肺炎的X线表现和鉴别诊断[1].pptx
《肺炎的X线表现和鉴别诊断[1].pptx》由会员分享,可在线阅读,更多相关《肺炎的X线表现和鉴别诊断[1].pptx(83页珍藏版)》请在淘文阁 - 分享文档赚钱的网站上搜索。
1、 引起肺部急性炎症的病原有细菌、病毒、真菌、引起肺部急性炎症的病原有细菌、病毒、真菌、原虫、寄生虫,其他病因有过敏、理化因素及放原虫、寄生虫,其他病因有过敏、理化因素及放射线等。射线等。根据根据X X线及病理大体形态,肺炎分为大叶性肺炎、线及病理大体形态,肺炎分为大叶性肺炎、支气管肺炎(小叶性肺炎)和间质性肺炎。支气管肺炎(小叶性肺炎)和间质性肺炎。由于各种肺炎有时有其特征性表现,因此需要了由于各种肺炎有时有其特征性表现,因此需要了解不同原因肺炎的影像表现。解不同原因肺炎的影像表现。肺炎的分类第1页/共83页XX线平片是诊断肺炎的主要方法,其价值为:线平片是诊断肺炎的主要方法,其价值为:可确定
2、肺部可确定肺部有无病变有无病变 可确定可确定部位部位 可确定可确定范围范围 了解病变的了解病变的动态变化动态变化 了解有无了解有无合并症合并症 观察观察治疗效果和判断预后治疗效果和判断预后影像学检查在肺炎诊疗中的作用价值第2页/共83页 肺炎主要采用肺炎主要采用X X线平片检查。线平片检查。CTCT检查主要用于肺炎合并症的诊断以及检查主要用于肺炎合并症的诊断以及X X线线 诊断困难的病例。诊断困难的病例。肺炎的病原诊断需根据临床及病原学检查肺炎的病原诊断需根据临床及病原学检查 影像检查可以提供鉴别诊断的可能范围影像检查可以提供鉴别诊断的可能范围 数字化的影像技术具有较高的应用价值(数字化的影像
3、技术具有较高的应用价值(CRCR、DRDR)可提高图像的质量、可防止交叉感染)可提高图像的质量、可防止交叉感染第3页/共83页入院时入院时入院入院3 3天后天后第4页/共83页第5页/共83页人禽流感肺炎的影像表现 人禽流感未引起肺部病变时人禽流感未引起肺部病变时X X线胸片所见正常。线胸片所见正常。当引起肺炎时出现胸部异常影像当引起肺炎时出现胸部异常影像:(1 1)病病变变形形态态:人人禽禽流流感感肺肺炎炎的的基基本本影影像像表表现现是是肺肺内内片片状状影影像像,病病变变形形态态可可表表现现为为斑斑片片状状、大大片片状状及及斑斑片片融融合合影影像像,边边缘缘模模糊糊。病病变变密密度度呈呈肺肺
4、实实变变或或磨磨玻玻璃璃密密度度,可可见见“空空气气支支气气管管征征”。肺肺纹纹理理增增粗粗模糊。模糊。(2 2)病病变变部部位位:病病变变位位于于一一侧侧或或两两侧侧肺肺部部,上上、下下肺肺野野均均可可有有病病变变,多多以以双双下下肺肺为为重重。常常为为两两肺肺弥弥漫性漫性分布。分布。第6页/共83页(3 3)病病变变的的范范围围:早早期期病病变变为为局局限限性性片片状状阴阴影影,进进展展后后呈呈多多灶灶性性或或弥弥漫漫性性分分布布,可可累累及及一一个个或或多多个个肺肺段段、肺肺叶叶,也也可可位位于于一一侧侧肺肺或或双双肺肺。但但一一般般不不按按肺肺叶叶或或肺肺段段分分布布。病病灶灶进进展展
5、快快,重重症症患者很快出现双肺弥漫性病变。患者很快出现双肺弥漫性病变。(4 4)动动态态变变化化:胸胸部部影影像像表表现现变变化化较较快快。重重症症患患者者肺肺内内病病变变进进展展迅迅速速,短短期期内内病病灶灶明明显显增增多多,从从小小片片到到大大片片,从从单单侧侧到到双双侧侧。病病变变密密度度也也发发生生明明显显的的变变化化。在在恢恢复复过过程程中中肺肺内内病病变变的的吸吸收收也较快也较快。第7页/共83页(5 5)合合并并症症:易易发发生生急急性性呼呼吸吸窘窘迫迫综综合合征征(ARDS)(ARDS)合并合并ARDSARDS时两肺出现广泛实变影像。时两肺出现广泛实变影像。辅辅助助通通气气治治
6、疗疗的的患患者者可可发发生生气气胸胸和和纵纵隔隔气气肿肿。少少数可合并胸腔积液。数可合并胸腔积液。(6 6)影影像像与与临临床床的的联联系系:临临床床表表现现严严重重时时,肺肺部部影影像像改改变变也也最最为为广广泛泛。当当临临床床状状况况好好转转时时,肺肺部部影影像像也也逐逐渐渐吸吸收收。但但也也有有报报道道肺肺部部影影像像正正常常及及病病变变较较轻轻者者而死亡的病例。而死亡的病例。第8页/共83页Casereport1Admitted on 13/01/04,died on 23/01/04.History of contact to flu chicken.But she with ano
7、ther sister together looked after her brother who had died with diagnosis of acute atypic pneumonia(no sample collected)just 3 days before.Main complains:High sudden fever,dry cough,headache,no shortness of breath.Physical examination:temp 39.90C,pulse 90,BP 110/60,RR 20/min.Oxygen saturation 98%.Ot
8、her signs were normal.Lab findings on admission:WBC 4.8 G/L,(67%neutrophils),platelets 139 G/L,BUN 3.3mmol/l.Chest X-ray:“no remarkable changes”.第9页/共83页 Case1第10页/共83页Case1第11页/共83页Case1第12页/共83页Casereport2 Admittedon13/01/04,diedon23/01/04.Admittedon13/01/04,diedon23/01/04.Shewasoldersisteroftheca
