肺部疾病的影像诊断【双语+图片】.docx

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1、Radiology 2008;246:697-722Fleischner Society: Glossary of Terms for Thoracic ImagingDavid M. Hansell, MD, FRCP, FRCR, Alexander A. Bankier, MD, Heber MacMahon, MB, BCh, BAO, Theresa C. McLoud, MD, Nestor L. Muller, MD, PhD, and Jacques Remy, MDFrom the Department of Radiology, Royal Brompton Hospita

2、l, Sydney Street, London SW3 6NP, United Kingdom (D. M. H.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (A. A. B.); Department of Radiology, University of Chicago Hospital, Chicago, Ill (H. M.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (T

3、. C. M.); Department of Radiology, Vancouver General Hospital, Vancouver, British Columbia, Canada (N. L. M.); and Department of Radiology, CHRU de Lille, Hopital Calmette, Lille, France (J. R.). Received April 21, 2007; revision requested May 29; revision received June 6; accepted August 7; final v

4、ersion accepted September 19. Address correspondence to: D. M. H. (e-mail: d. hanselISrbht. nhs.曲).ABSTRACTMembers of the Fleischner Society compiled a glossary of terms for thoracic imaging that replaces previous glossaries published in 1984 and 1996 for thoracic radiography and computed tomography

5、 (CT),工耍p0土jyely. The need to 憩趣捡 the previous YW?里came from the /ggQ酗复上9n that new words have emerged, others have become obsolete, and the meaning of some terms has changed. Brief descriptions of some diseases are included, and工jg examples (chest radiographs andCT scans) are provided for the major

6、ity of terms.INTRODUCTIONThe present glossary is the third prepared by members of the Fleischner Society and replaces the glossaries of terms for thoracic radiology (1.) and CT (2), respectively. The impetus to combine and update the previous versions came from the recognition that with the recent d

7、evelopments in imaging new words have arrived, others have become obsolete, and the meaning of some terms has changed. The intention of this latest glossary is not to be exhaustiye but to concentrate on those terms whose meaning may be problematic. Terms and techniques not used exclusively in thorac

8、ic imaging are not included.Two new features are the inclusion of brief descriptions of the “1坷空上卜应1*工1上垣1 pneumon i as (11 Ps) and pictorial examples (chest radiographs and computed tomographic CT scans) for the majority of terms. The decision to include vignettes of the I IPs (but not other pathol

9、ogic entities) was based on the perception that, despite the recent scrutiny and reclassification, the I IPs remain a confusing group of diseases. We trust that the illustrations enhance, but do not distract from, the definitions. In this context, the figures should be regarded as of less importemce

10、 than the text-they are merely examples and should not be taken as representing the full range of possible imaging appearances (which may be found in the references provided in this glossary or in comprehensive textbooks).We hope that this glossary of terms will be helpful, and it is presented in th

11、e spirit of the sentiment of Edward J. Huth that *scientific writing calls for precision as much in naming things and concepts as in presenting data* (3). It is right to repeat the request with which the last Fleischner Society glossary closed: *Use of words is inherently controversial and we are pl

12、eased to invite readers to offer improvements to our definitions* (2).GLOSSARYAcinus腺泡Anatomy.The acinus is a structural unit of the lung distal to a terminal bronchiole and is supplied by first-order respiratory bronchioles; it contains alveolar ducts and alveoli. It is the largest unit in which al

13、l airways participate in gas exchange and is approximately 6 - 10 mm in diameter. One secondary pulmonary lobule contains between three and 25 acini (4).Radiographs and CT scans.Individual normal acini are not visible, but acinar arteries can occasionally be identified on thin-sectionCT scans. Accum

14、ulation of pathologic material in acini may be seen as poorly defined nodular opacities on chest radiographs and thin-section CT images. (See also nodules,)解剖：腺泡是终末细支气管以远的肺结构单位，由一级呼吸细支气管供给。腺泡含肺泡管和肺泡，它是 全部气道都参与气体交换的最大肺单位，直径610 mm。一个二次肺小叶含325个腺泡。X和CT表现：正常时见不到个别的腺泡，但在薄层CT上偶可见腺泡动脉。腺泡内积聚病理物 质时，X线胸片和薄层CT上

15、可见边缘模糊的结节。acute interstitial pneumonia, or AIP 急性肺间质肺炎Pathology.The term acute interstitial pneumonia is reserved for diffuse alveolar damage of unknown cause. The acute phase is characterized by edema and hyaline membrane formation. The later phase is characterized by airspace and/or interstitial o

