pneumonia
按病变分布分为：
大叶性肺炎Lobar pneumonia
炎症累及肺叶或肺段
支气管肺炎(小叶性肺炎) bronchopneumonia or Lobular pneumonia
炎症累及多个肺小叶为主
间质性肺炎Interstitial pneumonia
炎症累及肺间质为主
Lobar pneumonia—大叶性肺炎临床
右中叶肺炎 累及肺叶：以叶间裂为界的大片致密影,但体积
不缩小,无叶间裂的移位
Lobar pneumonia
The X-ray feature is a large homogenous radiopaque shadow there is no volume loss air bronchogram is common Borders of the shadow appear
呼吸系统影像诊断
重点复习
Bronchial Obstruction
directness signs 局部支气管狭窄 stenosis 支气管闭塞 Obstruction 肿块 mcaavsistyin bronchial 管壁增厚 tbhriocnkechnieadl wofall
Indirectness signs ：
发于儿童及青壮年 好发于段以下3-5级小支气管
bronchiectasis
临床表现：咳嗽、咳血、咳痰 Continuous cough, purulent sputum,recurrent
haemoptysis 分 型：柱状型(Cylindrical bronchiectasis)、
囊状型(Cystic bronchiectasis)、 曲张型(Varicose bronchiectasis)
实变期（红色或灰色肝样变期）
支气管气像 Air bronchogram
致密阴影内,可见透亮支气管影
消散期X线改变 Lobar pneumonia Resolution stage
病变密度逐渐减低，呈大小 不等、分布不规则的斑片状 阴影
The shadow of consolidation becomes scatter
cavity and air containing space
空气半月征 Air crescent sign
曲菌球
支气管血管束增粗
肺间质病变
peribronchovascul arburdle
interstitial thicking
小叶核增大 Lobular core thicking
Signet-ring sign 印戒征
Lobar pneumonia
实变期（红色或灰色肝样变期）
The consolidation stage 密度均匀的致密影 a large homogeneous
radiopaque shadow in the lung field
No volume loss Air bronchogram is common
cough,purulent sputum,pleuritic pain 呼吸困难甚至紫绀
支气管扩张bronchiectasis
本
肺炎pneumonia
大叶性肺炎
节
小叶性肺炎
课
间质性肺炎
内
支原体肺炎
肺结核Pulmonary tuberculosis
容
肺癌Lung cancer
纵隔肿瘤mediastinal tumor
支气管扩张
bronchiectasis
支气管内径不同程度异常增宽 多数为后天性，少数为先天性，好
obstructive atelectasis.
肺体积缩小 Incomplete expansion of the lung, The size of lung shrunken
密度增高 Increased density
obstructive emphysema
肺Ov体er积in膨fla大tion 密度减低 Density reduce
X线表现 Lobar pneumonia
X-ray features
影像学表现与病理改变密切相关,是病理改变在 影像学上的反映
充血期 The congestive stage 可无阳性发现, 临床症状出现3--12小时后才出
现X线征象 No X-ray changes
病变区肺纹理增多，透亮度减低 an increase of lung marking
树芽征（tree-budded sign）
小叶间隔增厚
Interlobular septal thicking
interstitial nodules multinodular and miliary diseases
air-space nodule
磨玻璃影ground-glass opacity,GGO： 肺内密度增高的模糊影，但肺纹理可见
支气管呈囊状、柱状 囊柱状扩张
Tubular,Varicose or Cystic bronchial dilatation
bronchiectasis
囊状、柱状
bronchiectasis
曲张型扩张
囊柱状 念珠状 粗细不均 Tubular and Cystic bronchial dilatation
Air bronchogram
如消散缓慢,反复发作,年龄较大的患者,与阻 塞性肺炎鉴别
大 叶 性 肺 炎 CT 表 现
支气管气象 Air bronchogram
right lower lobe pulmonary consolidation with air bronchograms.
二 支气管肺炎
弥漫性间质纤维化 Diffuse interstitial fibrosis
Calcification
nodule and mass
Benign
lobulation
spiculation
血管集束征病灶胸膜Fra bibliotek小片状浸润Malignant
支气管充气征
air containing space
worm-eaten cavities Thin-walled cavity thick-walled cavity
透亮影， an increase of lung
markings Surrounding infiltrate or
fibrosis 合并感染时有液平及囊
壁增厚。 dilated bronchi, sometimes with air-fluid
levels
支气管造影
bronchography ：
液平 air-fluid levels 囊壁增厚
bronchiectasis
粘液栓塞-“指状征 ” Gloved finger sign
Abstract
bronchiectasis
CT features
Bronchial wall thickening
“戒指征The signet ring sign和”
bronchiectasis
平片价值有限,支气管造影病人痛苦
bronchiectasis
主要依靠CT诊断 HRCT ( high resolution CT)
HRCT表现
戒指征 The signet ring sign
bronchiectasis
囊状型 葡萄串征clusters of grapes sign
“轨道征track sign” 支气管管径粗细不均--囊柱状改变
Varicose type 葡萄串样囊状阴影，合并感染时有液平
clusters of grapes sign with air-fluid levels 粘液栓塞时呈“指状征”改变Gloved finger sign
肺炎 (pneumonia)
Caused by pneumococcus肺炎链球菌致病 Onset suddenly ,rapid development
of high pyrexia , pleuritic pain cough A characteristic rusty color sputum铁锈色痰
pathologic changings of
胸腔积液
（pleural effusion）
游离性胸腔积液 free pleural effusion 少量积液 中量积液： 大量积液：
局限性胸腔积液localized pleural effusion 包裹性积液 叶间积液 肺底积液
胸膜凹陷征
胸膜凹陷征pleural indentation sign
Classfication of pneumonia
According to the anatomic position of the lesion:
Lobar pneumonia Bronchopneumonia or Lobular
pneumonia Interstitial pneumonia According to the etiology of the
（bronchopneumonia）
又称小叶性肺炎(lobular pneumonia) 致病菌为链球菌、葡萄球菌、肺
炎双球菌streptococcus,
staphylococcus, pneumococcus
多见于婴幼儿、老年及极度衰弱 患者，或手术后
bronchopneumonia
临床表现Symptoms: 起病急，高热寒战 high pyrexia 咳嗽、咳泡沫粘液脓性痰、胸痛
红色肝样变期The red consolidation stage : 肺泡内充满渗出液,有较多红细胞,肺组织切面呈红色