七年制chest -呼吸常见病

Imagingdiagnosisofrespirotarydiseasepart1AiPingChenClinicalsymptom:cough,Purulentfoul-smellingsputum,emptysis,orhaemoptysis.儿童，青年多见，多见于左下叶、右中叶及右下叶。咳嗽、咳痰、咯血支气管扩张bronchiectasisBronchiectasis支扩Bronchiectasisisdefinedaslocalized,irreversibledilatationofthebronchialtree.congenitaloraquired---Thereareseveralcausesofbronchiectasis,postinfectiouscauses;congenitaldefectsofastructurenature;chronicgranulomatousinfectionsuchastuberculosis.无异常发现支气管及肺间质慢性炎症引起肺纹理增多，增厚，紊乱。可呈管状、杵状、囊状蜂窝状影，或卷发状。继发感染：呈小斑片状模糊影，常不易治愈，或于同一地方反复发作。X线表现BronchiectasisPathologyDamageofbronchuswallPressionofbronchusincreaseCircumferencetissuedraught支气管壁破坏支气管内压增加周围组织牵拉（疤痕、肺不张等）BronchiectasisBronchiectasiscanbedividedintothreemorphologictypes:cylindrical,saccular,mixedtype.柱状、囊状或静脉曲张型。Cylindricalbronchiectasisreferstoageneralizedmoreorlessregularwideningofthelargebronchi.Saccularbronchietasisshowsthatthebronchiterminateinsac-likecavities.Bronchiectasis:lungmarkingsoftheleftlowlobeincrease,andsmallsac(sac-likecavities)Bronchiectasis:lungmarkingsoftheleftlowlobeincrease,andsmallsac(sac-likecavities)BronchiectasisBronchographicinvestigationisimportantandnecessarytodelineatethetotalextentofthedisease.Inthebronchogram,thecylindricbronchiectasismaybeshowclub-shapeddilatationofthebronchi,whilethesaccularbronchiectasiswillshowsaccularorcysticdilationoftheaffectedbronchi.Bronchogram:saccularbronchictasisintheleftlungBronchiectasisCTishelpfulespeciallyinthemoreadvancedformsofbronchiectasis,cylindricalbronchiectasiscausessmoothdilatationofbronchi,recognizableas“tramline”whenseeninthescanplaneandasthesignet-ringsignincross-section.Thesignetringsignreferstothethickenedanddilatedbronchus,saccularbronchiectasiscanbediagnosedmostreliablybyCT,sometimewecanseeair-fluidlevelinthedilatedbronchus.HRCT：支气管壁增厚，管腔增宽。呈“轨道征”或“印戒征”。柱状、囊状或静脉曲张型。bronchictasistramline轨道征signet-ringsign印戒征air-fluidlevelinthesac.bronchictasistramline”andthesignet-ringsignincross-section.bronchictasistramline”andthesignet-ringsignincross-section.Question:whereisthebronchiectasis?PneumoniaThecausativeorganismsarevariable:病原体多样感染：细菌、病毒、真菌、支原体、衣原体、立克次体、寄生虫理化性：类脂性、毒气、药物、放射线等免疫和变态反应PneumoniaPneumoniacancauseawidevarietyofabnormalfindingsonthechestradiograph.Commonly,itpresentsasalveolarconsolidation,whichcanbesegmentalorlobar,ormaybepatchy,fluffy,alveolarinfiltrates-withoutanysegmentaldistribution(bronchopneumoniapattern)..Pneumoniaalsomaypresentasdiffusealveolardiseaseorasdiffuseinterstitialdisease.Italsocanpresentassingleormultiplenodules.Thepresenceofpneumoniasometimesmaybemaskedbyanassociatedpleuraleffusion,congestivefailure,oradultrespiratorydistresssyndrome(ARDS).PneumoniaAccordingtotheradiologicappearance,pneumoniacanbecommonlydividedintolobarpneumonia,bronchopneumoniainterstitialpneumonia.LobarpneumoniaLobarpneumoniamostcommonlyiscausedbyS.pneumoniae肺炎链球菌,butitcanalsooccurwithotherorganisms.Lobarpneumoniarepresentsatypeofinflammationofthelungcharacterizedbyout-pouringofexudatesintothealveoliwithlittlechangeinthebronchiorinterstitialtissue.Theout-pouringoffluidisgenerallyconsideredtoresultfromalocalsensitivityreactiontothepolysaccharidesinthecapsuleofthepneumococcus.ThebacteriaarerapidlycarriedbytheedemafluidfromalveolustoalveolusLobarpneumoniaEarlystage:InflammatoryedemaConsolidationstageResolutionstageLobarpneumoniaEarlystage:InflammatoryedemaTheinfectionandedemahaveusuallyspreadthroughoutasegmentofthelung.X-rayfindings:Thelungmarkingsincrease.Itdoesnotcompletelyobscurethepulmonaryvesselsintheareabecausemanyofthealveoliarestillaerated.LobarpneumoniaConsolidationstageThelungischaracterizedbyaratherdenseshadowofuniformopacity.Ifthebronchiremainpatent,theaircolumnwithinthemstandsoutasdark.Thepresenceofanairbronchogramwithinashadowinthepulmonaryfieldindicatesthatthedensityisduetoconsolidationoflung.Ifadequateantibiotictreatmentisgiven,nofurtherspreadtakesplace.1.大叶性肺炎病理过程①充血期：12-24hr。毛细血管充血，少量浆液渗出，肺泡部分仍含气；②实变期：2-5d，分红色和灰色肝硬变期，肺泡内充满炎性渗出物。③消散期：1w后开始,2-3w消散。Ｘ线表现可无异常或肺纹理增粗。均匀实变影，与肺叶、段一致的高密度影，随各肺叶形态不同而不同。不均匀斑片状，逐渐吸收，胸膜侧最晚，可有胸膜增厚、纤维条索lobarpneumoniaconsolidationofrightupperlungand“airbronchogram“consolidationofrightmiddleloberconsolidationofrightupperloberLobarpneumoniaResolutionstageThehomogenicityiftheshadowofconsolidationislostanditbecomesmottledastheexudateinvariousportionsoftheaffectedlungisabsorbedandalveolihereandtherearefilledwithair.Thepathologicconsistsofintermingledareasofconsolidationofvaryingdegree,aerationofthealveoliandareasofatelectasis.Thelatterareoftenrepresentedonthefilmbystreak-likeshadow.Theseshadowsdisappearasthelungre-expandsandresolutioniscompleted.ResolutionstageintherightupperloberStreaklikeshadowResolutionstageintheleftlowerloberconsolidationofleftupperlober双上叶见大片状致密影，可见支气管充气征consolidationofrightandleftupperlober(airbronchogram)Bronchopneumonia(lobularpneumonia)ItiscommonlyseenininfantsandelderlypatientsbyinfectionbyStaphylococcusaureus,mostgram-negativebacteriaandsomefungi.Itbeginsasabronchialinfectionandhasatendencyto