16、rganization (5). The histologic pattern is indistinguishable from that of acute respiratory distress syndrome.病理：急性肺间质肺炎为原因不明的弥漫肺泡损害。急性期的特征为水肿和透明膜形成，晚期的特征为气 腔和(或)间质机化。组织学所见不能与急性呼吸窘迫综合征鉴别。Radiographs and CT scans.In the acute phase, patchy bilateral ground-glass opacities are seen (6), often with som

17、e sparing of individual lobules, producing a geographic appearance; dense opacification is seen in the dependent lung (Fig 1). In the organizing phase, architectural distortion, traction bronchiectasis, cysts, and reticular opacities are seen (7).急性期可见两肺斑片状磨玻璃影，其间个别肺小叶正常，出现地图样分布，在肺的下垂部可见致密影。 在机化期可见肺

18、结构扭曲、牵引性支气管扩张、囊肿和网影。Figure 1: Transverse CT scan in a patient with acute interstitial pneumonia.air bronchogram空气支气管征Radiographs and CT scans.An air bronchogram is a pattern of air-filled (1 ow-attenuation) bronchi on a background of opaque (high-attenuation) airless lung (Fig 2). The sign implies (

19、a) patency of proximal airways and (b) evacuation of alveolar air by means of absorption (atelectasis) or replacement (eg, pneumonia) or a combination of these processes. In rare cases, the displacement of air is the result of marked interstitial expansion (eg, lymphoma) (8).X和C T表现：空气支气管征是一种在含气少的致密

20、(高衰减)肺的背景上见到含气(低衰减)支气管 的表现。该征象表明：(a)近侧气道通畅；(b)肺泡内的空气经吸收(肺不张)或取代(肺炎)，或两 者综合而消失，在少见病例(如淋巴瘤)中空气的消失是显著的间质膨胀的结果。Figure 2: Transverse CT scan shows air bronchogram as air-filled bronchi (arrows) against background of high-attenuat ion lung.air crescent空气半月征Radiographs and CT scans. An air crescent is a co

21、llection of air in a crescentic shape that separates the wall of a cavity from an inner mass (Fig 3). The air crescent sign is often considered characteristic of either Aspergillus colonization of preexisting cavities or retraction of infarcted lung in angioinvasive aspergillosis (9,10). However, th

22、e air crescent sign has also been reported in other conditions, including tuberculosis, Wegener granulomatosis, intracavitaryhemorrhage, and lungcancer.(See also mycetoma.)X和CT表现：为半月形空气积聚，将空洞壁与洞内肿块分开.该征象通常被认为是曲菌移植到已有的空 洞内或在血管侵袭性曲菌病中梗死的肺收缩的结果。但该征象也见于其他情况，包括结核病、韦格肉芽肿、 空洞内出血和肺癌。Figure 3: Magnified ches

23、t radiograph shows air crescent (arrows) adjacent to mycetoma.air trapping空气潴留Pathophysiology.Air trapping is retention of air in the lung distal to an obstruction (usually partial).CT scans.Air trapping is seen on end-expiration CT scans as parenchymal areas with less than normal increase in attenu

24、ation and lack of volume reduction. Comparison between inspiratory and expiratory CT scans can be helpful when air trapping is subtle or diffuse (11,12) (Fig 4). Differentiation from areas of decreased attenuation resulting from hypoperfusion as a consequence of an occlusive vascular disorder (eg, c

25、hronic thromboembolism) may be problematic (13), but other findings of airways versus vascular disease are usually present. (See also mosaic attenuation pattern.)病理生理学：空气潴留是指气道阻塞(常为部分性)导致的远处肺内的气体潴留CT：空气潴留见于呼气相末CT扫描像上，表现为肺实质区的衰减较正常为少，且肺体积不缩小。当 空气潴留轻度或弥漫性时，比较吸气相和呼气相CT有价值。其通常难与阻塞性血管病(如慢性肺栓塞) 低灌注所致的衰减减少

26、区鉴别，但常有与血管病相对应的气道病的其他表现。Figure 4: Transverse CT scans at end inspiration and end expiration show air trapping.Airspace 气腔Anatomy.An airspace is the gas-containing part of the lung, including the respiratory bronchioles but excluding purely conducting airways, such as terminal bronchioles.Radiographs

27、 and CT scans.This term is used in conjunction with consolidationt opacity, and nodules to designate the filling of airspaces with the products of disease (14).解剖：是肺的含气部分，包括呼吸细支气管，但不包括单纯的传导性气道，如终末细支气管X线和CT表现：气腔一词用于和实变、致密影、结节有关联处，以描述由病变所致的气腔充盈。aortopulmonary window 主肺动脉窗Anatomy.The aortopulmonary win

