肺部感染-影像學(xué)和病理-課件

肺部感染-

影像學(xué)和病理第1頁，共51頁。Outline流行病學(xué)影像學(xué)病理學(xué)第2頁，共51頁。細(xì)菌性-大葉性肺炎病原菌：Streptococcuspneumoniae，CAP(35%),

Klebsiellapneumoniae

Legionellapneumophila病理生理：如以下圖第3頁，共51頁。第4頁，共51頁。early(A)andadvanced(B)stagesoflobarpneumoniacausedbyStreptococcuspneumoniae.In(A),theairspacesarefilledwithedemafluid;onlyoccasionalneutrophilsareevident.In(B),neutrophilspredominate.第5頁，共51頁。細(xì)菌性-小葉性肺炎病原菌：Staphylococcusaureus

Escherichiacoli

Pseudomonasaeruginosa

Anaerobes

Haemophilusinfluenzae

第6頁，共51頁。第7頁，共51頁。第8頁，共51頁。Chestradiographshowsareasofconsolidationintherightupperandleftlowerlobes.Thepatientwasa23-year-oldmanWithbronchopneumonia

第9頁，共51頁。High-resolutioncomputedtomography(CT)scanshowscentrilobularnodules(arrows)andlobularareasofconsolidation(arrowhead)andground-glassopacity(curvedarrow).Thepatientwasa53-year-oldmanwithbronchopneumonia.第10頁，共51頁。并發(fā)癥-肺膿腫病原菌：anaerobicbacteria，S.aureus,P.aeruginosa,andK.pneumoniaeInflammatorymasswithcentralpurulentnecrosis

Frequentlycavitate

Smoothorshaggyinnermargins

Air-liquidlevelscommon

Maximalwallthicknessusually<15

Low-attenuationcentralregionandrimenhancementonCTscan第11頁，共51頁。第12頁，共51頁。并發(fā)癥-壞死性肺炎Bulgingfissuresign.Posteroanteriorchestradiographshowsdenserightupperlobeairspaceconsolidationwithdownwardbulgingoftheminorfissure.Thepatientwasa66-year-oldmanwithpneumococcalpneumonia.第13頁，共51頁。Necrotizingpneumonia.Chestradiograph(A)showsinhomogeneousanddenseconsolidationintherightlung.Computedtomography(CT)(B)imageshowsalargecavityandsloughedlungwithinthecavity(arrow).Thepatientwasa42-year-oldalcoholicmanwithnecrotizingpneumoniasecondarytoKlebsiellapneumoniaeandanaerobicorganisms.第14頁，共51頁。并發(fā)癥-氣瘤病原菌：金葡菌〔兒童〕，PCP〔免疫抑制的成人〕特點(diǎn)：薄壁含氣空洞，數(shù)天或周內(nèi)擴(kuò)大，可導(dǎo)致氣胸，數(shù)周或數(shù)月吸收第15頁，共51頁。肺膿栓來源：心內(nèi)膜炎，血栓性靜脈炎，靜脈置管，起搏器導(dǎo)線。影像學(xué)特點(diǎn)：空洞小結(jié)節(jié)，F(xiàn)eedingvesselsign第16頁，共51頁。image(A)showstwovesselsapparentlycoursingintoanodule(feedingvesselsign〕image(B)demonstratesthattheonlyvesselinclosecontactwiththenoduleisadrainingvein(arrow).第17頁，共51頁。肺炎鏈球菌肺炎CAP的主要致病菌〔40%〕危險(xiǎn)因素：高齡，慢性心肺疾病主要影像學(xué)表現(xiàn)：均一實(shí)變，毗鄰臟層胸膜次要表現(xiàn)：小葉性肺炎〔20-35%〕，球形實(shí)變〔圓肺炎〕，葉間裂膨出高密度實(shí)變其他：胸腔積液〔10%〕，同側(cè)淋巴節(jié)腫大〔CT上50%〕。CT價值：明確有無空洞或積膿第18頁，共51頁。

