暈征與反暈征(培訓(xùn)內(nèi)容)課件

暈征與反暈征

halosign

andreversedhalosign1優(yōu)選課件

結(jié)節(jié)與腫塊CT表現(xiàn)：致密影

直徑＜5mm稱微結(jié)節(jié)

（2～3mm粟粒結(jié)節(jié)）

直徑5～10mm稱小結(jié)節(jié)

≥10mm者統(tǒng)稱結(jié)節(jié)

一般將小于等3cm者稱為結(jié)節(jié)，大于3cm者稱為腫塊。基本概念2優(yōu)選課件是指肺部CT或薄層CT上，肺密度輕度增加，支氣管和血管輪廓可見，形似磨玻璃，稱磨玻璃密度影。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3優(yōu)選課件暈征CT表現(xiàn)——在CT上肺內(nèi)結(jié)節(jié)或腫塊周圍的暈狀磨玻璃密度影，低于中央結(jié)節(jié)，但高于正常肺組織，形似日暈。4優(yōu)選課件分類一、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）5優(yōu)選課件暈征病因ArchBronconeumol.2008;44(7):386-926優(yōu)選課件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7優(yōu)選課件一暈征-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).8優(yōu)選課件中國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9優(yōu)選課件免疫功能不全常見單純皰疹病毒、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10優(yōu)選課件slow-resolvingbacterialpneumonia(吸收延遲性肺炎)放線菌結(jié)核分枝桿菌一暈征-感染性疾病-細(xì)菌11優(yōu)選課件1.64歲男，退休，咳嗽、間斷咯血2月來診。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12優(yōu)選課件立克次體寄生蟲一暈征-感染性疾病-其他13優(yōu)選課件腎上腺嗜鉻細(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)14優(yōu)選課件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)15優(yōu)選課件細(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)16優(yōu)選課件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)17優(yōu)選課件Pulmonarylymphomaina73-year-oldpatientwhovisitedtheemergencyservicewithdyspnea.A:Anaxialscanofthelowerpulmonarylobesshowsmultiplepulmonarynoduleswithahalosignandatendencytocoalesceintheposteriorsegments.Thereisalsobilateralpleuraleffusion,somewhatgreaterontherightside.Thepatientdied3weeksafteradmission.B:Lowmagnificationimageofpulmonarynoduleshowingmainlyperibronchovasculartumorcellinfiltrationandmarkednecrosis(hematoxylin-eosin,magnification×4).C:Ahigher-magnificationimageoftheperipheryofthenoduleshowstheinfiltrationoftumorcellsalongthealveolarwalls(arrows)(hematoxylineosin,magnification×10).18優(yōu)選課件出血性結(jié)節(jié)非出血性結(jié)節(jié)三暈征-非感染性疾病19優(yōu)選課件三暈征-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20優(yōu)選課件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)21優(yōu)選課件結(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?nèi)龝炚?非感染性疾病非出血性結(jié)節(jié)22優(yōu)選課件反暈征是CT肺窗，中心為磨玻璃樣密度影，周圍是高密度新月形或環(huán)形條帶，與暈征的周圍稍低密密度磨玻璃影相反，稱反暈征。Voloudakietal1996cop23優(yōu)選課件反暈征病因24優(yōu)選課件一反暈征-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25優(yōu)選課件Invasivepulmonaryaspergillosisina54-year-oldfemalewithmultiplemyelomaandsecondaryplasmacellleukaemiawhohadundergonechemotherapy.(a)High-resolutionCTimageatthelungbaseshowsarightlower-lobepulmonarynodule(arrow)andthereversedhalosign(RHS)intheleftlowerlobe(curvedarrow)withadjacentground-glassopacities.(b)CTimagewithmediastinalwindowsettingsshowstheperipheralconsolidationoftheRHS(asterisks).Noteasmallrightpleuraleffusion.26優(yōu)選課件Pulmonaryzygomycosisina22-year-oldmalewithprecursorB-cellacutelymphocyticleukaemia.(a)CTimageshowsthereversedhalosign(RHS)intheleftupperlobe(arrows).