肺脓肿影像诊疗VIP免费

肺脓肿影像诊断Theimagingdiagnosisoflungabscess24/10/231主要内容1.病例回顾2.肺脓肿临床及病理3.肺脓肿影像诊断4.鉴别诊断5.小结(A)AnX-rayshowsanabnormalshadowintherightupperlobe.(B)ChestCTwithcontrastenhancementshowsaring-enhancingsolidmassmeasuring53×43mminsizeintherightupperlobewithsignificantmediastinallymphadenopathy.(C)APET/CTscanrevealsahighuptakeinthemass,withamaximumSUVof8.7,andthemediastionallymphnode,withamaximumSUVof3.7…AmJCaseRep.2014;15:243–245.LungcancermimickinglungabscessformationonCT24/10/233Afollow-upCTscanshowsanincreaseinthesizeofthemass59×49mm(53×43mm)Thefinalresultsofthepathologicexaminationshowedapleomorphiccarcinomafollow-up24/10/234Figure1.Chestradiographshowsalargecavitywithairfluidlevelinleftlung.Figure2.CECTThoraxatthelevelofcarinashowingalargecavitywithairfluidlevelinleftlung.Wallofthecavityisirregular.TheClinicalRespiratoryJournal.2009:116–117Carcinomalungmasqueradingaslungabscess24/10/235Figure1:ChestX-rayatpresentationshowingcompleteopacificationoftherighthemithorax.Figure2:CTscanchestshowingcompletereplacementoftherightlungwithmultipleabscesses.BronchialCarcinoidPresentingasMultipleLungAbscesses24/10/236male，24yearsold,cough,feverSecondarypulmonarytuberculosiswithcavity24/10/237follow-up文献24/10/238周震，吕岩，谢汝明，等.拟诊为肺脓肿的肺癌的CT特征及病理对照[J].临床放射学杂志,2014,33(1):29-33.方连曾.肺结核空洞继发感染误诊为原发性肺脓疡临床分析[J].临床肺科杂志2007,12(7):755.TairaN,KawabataT,GabeA.LungcancermimickinglungabscessformationonCTimages.AmJCaseRep[J].2014Jun7;15:243-5.KhuranaA,MohapatraPR,DhingraN.Carcinomalungmasqueradingaslungabscess[J].ClinRespirJ.2009Apr;3(2):116-7.WaheedZ,IrfanM,FatimiS,ShahidR.Bronchialcarcinoidpresentingasmultiplelungabscesses[J].JCollPhysiciansSurgPak.2013Mar;23(3):229-30.24/10/239肺脓肿概述定义：多种化脓性细菌感染导致的肺实质局灶性化脓性病变。常见病菌：金黄色葡萄球菌、化脓性链球菌、肺炎克雷伯杆菌铜绿假单胞菌、大肠埃希式菌、流感嗜血杆菌。90%合并厌氧菌感染24/10/2310临床分型发病机制病程长短吸入性肺脓肿（aspirationlungabscess）继发性肺脓肿（secondarylungabscess）血源性肺脓肿（hematogenouslungabscess）急性肺脓肿（1-2月）慢性肺脓肿（迁延3个月以上不愈合）24/10/2311【病理】三期肺组织化脓性炎症（早期）肺脓肿24/10/2312坏死脓肿形成期脓腔胸膜粘连、脓胸、脓气胸、支气管胸膜瘘脓肿吸收/纤维瘢痕（恢复期或慢性期）坏死组织液化破溃部分排除小血管炎性栓塞脓肿的特征为坏死的肺组织形成空洞。空洞充满脓液（坏死物质碎片/液体）或脓液加气体（空气）。脓肿可大可小，可单个或多发。脓肿可出现在肺的任何部位，根据不同的分类，有相应的好发部位。24/10/2313后期：破溃到支气管内，形成脓腔空洞、气液平面，大量脓痰。近胸膜脓肿：可发生局限性纤维蛋白性胸膜炎、脓气胸、支气管胸膜瘘慢性肺脓肿：周围细支气管受累则致变形或扩张。血管瘤、肉芽组织形成，反复咯血24/10/2314肺脓肿、脓气胸24/10/2315吸入性肺脓肿意识障碍、疲劳过度、鼻窦炎、牙槽脓肿等好发部位：右侧单发多见，上叶的后段或下叶背段好发部位：右侧单发多见，上叶的后段或下叶背段咳嗽反射异常吞咽障碍咳嗽反射异常吞咽障碍吸入吸入厌氧菌厌氧菌24/10/2316吸入性肺脓肿肺炎15天后变为肺脓肿肺炎15天后变为肺脓肿24/10/2317继发性肺脓肿细菌性肺炎支气管扩张支气管囊肿支气管肺癌支气管异物临近器官化脓性病变(如AIDS)好发部位：好发部位：部位不确定，临近原发病灶部位不确定，临近原发病灶炎症蔓延炎症蔓延24/10/2318继发性肺脓肿食管癌，食管-气管瘘，继发肺脓肿好发部位：不确定，临近原发病灶食管癌，食管-气管瘘，继发肺...