28、dow is the mediastinal region bounded anteriorly by the ascending aorta, posteriorly by the descending aorta, cranially by the aortic arch, inferiorly by the left pulmonary artery, medially by the ligamentum arteriosum, and laterally by the pleura and left lung (15, 16).Radiographs and CT scans.Foca

29、l concavity in the left mediastinal border below the aorta and above the left pulmonary artery can be seen on a frontal radiograph (Fig 5). Its appearance may be modified by tortuosity of the aorta. The aortopu 1 monary window is a common site of lymphadenopathy in a variety of inflammatory and neop

30、lastic diseases.解剖：主肺动脉窗其前为升主动脉，后为降主动脉，上为主动脉弓，下为左肺动脉，内为动脉导管韧带， 外为胸膜及左肺的纵隔内一个区域X线和CT表现：在正位X线胸片上为主动脉弓下、左肺动脉上、纵隔左缘上的局部凹陷处，它的表 现可随主动脉扭曲而改变。主肺动脉窗内常可见各种炎症和肿瘤疾病中的肿大淋巴结。Figure 5: Magnified chest radiograph shows aortopulmonary window.Iapical cap肺尖帽Pathology.An apical cap is a cap like lesion at the lung ape

31、x, usually caused by intrapulmonary and pleural fibrosis pulling down extrapleural fat (17) or possibly by chronic ischemia resulting in hyaline plaque formation on the visceral pleura (18). The prevalence increases with age. It can also be seen in hematoma resulting from aortic rupture or in other

32、fluid collection associated with infection or tumor, either outside the parietal pleura or loculated within the pleural space (19).Radiographs and CT scans.The usual appearance is of homogeneous soft-tissue attenuation capping the extreme lung apex (uni- or bilaterally), with a sharp or irregular lo

33、wer border (Fig 6). Thickness is variable, ranging up to about 30 mm (17). An apical cap occasionally mimics apical consolidation on transverse CT scans.病理：肺尖帽为肺尖部的帽状病变，常由肺或胸膜纤维化向下牵拉胸膜外脂肪所致，也可能是慢性缺血 导致的脏层胸膜透明斑形成的结果。其发生率随年龄增大而升高。也曾见于主动脉破裂所致血肿或其他位 于壁层胸膜外或胸膜腔内的并发感染或肿瘤的积液者X线和CT：常呈密度均匀的软组织影，覆盖于肺尖上面(一侧或两侧

34、)，下缘锐利或不规则，厚度不 一，可厚达30 nlm。在CT横断面像上肺尖帽偶可误认为肺尖部实变。Figure 6: Magnified chest radiograph shows apical cap (arrow).architectural distortion 结构扭曲Pathology.Architectural distortion is characterized by abnormal displacement of bronchi, vessels, fissures, or septa caused by diffuse or localized lung disease

35、, particularly interstitial fibrosis.CT scans.Lung anatomy has a distorted appearance and is usually associated with pulmonary fibrosis (Fig 7) and accompanied by volume loss.病理：结构扭曲是由于弥漫性或局限性肺部疾病，尤其是间质纤维化引起的支气管、血管、叶间裂或小叶 间隔的异常移位。CT：肺解剖结构扭曲常伴肺纤维化，并有肺容积缩小。Figure 7: Transverse CT scan shows architectu

36、raldistortion caused by pulmonary fibrosis.Atelectasis 肺不张Pathophysiology.Atelectasis is reduced inflation of all or part of the lung (20). One of the commonest mechanisms is resorption of air distal to airway obstruction (eg, an endobronchial neoplasm) (21). The synonym collapse is often used inter

37、changeably with atelectasis, particularly when it is severe or accompanied by obvious increase in lung opacity.Radiographs and CT scans.Reduced volume is seen, accompanied by increased opacity (chest radiograph) or attenuation (CT scan) in the affected part of the lung (Fig 8). Atelectasis is often

38、associated with abnormal displacement of fissures, bronchi, vessels, diaphragm, heart, or mediastinum (22). The distribution can be lobar, segmental, or subsegmental. Atelectasis is often qualified by descriptors such as linear, discoid, or platelike. (See also linear atelectasis, rounded a telec ta

39、sis.)病理生理学：部分或全部肺充气减少。最常见的机制之一为气道阻塞，远侧空气的吸收(如支气管内肿 瘤)。同义词萎陷可与肺不张交换使用，尤其在严重或伴有明显的肺密度增高时X线和CT表现：可见肺容积缩小，伴受累肺的密度增加(X线胸片)或CT衰减值增加(CT扫描)。 肺不张常伴有叶间裂、支气管、血管、膈肌、心脏或纵隔的异常移位。可以是叶、段或亚段分布。肺不张 常定量描述为线状、盘状或板状肺不张。也见于线状肺不张、圆形肺不张。Figure 8: Transverse CT scan shows atelectasis of right middle lobe as increased attenu

