lemon2008 发表于 2012-12-24 20:58:04

胸部常见病读片

History:Man with cough.
病史:男性,咳嗽
胸片所见:

lemon2008 发表于 2012-12-24 20:59:35

Granulomatous infection肉芽肿性感染

lemon2008 发表于 2012-12-24 21:02:43

{:soso_e182:}上面您回答对了吗?请看本例患者的CT图


lemon2008 发表于 2012-12-24 21:05:34

从以上CT表现您认为是哪种疾病?
A. Primary tuberculosis.原发型肺结核
B. Reactivation tuberculosis.活动性肺结核
C. PCP pneumonia.PCP肺炎
D. Cryptococcus. 隐球菌感染
E. Invasive aspergillosis.侵袭性曲霉病

lemon2008 发表于 2012-12-24 21:35:59

活动性肺结核

您诊断对了吗?

Additional clinical history:Forty-year-old homeless man with cough.其他临床病史:男性,40岁,咳嗽
   
Findings:影像表现

Chest radiograph:Patchy airspace consolidation in the bilateral upper lobes and perihilar regions bilaterally.Multifocal nodular opacities in the peripheral right upper lobe, left perihilar region, and lateral left upper lobe.
胸片:双肺上叶及肺野外带可见斑片状实变影,其内可见空腔影;右肺上叶外带、左肺野外带及左肺上叶可见多发结节样病灶。
CT Chest:Multifocal areas of airspace consolidation and scattered multinodular opacities involving both lungs, most pronounced in the upper lobes and superior segments of the lower lobes.Small eccentric cavitation in the left upper lobe consolidation.Bronchial wall thickening, centrilobular nodules, tree-in-bud pattern, scattered peribronchial infiltrates and acinar nodules, particularly in the dependent portions of the lungs, compatible with endobronchial spread.
CT所见:双肺可见多发含气空腔样结节样机散在多发结节影,以双肺上叶及下叶背段为著;左肺上叶实变区可见小偏心性空腔。支气管壁增厚、小叶中心型结节、树芽征、散在支气管周围浸润及腺泡结节,尤其发生于肺的独立部分,并支气管蔓延。

Differential diagnosis:
鉴别诊断:
Post-primary pulmonary tuberculosis继发性肺结核
Chronic fungal infection (histoplasmosis, coccidiomycosis) 慢性真菌感染(组织胞浆菌病,球孢子菌病)
Ankylosing spondylitis 强直性脊柱炎
Progressive massive fibrosis 重度肺纤维化
Sarcoidosis (late stage) 结节病(晚期)
Bronchogenic carcinoma支气管肺癌

Diagnosis:Post-primary tuberculosis
  诊断:继发性肺结核

lemon2008 发表于 2012-12-24 21:39:47


Key points:
关键点:
[*]Post-primary tuberculosis继发性肺结核


[*]Results from reactivation of a previously dormant primary infection (90% of cases) or represents continuation of the primary disease (minority of cases)
[*]Almost exclusively a disease of adolescence and adulthood
[*]Risk factors: impaired cellular immunity (HIV+, elderly, homeless, prisoners, indigent)
[*]Radiographic findings include:


[*]Airspace consolidation (lobular sized and peribronchial)
[*]Cavitations with variable wall thickness
[*]Endobronchial spread to dependent portions of lung (centrilobular nodules, tree-in-bud appearance, bronchial wall thickening)
[*]Other findings: fibrotic changes, volume loss, adenopathy, pleural effusions
[*]Distribution: often segmental, apical and apical posterior segments of upper lobes and superior segments of lower lobes, gravity dependent lobes (via bronchogenous spread)
[*]Signs of active disease: signs of endobronchial spread, cavitation, consolidation
[*]Inactive disease: requires stability over 6 months
[*]Sequela: Consolidation and nodules resolve over 9-12 months with successful treatment. May see signs of fibrosis, volume loss, calcifications of lung and lymph nodes
[*]If immunosuppressed, may progress to miliary tuberculosis, ARDS, extrathoracic dissemination to breast, spine, kidney, meninges, bone
References.

[*]Harisinghanai, MG. et al. Tuberculosis from Head to Toe RadioGraphics, 20, 449-470. March 2000.
[*]Winer-Muran, Helen. Statdx.com: "Post-Primary Tuberculosis" Accessed December 2010.


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