1、Pulmonary HRCT中日友好醫院放射科 謝晟第1頁，共44頁。Histology of Normal Lung第2頁，共44頁。Interstitial Compartments of the Lung Bronchovascular interstitium (surrounds the bronchovascular bundle) Centrilobular interstitium (surrounds the distal bronchiolovascular bundle) Interlobular septal interstitium (often seen as li

2、nes perpendicular to the pleura) Pleural interstitium 第3頁，共44頁。unilateral lymphangitic spread of tumor第4頁，共44頁。Basic HRCT PatternsLinesNodulesConsolidationGround-glass OpacityCysts第5頁，共44頁。Linear abnormalities include: a) thickened interlobular septa (image 1)b) bronchovascular interstitial thickeni

3、ng (image 1)c) reticular change (image 2).第6頁，共44頁。Location of Nodules:centrilobular, random interstitialTree-in-bud Pattern第7頁，共44頁。Histologic Section of Bronchopneumonia第8頁，共44頁。nodules represent centrilobular interstitial tumor cut in cross-section第9頁，共44頁。Causes of nodulesTumor infectious and no

4、n-infectious granulomasPneumoconioses mucous plugsendobronchial disease and hypersensitivity pneumonia. 第10頁，共44頁。第11頁，共44頁。Ground-glass Opacity caused by influenzal pneumonia第12頁，共44頁。Causes of Ground-glass Opacitypulmonary edema; ARDS; viral, mycoplasmal, and pneumocystis pneumonias; hypersensitiv

5、ity pneumonia; pulmonary hemorrhage;other diffuse interstitial lung diseases. 第13頁，共44頁。cysts represent multiple dilated bronchi (known as cystic bronchiectasis)第14頁，共44頁。Causes of cystscystic bronchiectasis multiple cysts confined to the subpleural lung are usually indicative of honeycombing, which

6、 results from chronic interstitial fibrosis.Langerhans cell histiocytosis lymphangioleiomyomatosis第15頁，共44頁。Diagnostic steps1. What are the major abnormalities in this case? a) Nodulesb) Linear opacitiesc) Consolidationd) Ground-glass opacity2. What is the distribution of the lesions? a) Bronchovasc

7、ular interstitiumb) Interlobular septac) Centrilobular regiond) Pleura第16頁，共44頁。Diffuse bronchitis/bronchiolitis on HRCT:Diffuse well- and poorly-defined centrilobular nodules Tree-in-bud pattern Thickening of bronchial walls Patchy pneumonic consolidation 第17頁，共44頁。Diagnostic features of endobronch

8、ial tuberculosis on HRCT:Tree-in-bud pattern Clustered centrilobular nodules Mass-like areas of consolidation Cavitation in larger nodules or masses 第18頁，共44頁。第19頁，共44頁。Diagnostic features of bronchiectasis, bronchitis, and bronchiolitis on HRCTBronchial dilation and wall thickening Tree-in-bud patt

9、ern Centrilobular nodules Mosaic perfusion of air trapping (more later) 第20頁，共44頁。numerous hematogenous metastatic nodules on HRCT:Usually random distribution Often smooth, well-defined Varying size common 第21頁，共44頁。第22頁，共44頁。Diagnostic features of miliary tuberculosis on HRCTRandom nodules Diffuse

10、distribution throughout lung Uniform size, upper lung Reticular change Traction bronchiectasis Focal lung sparing 第38頁，共44頁。Diagnostic features of usual interstitial pneumonia on HRCTSubpleural reticular opacities at the lung bases, early Associated cystic air spaces, 2 to 20 mm in diameter (honeyco

11、mbing) Traction bronchiectasis Patchy ground-glass opacities Architectural distortion in relation to normal lung Basal, subpleural predominance 第39頁，共44頁。Diagnostic features of Langerhans cell histiocytosis on HRCT Irregularly-shaped cysts with variable wall thickness Small centrilobular nodules les

12、s than 5 mm in diameter Middle and upper lung zone predominance of cysts and nodules 第40頁，共44頁。Diagnostic features of lymphangioleiomyomatosis on HRCTNumerous round, thin-walled cysts (in women of child-bearing age) Even and diffuse distribution, bilaterally 第41頁，共44頁。End-expirationEnd-inspirationDi

13、agnostic features of bronchiolitis obliterans on HRCT EarlyInhomogeneous mosaic perfusion discovered or accentuated on expiratory imagesLateBronchiectasis第42頁，共44頁。End-expiratory images help to determine whether mosaic perfusion is caused by air-trapping or primary vascular disease. Note: The contrast between light and dark is accentuated on the expiratory image. Note: The contrast between light and dark is not accentuated on the expiratory image. Causes of Mosaic or Inhomogeneous PerfusionSmall airway disease with a physiologic decrease in perf