40、ation (arrows) adjacent to right border of heart.azygoesophageal recess奇静脉食管隐窝Anatomy.The azygoesophageal recess is a right posterior mediastinal recess into which the edge of the right lower lobe extends. It is limited superiorly by the azygos arch, posteriorly by the azygos vein and pleura anterio

41、r to the vertebral column, and medially by the esophagus and adjacent structures.Radiographs and CT scans.On a frontal chest radiograph, the recess is seen as a vertically oriented interface between the right lower lobe and the adjacent mediastinum (the medial limit of the recess). Superiorly, the i

42、nterface is seen as a smooth arc with convexity to the left. Disappearance or distortion of part of the interface suggests disease (eg, subcarinal lymphadenopathy). On CT scans, the recess (Fig 9) merits attention because small lesions located in the recess will often be invisible on chest radiograp

43、hs (23).解剖：是右后纵隔隐窝，右下叶延伸至其右缘，上界为奇静脉弓，后为奇静脉和脊柱前胸膜，内侧为食管 和邻近结构X和CT表现：在正位X线胸片上表现为右下叶和邻近纵隔（隐窝内界）之间呈垂直方向的界面，该界 面的上部表现为凸向左的光滑的弧形。界面的部分消失或扭曲提示有病变（如隆突下淋巴结肿大）o在C T上应高度注意该隐窝，因为隐窝内的小病变在X线片上常见不到。Figure 9: Transverse CT scan shows azygoesophageal recess (arrows).azygos fissure 奇裂See fissurebeaded septum sign 串珠样

44、隔征CT scans.This sign consists of irregular and nodular thickening of interlobular septa reminiscent of a row of beads (Fig 10). It is frequently seen in lymphangitic spread of cancer and less often in sarcoidosis (24).该表现包括不规则或结节状的小叶间隔增厚，似一串珠子。常见 于癌的淋巴管播散和较少的结节病中。Figure 10: Transverse CT scan shows

45、beaded septum sign (arrows).Bleb肺大疱Anatomy.A bleb is a small gas-containing space within the visceral pleu闻脏层胸膜 or in he RUbpl991ml 1包8 胸膜肺,not larger than 1 cm in diameter (25).CT scans.A bleb appears as - th in-willed cystic air space contiguous with the pleura 与胸膜相连的薄壁囊性区域.Because the arbitrary （

46、size） distinction between a bleb and bulla is of little clinical importance, the use of this term by radiologists is discouraged. 由于任意 （大小）之间的气泡和泡的区的临床意义不大，放射专家不鼓励使用这一术语。解剖：为一小的位于脏层胸膜内或胸膜下肺内的含气间隙，直径Siem。CT表现：为邻近胸膜的薄壁囊性气腔。由于任意以大小来区别大泡（bulla）和大疱，无临床重要性， 故不鼓励放射诊断医师使用该术语。Bronchiectasis支气管扩张Pathology. 二9

47、/)卜12&4一9_工工二0丫0工卜? Qggjjzed 9r di且L dll0土9rL支气 管扩张症，是不可逆转的局部或弥漫性扩张支气管，usually resulting from chronic infection, proximal airway obstruction 近端气道阻塞，or congenital bronchial abnormality 先天性支气管异常(26). (See also traction bronchiectasis.(另见牵引支气管扩张。)Radiographs and CT scans.-Morphologic criteria on thin-s

48、ection CT scans 形态上标准的薄层 CT 扫描 include bronchial dilatation with respect to the accompanying pulmonary artery 包括就 伴随肺动脉扩张支气管(signet ring sign戒号)，lack of tapering of bronchi逐渐变细的支气管,and identification of bronchi within 1 cm of the pleural surface (27) (Fig 11). Bronchiectasis may be glassifigd空cyliKr

49、ig，varicose, or gystig根据受影响的支气管外观，支气管扩张症可分为圆 柱，静脉曲张，或囊隹It is often accompaniedby bronchial wall thickening, mucoid impaction 粘液嵌塞，and small-airways abnormalities (27 - 29). (See also signet ring sign.)病理：为不可恢复的局限性或弥漫性支气管扩大，常由慢性感染、近侧气道阻塞或先天支气管异常所致。 也见于牵引性支气管扩张X和CT表现：薄层CT的形态学标准包括与其伴行的肺动脉相比支气管扩大(印戒征)、支气管不 变细及胸膜面下工cm内可见支气管。根据扩张支气管的表现可分为柱状、静脉曲张状和囊状支气管扩张。