(b)CTscanperformed2monthslatershowsintervaldevelopmentofcavitation(aircrescentsign).ThepresenceofRHSinanimmunosuppressedpatientishighlysuggestiveofpulmonaryzygomycosis,especiallyifthepatientisreceivingprophylaxisforaspergillosis.27優(yōu)選課件Paracoccidioidomycosisina49-year-oldmale,residentofaruralareainBrazil.CTimageshowsreversedhalosign(RHS)lesions(arrows)andbilateralsmallpoorlymarginatedpulmonarynodules.ThepresenceofRHSinapatientfromanendemicregionforfungalinfectionshouldraiseconcernforthatspecificfungalinfection.28優(yōu)選課件一反暈征-感染性疾病-結(jié)核Tuberculosisina59-year-oldfemale.High-resolutionCTimageshowsbilateralsmallcentrilobularnodules,tree-in-budopacitiesandareasofreversedhalosign(RHS).NotethenodularappearanceoftheringofconsolidationoftheRHSlesions(arrows),whichmaybehelpfulinthedifferentiationbetweenactivegranulomatousdiseaseandcryptogenicorganisingpneumonia.Thepresenceofassociatedcentrilobularnodulesandtree-in-budopacitiesshouldraisesuspicionoftuberculosis.29優(yōu)選課件二反暈征-機(jī)化性肺炎（19%）Organisingpneumoniaina53-year-oldmalewithgraft-vs-hostdiseaseafterstemcelltransplantionfortreatmentofacutemyelogenousleukaemia.CTscanshowsbilateralperipheralandperibronchovascularconsolidativeopacitieswiththereversedhalosign(arrows).Open-lungbiopsyshowedorganisingpneumonia.Thepatientwastreatedwithsteroidswithresolutionofthelesions.30優(yōu)選課件二反暈征-機(jī)化性肺炎47-yr-oldfemalewasreferredtoatertiarycentre(StMichael’sHospital,Toronto,Canada)forfurtherevaluationofchroniccough,fever,progressiveexertionaldyspnoeaandfatigue.Coronalchestcomputedtomographyscanshowingmultipleareasofcentralground-glassopacity,surroundedbyringorcrescentic-shape,denseairspaceconsolidation,mainlyintheleftlowerlobeandtherightupperlobe.Transbronchialbiopsyshowingorganisingpneumonia31優(yōu)選課件三反暈征-非特異性間質(zhì)性肺炎TheBritishJournalofRadiology,May2011A52-year-oldfemalepresentedwithacoughandNewYorkHeartAssociation(NYHA)class2dyspnoeaof4monthsduration，CTimagesshowacentralground-glassopacitysurroundedbycrescentorring-shapedareasofconsolidation,showingthe‘‘reversedhalosign’’.(e)6daysand(f)6monthsofsteroidtherapy,bothshowedimprovement.32優(yōu)選課件四反暈征-結(jié)節(jié)病Sarcoidosisina44-year-oldfemale.High-resolutionCTimageshowsbilateralnodularopacitieswiththereversedhalosign(RHS)(arrows)andsmallpulmonarynoduleswithpredominantperilymphaticdistribution.ThepresenceoftheRHSassociatedwithnodulesinperilymphaticdistributionandmediastinalandhilarlymphadenopathy(notshown)shouldraisesuspicionofsarcoidosis.33優(yōu)選課件五反暈征-肺栓塞Acutepulmonaryembolismwithpulmonaryinfarctionina64-year-oldfemale.(a)CTimageshowsthereversedhalosigninthesuperiorsegmentoftherightlowerlobe.(b)CTimage(mediastinalwindowsettings)showsaclotinthedistalrightmainpulmonaryarteryextendingtothesuperiorsegmentalbranchoftherightlowerlobepulmonaryartery.(c)2monthfollow-upCTscanshowscavitationoftheinfarctedpulmonaryparenchyma.34優(yōu)選課件Multifocalpulmonaryadenocarcinomaina70-year-oldfemale.CTimageshowsbilateralulmonarynoduleswiththereversedhalosign(blackarrows)andground-glasspulmonarynodules(whitearrows).六反暈征-腫瘤35優(yōu)選課件Metastaticrenalcellcarcinomaina73-year-oldmale.TheCTscanshowsmultiplebilaterallesionswithreversedhalosign(RHS),biopsyproventorepresentmetastaticrenalcellcarcinomainabackgroundoffibrosisandnecrosis.Inpatientswithaknownprimarymalignancy,RHSlesionsmayrepresentatypicalpresentationofmetastaticdisease.Themaindifferentialdiagnosisisorganisingpneumonia,whichcanberelatedtodrugtoxicityifthepatientisreceivingchemotherapy.六反暈征-腫瘤36優(yōu)選課件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37優(yōu)選課件放療相關(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38優(yōu)選課件八反暈征-放療后改變Reversedhalosign(RHS)followingprotonradiationtherapyforapoorlydifferentiatedsquamous（鱗癌）cellcarcinomaina71-yearoldmale.(a)CTimageshowstheprimary