第19頁，共51頁。Lobarpneumoniaduetostreptococcuspneumonia第20頁，共51頁。RoundpneumoniaduetoStreptococcuspneumoniae第21頁，共51頁。BronchiolitisandbronchopneumoniaduetoStreptococcuspneumoniae第22頁，共51頁。ExtensivebilateralpneumoniaduetoStreptococcuspneumoniae第23頁，共51頁。葡萄球菌肺炎第24頁，共51頁。肺膿腫第25頁，共51頁。Coccalcoloniesaredenselysurroundedbyneutrophils(HE).StrongbasophiliaofthebacteriainH&EpreparationindicatesGrampositivity第26頁，共51頁。IncidentalterminalaspirationofMRSAcoloniesintothelung,leadingtoaculture-positiveresult(HE).MorphologicstudycaneasilydistinguishMRSA-inducedinfectionfromthecarrierstateofMRSAwithoutprovokingclinicalmanifestation.第27頁，共51頁。第28頁，共51頁。S.aureusbronchopneumonia,ischaracterizedhistologicallybypredominantlyperibronchiolarinflammation第29頁，共51頁。BronchopneumoniaduetoStaphylococcusaureus.Chestradiographshowsbilateralpoorlydefinednodularopacitiesandpatchyareasofconsolidation.Alsonotedisacentralvenousline.Thepatientwasa70-year-oldmanwithMRSApneumonia.第30頁，共51頁。EmpyemaduetoStaphylococcusaureus.Thepatientwasa44-year-oldmanandanintravenousdruguser.Hehadnoradiologicevidenceofsepticembolism.第31頁，共51頁。SepticembolismduetoStaphylococcusaureus.Thepatientwasa43-year-oldmanwithpositivebloodculturesforStaphylococcusaureus.第32頁，共51頁?？死装追窝證AP占1%-5%，HAP占15%危險(xiǎn)因素：嗜酒，慢性支氣管肺病，ICU病人常見影像學(xué)表現(xiàn)：CAP:均一大葉實(shí)變(右肺上葉多見〕HAP:多中心單側(cè)〔60%〕，雙側(cè)〔40%〕實(shí)變〔小葉性肺炎〕其他常見發(fā)現(xiàn)葉間裂膨出〔30%〕，胸腔積液〔60-70%〕，肺膿腫，膿胸CT價值：明確空腔或膿腫第33頁，共51頁。AutopsiedlungwithseverepneumoniainapatientwithdegenerativeneuronalDisorder。Numerouslargeandlongpathogensaredispersedwithintheedematousalveolarspace.Thepathogensarenotphagocytizedbyneutrophils(HE,lowpower).第34頁，共51頁。LobarpneumoniaduetoKlebsiellapneumoniae.Thepatientwasa73-year-oldwomanwithK.pneumoniaepneumonia.第35頁，共51頁。Klebsiellapneumoniaepneumoniaandabscessformation。Thepatientwasa53-year-oldman.C,D(3dayslater)第36頁，共51頁。大腸埃希氏菌肺炎CAP(4%),HAP的5-20%危險(xiǎn)因素：操勞過度病人常見影像學(xué)表現(xiàn)：多中心單側(cè)或雙側(cè)實(shí)變〔支氣管肺炎〕，下葉為主其他表現(xiàn)：胸腔積液第37頁，共51頁。

BronchopneumoniaduetoEscherichiacoli.Chestradiographshowspoorlydefinednodularopacities(arrows)intherightupperlobeandsmallbilateralfociofconsolidation.第38頁，共51頁。銅綠假單胞菌肺炎HAP占20%危險(xiǎn)因素：COPD,機(jī)械通氣，抗生素運(yùn)用，囊型纖維化定植菌常見影像學(xué)表現(xiàn)：小葉性肺炎，所有肺葉受累，CT提示小葉中心結(jié)節(jié)和tree-in-bud其他常見表現(xiàn)：肺膿腫〔20%〕，胸腔積液〔60%〕第39頁，共51頁。左上，右上:Perivascularcuffing征，左下：美蘭細(xì)菌染色。右下：痰圖片染色〔膠質(zhì)鐵染色〕第40頁，共51頁。痰染色左：膠質(zhì)鐵染色右：革蘭染色第41頁，共51頁。SeverepneumoniaduetoPseudomonas.第42頁，共51頁。流感嗜血桿菌肺炎5-20%的CAP病原菌危險(xiǎn)因素：COPD,嗜酒，高齡常見影像學(xué)表現(xiàn)：小葉性肺炎〔50-60%〕大葉性肺炎〔30-40%〕非常見表現(xiàn)：CT示小結(jié)節(jié)和樹芽征，圓肺炎，空洞〔不超過15%〕，胸腔積液〔50%〕第43頁，共51頁。圖左：NeonatalpneumoniacausedbyHaemophilusinfluenzaeinfection圖右：陽性痰涂片第44頁，共51頁。BronchiolitisandbronchopneumoniaduetoHaemophilusinfluenza.Thepatientwasa50-year-oldmanwithH.influenzapneumonia.第45頁，共51頁。常見影像學(xué)表現(xiàn)：小葉性肺炎〔50-60%〕大葉性肺炎〔30-40%〕Thepatientwasa42-year-oldalcoholicmanwithnecrotizingpneumoniasecondarytoKlebsiellapneumoniaeandanaerobicorganisms.Mass-likeconsolidationduetoLegionellamicdadeiContrast-enhancedWithbronchopneumonia來源：心內(nèi)膜炎，血栓性靜脈炎，靜脈置管，起搏器導(dǎo)線。aureus,P.early(A)andadvanced(B)stagesoflobarpneumoniacausedbyStreptococcuspneumoniae.危險(xiǎn)因素：操勞過度病人影像學(xué)特點(diǎn)：空洞小結(jié)節(jié)，F(xiàn)eedingvesselsign常見影像學(xué)表現(xiàn)：小葉性肺炎〔50-60%〕大葉性肺炎〔30-40%〕CAP:均一大葉實(shí)變(右肺上葉多見〕ThepatientCAP的主要致病菌〔40%〕軍團(tuán)菌肺炎2-5%CAP危險(xiǎn)因素：高齡，男性，腫瘤或器官移植主要影像學(xué)表現(xiàn)：大葉性肺炎，進(jìn)展至多葉受累少見表現(xiàn)：球形實(shí)變〔圓肺炎〕，單個或多個結(jié)節(jié)或者腫塊樣實(shí)變并發(fā)癥：空洞〔免疫抑制病人〕，肺門淋巴結(jié)腫大(免疫抑制病人〕，胸腔積液〔35-60%〕第46頁，共51