCTshowsnumerousdiscrete许多不连续的,round圆形,thin-walledlungcysts薄壁囊状气腔(Figure2).Interveninglungparenchymaappearsnormal病变之间为正常肺,andthereisnoevidenceoffibrosis无纤维化迹象.Cystsarediffuselydistributed囊状病变呈广泛分布,andmanycystsarevisibleatthelungbases许多在肺底可见(Figure6).

703Doesthiscysticdiseaserepresenthoneycombing囊状气腔表现蜂窝肺?(a)Yes(b)No

704NoCorrect.Thecystsareisolated单独的,donotsharewalls无共同的壁,areunassociatedwithfindingsoffibrosis与纤维化无联系,andareassociatedwithpulmonaryfunction肺功能findingsofobstructionratherthanrestriction阻塞胜于限制.

705Diagnosis:Lymphangiomyomatosis淋巴管肌瘤病occurringinassociationwithtuberoussclerosis联想结节性脑硬化,presentingwithlungcysts肺囊状气腔.

706Case97ina44-year-oldmanwithahistoryofcigarettesmoking吸烟史andshortnessofbreath气短

707HRCTshowsnumerous许多,thickandthin-walledlungcysts厚或薄壁囊状气腔.Someareveryirregularinshape一些形态很不规则.Interveninglungparenchymaappearsnormal之间可见正常肺实质,andthereisnoevidenceoffibrosis无纤维化征象.Cystsarelargestandmostnumerousinthelungapices囊肿是大的，大多在肺尖(Figure1).Cystsatthelungbasesaresmallerandlessnumerous肺底小、少.TheleftcostophrenicangleappearssparedFigure4.

708不规则形态

709DoesthiscysticdiseaserepresentLAM表现是淋巴管肌瘤病吗?(a)Yes(b)No

710NoCorrect.Theirregularshapeofthecystandtheirupperlobepredominancewouldbeunusual上叶优势、不规则形态是不寻常的.Also,andmoreimportant,LAM,forpracticalpurposes,occursonlyinwomen淋巴管肌瘤病仅见妇女.

711Diagnosis:Langerhanshistiocytosis肺组织细胞增生症,presentingwithlungcysts肺囊状气腔

712Case98ina45-year-oldmanwithahistoryofcigarettesmoking吸烟史,chroniccough慢性咳嗽,andrecenthemoptysis近来咳血

713HRCTshowsnumerous许多的,thickandthin-walledlungcysts(Figure2)appearinginclusters厚、薄壁气腔成丛,withinterveninglungappearingnormal之间可见正常肺组织.Notethatthelungbasesarespared肺底是少量的(Figure3).Ascanthroughtherightupperlobeshowsground-glassopacity(Figure1)inassociationwithsomeinterlobularseptalthicknening右上叶磨玻璃密度伴一些间隔增厚.

714成丛的囊气腔

715肺底是少量的

716右上叶磨玻璃密度伴少量间隔增厚

717Couldthisbe能是:(a)LAM淋巴管肌瘤病(b)pneumocystispneumoniawithpneumatocelesPCP伴肺气囊(c)histiocystosiswithpulmonaryhemorrhage组织细胞增生症伴肺出血

718histiocystosiswithpulmonaryhemorrhageThisisthebestdiagnosis最好的诊断.Thepatientisasmoker患者吸烟,thecystsareupperlobeindistribution囊状气腔上叶分布,andtheground-glassopacitycouldrepresenthemorrhage磨玻璃密度表现肺出血,leadingtohishemoptysis历史：咳血.

719Case99ina27-year-oldmanwithAIDS,alowCD4count,markeddyspnea,andfever明显的呼吸困难

720HRCTshowspatchygroundglassopacityintheupperlobes上叶补丁状磨玻璃密度,morepronouncedontheleftthantheright左为主.Theground-glassopacityisaccompaniedbymildinterstitialthickening伴轻度的间质增厚,manifestedasafaintlynodularappearanceandseptalthickening表现轻微的结节样改变.Twothin-walledlungcystsarevisible薄壁肺囊肿可见.

721Whatisthemostlikelydiagnosis最可能的诊断?(a)PneumocystiscariniipneumoniawithpneumatocelesPCP伴肺气囊(b)LAM淋巴管肌瘤病(c)Histiocytosis组织细胞增多症(d)Emphysema肺气肿

722PneumocystiscariniipneumoniawithpneumatocelesPCP伴囊状气腔Correct.Thepresenceofground-glassopacityinanAIDSpatientswithalowCD4countishighlypredictiveofpneumocystispneumonia.