9、se1.Shewasoldersisterofthecase1.Maincomplainsonadmission:Fever,drycoughanddiarrhea,noshortnessofMaincomplainsonadmission:Fever,drycoughanddiarrhea,noshortnessofbreath.breath.Physicalexamination:temp39.6Physicalexamination:temp39.60 0C,pulse100,BP100/60,RR20/min,noC,pulse100,BP100/60,RR20/min,norales
10、inbothlungs.Oxygensaturation99%.Othersignswerenormal.ralesinbothlungs.Oxygensaturation99%.Othersignswerenormal.Labfindingsonadmission:WBC5.6G/L,(69%neutrophils),platelets131Labfindingsonadmission:WBC5.6G/L,(69%neutrophils),platelets131G/L,BUN3.4mmol/l.G/L,BUN3.4mmol/l.ChestX-ray:noremarkablechanges.
11、ChestX-ray:noremarkablechanges.Clinicalcourse:Clinicalcourse:Onthe4thday:Becameworsewithcontinuousfever39Onthe4thday:Becameworsewithcontinuousfever390 0C,coughing,C,coughing,shortnessofbreathRR40/min,crackleralesinbothlungs,SaO2was86%.shortnessofbreathRR40/min,crackleralesinbothlungs,SaO2was86%.BP10
12、0/60.WBC3.5G/l.GOT77,GPT40U/l.AdditiontreatmentwithBP100/60.WBC3.5G/l.GOT77,GPT40U/l.AdditiontreatmentwithoxygentherapybymaskandantibioticsoxygentherapybymaskandantibioticsAxepimAxepim(头孢吡肟),(头孢吡肟),Tavanic,Tavanic,ZithromaxandZithromaxandSolumedrolSolumedrol(甲强龙),(甲强龙),Butitseemedtobeuneffected.Buti
13、tseemedtobeuneffected.第13页/共83页Case2第14页/共83页Case2第15页/共83页Case2第16页/共83页Casereport3 Admittedon05/01/04,diedon09/01/04.Admittedon05/01/04,diedon09/01/04.Havinghistoryofcontactwithfluchicken.ShelookedafterherdaughterwhoHavinghistoryofcontactwithfluchicken.Shelookedafterherdaughterwhohaddiedofacuteaty
14、picpneumonia(H5N1confirmed)atthePediatricshaddiedofacuteatypicpneumonia(H5N1confirmed)atthePediatricsHospitaljust2daysbefore.Hospitaljust2daysbefore.Maincomplains:Feelingfatigue,fever,chestdiscomfortandshortnessofMaincomplains:Feelingfatigue,fever,chestdiscomfortandshortnessofbreath.Shewenttoprovinc
15、ialhospitalandCXRwasperformedbutnobreath.ShewenttoprovincialhospitalandCXRwasperformedbutnochangeonfilm.However,onthe3changeonfilm.However,onthe3rdrdoftheillness,respiratorydistressquicklyoftheillness,respiratorydistressquicklydevelopedandshewasreferedtoNICRTM.developedandshewasreferedtoNICRTM.Onadm
16、ission:temp38Onadmission:temp380 0C,pulse90,BP80/40,RR30/min.OxygensaturationC,pulse90,BP80/40,RR30/min.Oxygensaturation64%.64%.Labfindings:WBC1.7G/L,(63.5%neutrophils),platelets66G/L,BUNLabfindings:WBC1.7G/L,(63.5%neutrophils),platelets66G/L,BUN14.3mmol/l.14.3mmol/l.ChestX-ray:changeswithopacitiesu
17、nclearboundaryinfiltrationsover2ChestX-ray:changeswithopacitiesunclearboundaryinfiltrationsover2lungs.lungs.Management:Oxygentherapywithmaskbutnoeffect,BiPAPventilationManagement:Oxygentherapywithmaskbutnoeffect,BiPAPventilationwasapplied.SaO2wasaround83-90%.Antibioticswasapplied.SaO2wasaround83-90%
