课件-结节病陈文慧.ppt

* 90例结节病影像学特征 马骏. 中华放射学杂志. 2006;40(9):923-27. * 马骏. . 中华放射学杂志. 2006;40(9):923-27. 90例结节病影像学特征 * 结节病的影像 * Polverosi R, et al. Radiol med .2014;119:384–392 CT特点与临床演变 * the patients requiring treatment who have a greater risk of relapse Therapy was more effective and recurrences occurred more often in patients with a typical pattern Persistence of the inflammatory process rather than the radiological pattern at onset is a prognostic factor for recurrence . Polverosi R, et al. Radiol med .2014;119:384–392 CT特点与临床演变 * 结节病的影像 * 结节病的影像 * Fig. 4 First HRCT study in an asymptomatic patient. Nodules measuring 2 and 5 mm can be seen in both upper lobes (a, arrows). Minimum nodular thickening of the septa in the apical segment of the right upper lobe and nodules along the fissures in the upper lobes bilaterally (b, arrow). Numerous lymph nodes were identified in the right paratracheal and aortopulmonary window (arrowheads). Follow- up HRCT obtained 1 year later, without therapy. Appearance of another nodule in the right upper lobe (c, arrow) and increased perilymphatic nodular pattern in the right apex * First HRCT study in a patient with dyspnoea and dry cough. Typical pattern with perilymphatic nodules in the upper lobes, tending to coalesce in the left parahilar region (a, b). Numerous enlarged mediastinal lymph nodes, bilaterally (arrows). Follow-up HRCT obtained 2 years later, after therapy with steroids and persistence of symptoms. Marked increase of nodular pattern (c) with initial reduction in volume of the right upper lobe (d) * * * 如何认识结节病 呼吸与危重症医学科三部 陈文慧 2016年07月05日 * 结节病是一种原因不明的以非干酪性坏死肉芽肿为病 理特征的系统性疾病 常侵犯肺、双侧肺门淋巴结,临床上90%以上有肺的改变,其次是皮肤和眼的病变 浅表淋巴结、肝、脾、肾、骨髓、神经系统、心脏等几乎全身每个器官均可受累 结节病概述 * 尚不清楚 遗传因素：家族聚集性 环境因素 感染： 病毒(疱疹病毒、 EB病毒、逆转录病毒、柯萨奇病毒、CMV) 伯氏疏螺旋体 痤疮丙酸杆菌 结核菌和其他分枝杆菌 肺炎衣原体 理化： 免疫因素 病因 * 病理 非干酪性肉芽肿 结节由聚集的巨噬细胞和上皮样细胞组成，上皮样细胞相互融合成朗罕氏多核 细胞 淋巴细胞多在结节周边浸润 * 全身表现 缺乏特异性：30%～40%病例无临床症状 症状轻微：乏力、低热、食欲不振、肌肉及关节疼痛 胸内表现 纵隔淋巴结受累95 ～ 98% 肺脏受累90% 呼吸困难、咳嗽、胸痛：30 ～ 50% 咯血：罕