723DISCUSSIONIthasbeenestimatedthat10-35%ofpatientswithPCPdemonstrateeitherair-filledcystsorpneumatoceles,typicallyinvolvingtheupperlobes上叶气囊.Also,upto35%ofpatientswithcystsdevelopapneumothorax可发展成气胸.

724Case100ina35-year-oldmanwithAIDS,alowCD4count,andahistoryofpreviouspneumocystispneumonia以往有PCP历史

725HRCTshowsnumerousthinwalledcystsinbothlungs双肺多的薄壁囊状气腔,andarightsidedpneumothorax右侧气胸.Notethatonecystprojectsfromthepleuralsurface以囊状气腔突出胸膜表面.Theruptureofsuchacystisthelikelycauseofthepneumothorax破裂很可能导致气胸.Somefocalandpatchyareasofground-glassopacityarealsopresent磨玻璃密度影可见;thiscouldreflectongoingpneumocystisinfectionortheresultofpriorinfections.

726胸膜表面的囊状气腔

727Diagnosis:Pneumocystiscariniipneumonia(previous)PCPwithpneumatocelesandpneumothorax伴囊状气腔、气胸.

728Case101ina22-year-oldwomanwithaknownhistoryoflaryngealpapillomas喉乳突淋瘤forwhichshehashadmultiplelaryngoscopicresections多次喉镜切除术

729

730HRCTshowsnumerousthin-walledcysts(Figure2)inbothlungs双侧薄壁气囊.Somearequiteirregularinshapeorappearfused一些不规则.Inseverallocations,smallnodulesarevisible,asisolatedabnormalitiesorinrelationtoorwithinthecysts囊内小结节影.

731囊内小结节影

732Diagnosis:Bronchopulmonarypapillomatosiswithlungcysts支气管肺的多发乳头状瘤伴肺囊状气腔。

733Case102ina81-year-oldmanwithasmokinghistory吸烟史,aclinicaldiagnosisof临床诊断COPD,andincreasingshortnessofbreath气短

734

735HRCTshowsnumerousareasoflucency,ascomparedtothebackgroundofnormallung以正常肺为背景多发透亮区.Thelucenciesdonothavevisiblewalls无可见的壁.Theyappeartobeevenlyspacedthroughoutthelung均匀隔开,whenviewedincrosssection.Someofthelucenciescanbeseentobecentrilobularorsurroundthecentrilobularartery小叶中心或包绕中心动脉.以上叶为优势

736多发透亮区

737小叶中心型

738Whatisthemostlikelydiagnosis最可能的诊断?(a)Pneumoniawithpneumatoceles肺炎肺气囊(b)LAM淋巴管肌瘤病(c)Histiocytosis组织细胞增多症(d)Emphysema肺气肿

739EmphysemaCorrect.Thisappearanceisdiagnosticofcentrilobularemphysema小叶中心型肺气肿.Centrilobularemphysemaresultsinfocallucencieswithoutwalls无壁透亮区,hasaspottyorcentrilobulardistributionincrosssection,andanupperlobepredominance上叶优势.

740Case103ina46-year-oldmalenonsmoker不吸烟withaleftlungtransplantforemphysema左肺移植

741Inthispatient,thenormaltransplantedleftlungtobecomparedtotheabnormalrightlung左移植肺正常表现、右侧异常(Figure3).Notethattherightlungismorelucent,larger,andcontainsmuchsmallervesselsthanthenormalleftlung有肺透亮度增加、肺纹纤细.Theabnormalityisdiffuse,andtheupperandlowerlobesareinvolvedtothesamedegree弥漫、右侧上下叶

742Whatisthemostlikelydiagnosis最可能的诊断?(a)Centrilobularemphysema小叶中心型肺气肿(b)Panlobularemphysema全小叶型肺气肿(c)Bullousemphysema大泡型肺气肿

743PanlobularemphysemaCorrect.Thesefindingsaretypicalofpanlobularemphysema典型的全小叶肺气肿.Thelungisdiffuselyabnormal,beingtoolucentandcontainstofewvessels弥漫、透亮区增加、肺纹理稀少.Focallucencies,aswouldbeseenwithcentrilobularorbullousemphysema,arenotvisible.

744Case104ina58-year-oldmanwithasmokinghistoryandshortnessofbreath吸烟气短

745HRCTshowsspottyareasoflucencywithoutvisiblewallstypicalofcentrilobularemphysema多小叶中心型肺气肿.Inaddition另外,arowofdiscretesubpleurallucencies胸膜下部连续,1-2cminsize大小,appeartobemarginatedbyinterlobularsepta可见小叶间隔.Theserepresentparaseptalemphysema间隔旁型.