18、.AntibioticsAxepimAxepim(头孢吡肟)(头孢吡肟),SolumedrolSolumedrol,TequinandDopaminTequinandDopamin(多巴胺)(多巴胺)wereministeredalso.wereministeredalso.第17页/共83页Case3第18页/共83页Case3第19页/共83页Case3第20页/共83页 Admittedon16/01/04.Dischargedon30/01/04.Admittedon16/01/04.Dischargedon30/01/04.Havingnohistoryofcontactwithfl
19、uchicken.ButmanyillchickendiedHavingnohistoryofcontactwithfluchicken.Butmanyillchickendiedaroundareawherepatientwasliving.aroundareawherepatientwasliving.Presenthistory:5daysofillnessathome.Highfever,sputumcoughingandPresenthistory:5daysofillnessathome.Highfever,sputumcoughingandshortnessofbreath.He
20、AdmittedtoBacGiangprovincialhospital,CXRshortnessofbreath.HeAdmittedtoBacGiangprovincialhospital,CXRshowedseriouslesions.Thenextday,conditionbecamemorecriticalwithshowedseriouslesions.Thenextday,conditionbecamemorecriticalwithdifficultyinbreathandhewasreferedtoNICRTM.difficultyinbreathandhewasrefere
21、dtoNICRTM.Onadmission:temp38.5Onadmission:temp38.50 0C,pulse84,BP110/70,RR54/min,crackleralesinC,pulse84,BP110/70,RR54/min,crackleralesinboth2sidesoflung.SaO282%.both2sidesoflung.SaO282%.Labfindings:WBC3.9G/L,(75.5%neutrophils),platelets127G/L,BUNLabfindings:WBC3.9G/L,(75.5%neutrophils),platelets127
22、G/L,BUN6.6mmol/l.6.6mmol/l.ChestX-ray:Opacitieswithunclearboundaryover2lungs.ChestX-ray:Opacitieswithunclearboundaryover2lungs.Management:Oxygentherapywithmask,Tamiflu,Management:Oxygentherapywithmask,Tamiflu,AxepimAxepim(头孢吡肟)(头孢吡肟)Solumedrol.SaO2wasimproved91-95%.Solumedrol.SaO2wasimproved91-95%.C
23、linicalcourse:Clinicalcourse:After2daysoftreatment:Conditionwasimproved.NolongerfeverorAfter2daysoftreatment:Conditionwasimproved.Nolongerfeverorshortnessofbreath.SaO295-99%.Labfindings:WBC10.8G/l,GOT148,shortnessofbreath.SaO295-99%.Labfindings:WBC10.8G/l,GOT148,GPT194,LDH1014.+Dischargedonthedayof1
24、4GPT194,LDH1014.+Dischargedonthedayof14thth.Casereport4第21页/共83页Case4第22页/共83页Case4第23页/共83页Case4第24页/共83页Casereport5 Admittedon16/01/04.Dischargedon11/02/04.Admittedon16/01/04.Dischargedon11/02/04.Havinghistoryofcontactwithfluchicken.ManyillchickendiedaroundHavinghistoryofcontactwithfluchicken.Many
25、illchickendiedaroundareawherepatientwasliving.areawherepatientwasliving.Presenthistory:7daysofillnessathome.Highfever,sputumcoughingandPresenthistory:7daysofillnessathome.Highfever,sputumcoughingandshortnessofbreath.shortnessofbreath.Onadmission:temp38.2Onadmission:temp38.20 0C,pulse120,BP100/60,RR5
- 配套讲稿:
如PPT文件的首页显示word图标,表示该PPT已包含配套word讲稿。双击word图标可打开word文档。
- 特殊限制:
部分文档作品中含有的国旗、国徽等图片,仅作为作品整体效果示例展示,禁止商用。设计者仅对作品中独创性部分享有著作权。
- 关 键 词:
- 肺炎 表现 鉴别 诊断
限制150内