746小叶中心型肺气肿

747胸膜下透亮区

748Diagnosis:Paraseptalemphysemaassociatedwithcentrilobularemphysema间隔旁型肺气肿伴小叶中心型肺气肿.

749Case105ina34-year-oldmanwithasmokinghistoryandmarked显著吸烟史,progressive,shortnessofbreath气短

750HRCTshowsnumerouslargeandsmallareasoflucency许多大的、小的透亮区(Figure1),ascomparedtothebackgrounddensityofnormallung周围可见正常肺.Notethatsomespottylucencieswithoutvisiblewalls无壁透亮区canbeseen.Thesearetypicalofcentrilobularemphysema为小叶中心型肺气肿.Inaddition另外,arowofdiscretesubpleurallucencies,1-2cminsize,appeartobemarginatedbyinterlobularsepta胸膜下间隔旁型肺气肿.Theserepresentparaseptalemphysema.Insomeregions,areasofparaseptalemphysemaareassociatedwithairtrapping,andhavemarkedlyincreasedinsize.Thesecysticregionsofemphysema,oftenmarginatedbyathinwall,aretermedbullae薄壁的肺大泡.

751小叶中心型肺气肿

752间隔旁型肺气肿

753肺大泡

754Diagnosis:Bullousemphysema大泡型肺气肿.

755Case114ina19-year-oldmanwithchronicpurulentsputum慢性脓痰productionandshortnessofbreath气短

756Findingsofbronchiectasisinthispatientinclude支扩在这些病例中包括:thesignetringsign印戒征bronchialwallthickening支气管壁增厚tramtracks双轨征bronchivisibleinthelungperiphery外围支气管显著mucousorpus-fillingbronchi粘液栓volumeloss体积减低

757印戒征

758支气管壁厚

759双轨征

760胸膜下明显

761粘液栓

762体积减低

763Themostlikelydiagnosisis最可能的诊断:(a)cysticfibrosis囊肿性肺纤维化(b)priorinfection先前的感染(c)asthma哮喘

764cysticfibrosis囊肿性肺纤维化Correct.Becauseofthepatientsyoungage患者年轻,symptoms,andtheseverityanddiffusenatureoftheabnormalities,cysticfibrosisismostlikely弥漫、严重囊肿性肺纤维化很可能.Anotherfindingsuggestiveofthisdiseaseisanincreaseinlungvolumes下肺体积增大(Figure4).Noticethatsomeofthebronchiappearquiteirregularincontour支气管轮廓十分不规则.Thisisappearanceistermedvaricosebronchiectasis曲张性支气管扩张.

765曲张性支气管扩张

766Diagnosis:Cysticfibrosiswithvaricosebronchiectasis囊肿性肺纤维化伴曲张性肺纤维化.

767Case115ina45-year-oldwomanwithrespiratorydifficultiessincechildhood孩童时期呼吸困难,whohadprogressiverespiratoryinsufficiencyleadingtoleftlungtransplantation左肺移植

768Whatistheprimaryabnormalityinthispatient主要的异常?(a)emphysema肺气肿(b)lungcysts肺囊肿(c)bronchiectasis支扩

769bronchiectasis支扩Correct.Althoughthisappearancemimicsbothcysticlungdiseaseandbullousemphysema,thepresenceofthe“signet-ringsign”indicatesthatbronchiectasisispresent尽管似肺大泡、囊肿，但有印戒征.Thecysticappearanceofthedilatedbronchiistypicalofcysticbronchiectasis典型的囊状支扩.Notetheabnormalbronchiappearcentralinlocation在中心区域.Lungappearslucentbecauseofairtrapping.Theleftlung,resectedatsurgery,showedadeficiencyofbronchialcartillageinvolvingmediumsizedbronchiresultinginbronchiectasis.

770印戒征

771Diagnosis:Williams-Campbellsyndrome综合症withcysticbronchiectasis伴囊状支扩.

772Case116ina48-year-oldwomanwithsymptomsofasthmaandbronchialwallthickeningseenonchestradiographs哮喘支气管壁增厚

773HRCTshowsseveralareasofbronchiectasisinvolvingthemidlungregions支扩.Thebronchiappearthickwalled,irregular,andfailtoshownormaltapering.Whatisthemostlikelydiagnosisinthispatient最可能的诊断?(a)uncomplicatedasthma简单的哮喘(b)cysticfibrosis囊肿性纤维化(c)allergicbronchopulmonaryaspergillosis过敏性支气管肺曲霉病

774allergicbronchopulmonaryaspergillosis支气管肺曲霉病Correct.Inapatientwithsymptomsofasthma哮喘,thepresenceofbronchiectasis支扩,particularlyinvolvingcentralbronchi中央支气管,istypicalofallergicbronchopulmonaryaspergillosis典型的过敏性肺曲霉病.

775Case117ina63-year-oldmanwithchroniccoughandsputumproduction慢性咳嗽咳痰

776Whatdiagnosiswouldyouconsider最可能的诊断?(a)post-infectiousbronchiectasis感染性支扩(b)chronicimmunedeficiency慢性免疫缺陷(c)immotileciliasyndrome不能游动的纤毛综合症(d)infectionwithmycobacteriumaviumcomplex(MAC)分支杆菌感染

777Infact事实上,anyofthesediagnosesispossible好多诊断可能.HRCTshowsmultifocalbronchiectasis支扩associatedwiththefindingof“tree-in-bud”树丫征atthelungbases."Tree-in-bud"isindicativeofchronicairwayinfectionwithimpactionofbronchioles,andwouldbeexpectedinanyofthese.Inthisman,therewasnoevidenceofimmunedeficiencyorimmotileciliasyndrome,andcultureyieldedbacteriaratherthanMAC.

778支扩

779树丫征

780Diagnosis:Bronchiectasis支扩(postinfectious感染后)associatedwithchronicbacterialinfection慢性细菌感染andtree-in-bud树丫征.

781Case11835-year-oldcollegestudent大学生withdrycough干咳,mildshortnessofbreath轻度气短andanabnormalchestradiograph

782Whatisthemostlikelydiagnosis最可能的诊断?(a)cysticdisease(e.g.histiocytosis)组织细胞增多症(b)bronchiectasis支扩(c)bullousemphysema大泡型肺气肿(d)honeycombcysts蜂窝肺

783Bronchiectasis支扩Correct.Thisisadifficultdiagnosis诊断是困难的.Theaircontainingcysticstructuresappeartoothickwalled囊状壁厚andnumeroustorepresentbullae,andthereisnootherevidenceofemphysema无其他显著的肺气肿.Theupperlobedistributionwouldbeveryunusualforhoneycombing上叶分布.Thisappearanceisconsistentwithhistiocytosis与组织细胞增多症相似,butthepresenceofbranchingtubularstructures管状结构分支ismostinkeepingwithbronchiectasis支持支扩.Bronchiectasisismoreeasilydiagnosedatotherlevels.

784管状分支

785支扩

786Whatisthemostlikelycauseofthebronchiectasis引起支扩的最可能的原因(a)post-infectiousbronchiectasis感染后支扩(b)allergicbronchopulmonaryaspergillosis过敏性支气管肺霉菌病(c)cysticfibrosis囊肿性肺纤维化(d)end-stagesarcoidosis末期结节病

787end-stagesarcoidosis末期结节病Correct.Thesefindingsaretypicalofend-stagesarcoidosis典型的末期结节病,withcysticbronchiectasisrelatedtofibrosis纤维化造成支扩.Tractionbronchiectasisandcysts牵拉支扩常见arecommon,andanupperlobeandposteriordistributionistypical上叶后分布.Alsonotenotethickeningandnodularityofthemajorfissures叶裂结节状,acommonfindinginsarcoidosis结节病常见征象。

788叶裂结节状

789Diagnosis:End-stagesarcoidosis末期结节病withcysticbronchiectasis囊状支扩

790Case119ina21-year-oldmanwithchronicpurulentsputum慢性脓痰productionandshortnessofbreath气短

791

792Themostlikelydiagnosisis最可能的诊断:(a)cysticfibrosis囊肿性纤维化(b)priorinfection感染(c)allergicbronchopulmonaryaspergillosis过敏性支气管肺曲霉病

793cysticfibrosis囊肿性肺纤维化Correct.Becauseofthepatient‘syoungage年轻,symptoms,andtheseverityanddiffusenatureoftheabnormalities弥漫,cysticfibrosisismostlikely.

794Diagnosis:Cysticfibrosiswithbronchiectasis囊肿性肺纤维化伴支扩

795肺膨胀不全

796Branchingornodularcentrilobularopacities小叶中心结节,

797空气潴留;马赛克灌注

798胸膜下囊状肺损害

799Case120ina22-year-oldmanwithaknownhistoryofcysticfibrosis囊肿纤维化历史

800

801马赛克灌注，高密度区，肺血管增粗

802Diagnosis:Cysticfibrosis囊肿性肺纤维化withbronchiectasis支扩andmosiacperfusion马赛克灌注。

803Case121ina46-year-oldwomanwithprogressiveshortnessofbreathfollowingabonemarrowtransplant骨髓移植气短

804Themostlikelydiagnosisis最可能的诊断:(a)ground-glassopacityduetopneumocystispneumonia磨玻璃密度由于PCP(b)mosaicperfusionduetobronchiolitisobliterans马赛克灌注由于细支气管炎阻塞

805mosaicperfusionduetobronchiolitisobliteransCorrect.Thisappearanceistypicalofbronchiolitisobliteransoccurringasacomplicationofbonemarrowtransplantation典型的小气道阻塞.Notethatthereisbronchiectasis支扩present,acommonfindinginthisdisease.Thisfindingssuggeststhatmosaicperfusionispresent,duetoairwayobstruction.Alsonotethatvesselsappearlargerinthedenselungregions.高密度区肺血管增粗

806支扩

807马赛克灌注；高密度区肺血管增粗

808Diagnosis:Bronchiolitisobliteranswithmosiacperfusion闭塞性细支气管炎伴马赛克灌注。

809Case122ina48-year-oldwomanwithprogressiveshortnessofbreathfollowingbilaterallungtransplantation双肺移植后气短

810Themostlikelydiagnosisis最可能的诊断:(a)ground-glassopacityduetopneumocystispneumonia磨玻璃密度由于PCP(b)mosaicperfusionduetobronchiolitisobliterans马赛克灌注由于闭塞性细支气管炎

811mosaicperfusionduetobronchiolitisobliteransCorrect.Thisappearanceistypicalofbronchiolitisobliteransoccurringasacomplicationoflungtransplantation.Thelungsareinhomogeneousinattenuation.Alsonotethatvesselsappearlargerinthedenselungregions.高密度区肺血管增粗

812马赛克灌注

813呼气相能被证实

814Case123a15-year-oldboywithhemoptysis咳血吸气与呼气相

815Themostlikelydiagnosisis最可能的诊断:(a)ground-glassopacity磨玻璃密度(b)mosaicperfusion马赛克灌注

816ground-glassopacityCorrect.Notethatboththedenseandlessdenseregionsincreaseinattenuationontheexpiratoryview肺血管大小正常.Thisistypicalofground-glassopacity.Thereisnoevidenceofairtrapping无空气潴留

817Case124ina45-year-oldwomanwithprogressiveshortnessofbreathfollowinganupperrespiratoryinfection上叶呼吸感染气短.吸气、呼气相

818Althoughtheinspiratoryscanisnormal尽管吸气像是正常的,thepost-expiratoryscanshowssignificantpatchyairtrapping呼气相违补丁状空气潴留.Thedifferentialdiagnosisofthiscombinationincludesbronchiolitisobliterans闭塞性细支气管炎,asthma哮喘,andhypersensitivitypneumonitis过敏性肺炎asthemostcommoncauses.Thesediseasescanproducesmallairwayobstructionastheonlyrecognizableabnormality小气道阻塞.

819Diagnosis:Bronchiolitisobliterans(post-infectious)withairtrapping闭塞性细支气管炎伴空气潴留。

820Case125ina53-year-oldwomanwithcoughandasthma咳嗽哮喘.吸气；呼气相

821Althoughtheinspiratoryscanisnormal吸气扫描正常,thepost-expiratoryscanshowssignificantpatchyairtrapping呼气相空气潴留.Thedifferentialdiagnosis鉴别诊断ofthiscombinationincludes包括bronchiolitisobliterans阻塞性细支气管炎,asthma哮喘,andhypersensitivitypneumonitis过密性肺炎asthemostcommoncauses.Thesediseasescanproducesmallairwayobstructionastheonlyrecognizableabnormality.

822Diagnosis:Asthmawithairtrapping哮喘伴空气潴留

823Case12647-year-oldwomanwithanaviaryinherhouse养鸟,progressiveshortnessofbreath气短,low-gradefever低热,andnonproductivecough.吸气、呼气相

824空气潴留、马赛克灌注

825空气潴留

826Diagnosis:Hypersensitivitypneumonitispresentingwithground-glassopacityandairtrapping.过敏性肺炎伴磨玻璃密度、空气潴留

827Case12740-year-oldwomanwithexposuretobirds养鸟,progressiveshortnessofbreath气短咳嗽,andnonproductivecough.吸气、呼气相呼气相

828Diagnosis:Hypersensitivitypneumonitis过敏性肺炎,presentingwithcentrilobularnodules小叶中心结节andairtrapping空气潴留.

829谢谢！！！