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CT skanning af Lunger
Billeddiagnostisk kursus i Pdiatrisk Pulmonologi
Onsdag den 14. april 2010
Gratien Andersen, overlgeBilleddiagnostisk Afdeling
rhus Universitetshospital, Skejby
Bronkiektasier
Definition:Bronko-artieriel ratio >1.2Bronkier, der er strre end den ledsagende arterier (praktisk definition)ledsagende arterier (praktisk definition)
3 typer:Cylindriske, varikse og cystiske
Diagnostisk njagtighed ved HRCT: 95%
Cylindriske
Varikse
Cystiske
Atelektaser
Atelektase
Kongenitte forandringer
Anomalier med normal vaskulatur Kongenit lobrt emfysem Bronkogen cyste CCAM (Congenital Cystic Adenomatoid Malformation) Pulmonal agenesi og hypoplasi Pulmonal agenesi og hypoplasi Segmentr bronkial atresi
Anomalier med abnorm vaskulatur Pulmonal sekvester Pulmonale arteriovense malformationer Pulmonary Varix
Kongenit lobrt emfysem
Bronkogen cyste
CCAM(Congenital Cystic Adenomatoid Malformation)
Type I: 50% En eller flere cyster >2cm
Type II: Type II: 40%Multiple cyster 1-10 mm i diameter
Type III: 10%Multiple mikroskopiske cyster (
CCAM(Congenital Cystic Adenomatoid Malformation)
CCAM(Congenital Cystic Adenomatoid Malformation)
Persisterende interstitiel emfysem
CCAM(Congenital Cystic Adenomatoid
Malformation)
Segmentr bronkial atresi
Kongenit bronkocele/mykocele
Pulmonal sekvester
Intralobr: 70% Erhvervet sekvestrering? (Kroniske infektioner) Arterie fra aorta Vene drnage til lungevene / ve. Atrium
Ekstralobr Kongenit sekvestrering Arterie fra aorta Vene drnage til cava inf., azygous, portae, Ledsagende anomalier: Diafrgmaeventration/hernia, fistler til GI system,
Pulmonal sekvester
Pulmonal sekvester
Pulmonal varix
AVM
Multiple 35 50% Bilat. 10 - 20%
I 60% associeret med Osler-Weber-Rendu syndrom (Hereditr hmoragisk telangiektasi)
Pulmonale tumorer
Benign tumor: Laryngotrakeal papilom Hamartom Hmangiom, Leiomyom, lipom
Malign tumorPrimr
Bronkial carcinom Bronkial carcinom Pulmonal blastom Rabdomyosarkom Leiomyosarcom, hmangiopericytom, bronkogensarkom etc
Sekundr (Metastaser): F.eks. fra Wilms tumor, osteogen sarkom, rabdomyosarkom, lymfom etc
Diffuse infiltrativelungeforandringer
Interstitiellelungeforandringer
HRCT
Interstitial lung disease
Chestradigraphy
HRCTradigraphy
Accuracy 34% 61%
Confidence in diagnosis 18% 42%
Diagram shows anatomy and dimensions of secondary lobule and pulmonary acinus.
Webb W R Radiology 2006;239:322-338
2006 by Radiological Society of North America
Rntgen af 1 mm snit
Centrilobulr B=Bronkiole A=Arterie
V=Vene S=Interlobr septum
Interlobr septal fortykkelseInterstitiel pulmonal dem
Interlobr septal fortykkelseLymfangiektasi:
Nodulr septal fortykkelse
Differential Diagnosis of Interlobular Septal Thickening
Diagnosis CT Appearance of Thickening
Pulmonary edema Smooth
Congenital lymphangiectasia Smooth or nodular
Sickle cell disease Smooth
Idiopathic pulmonary fibrosis IrregularIdiopathic pulmonary fibrosis Irregular
Lymphangitic carcinoma Smooth or nodular
Lymphocytic interstitial pneumonia Smooth or nodular
Sarcoidosis Nodular or irregular
Alveolar proteinosis Smooth
Idiopathic pulmonary hemosiderosis Smooth
Hypersensitivity pneumonitis Smooth or nodular
Subleurale fortykkelser
Honeycombing
Fibrose + destruktive forandringerSm subpleurale cyster og sm bronkiektasier
Nodulre forandringer
Differential Diagnosis of Peribronchial Nodules
Congenital lymphangiectasia SarcoidosisCongenital lymphangiectasia Sarcoidosis
Lymphangitic carcinomatosis Lymphocytic interstitial
Langerhans cell histiocytosis Pneumonia
Peribronkiale forttningerSarcoidose
A: Centrale og perifere B:Centrale
Differential Diagnosis of Centrilobular Nodules
Diagnosis CT Appearance of Nodules- Langerhans cell histiocytosis Well defined; mid and upper lung zone
predominance, relative sparing of lung bases
- Idiopathic pulmonary Well or poorly defined; often central - Idiopathic pulmonaryhemosiderosis
Well or poorly defined; often central distribution
- Hypersensitivity pneumonitis Poorly defined; bilateral symmetric; patchy or diffuse; mid and lower lung predominance
- Cryptogenic organizing pneumonia Ill-defined; subpleural or central
- Bronchiolitis obliterans, proliferative type
Well defined
- Endobronchial spread of tuberculosis
Well or ill-defined nodules or tree-in-bud pattern
Centrilobulre forttninger
5-10 mm fra overfladen
Fra 2-3 mm til 1cm i strrelse
Patient med astma: Dilaterede, vskefyldte bronkioler
strrelse
Med forgreninger Tree-in-bud
Tree-in-bud = small airway disease
Diffuse forttninger
Veldefinerede, diffuse og/eller symetriskeforttninger
Langerhans histiocytose
Fordelingen er uden sammenhng med lungens arkitektur
Eksempler: -Milir tuberkulose-Svampeinfektioner-Metastaser-Langerhans histiocytose
Lunge-attenuation
getMat-glas konfiguration (Ground-Glass Opacity) Konsolideret lungevv
Nedsat Cystiske lungeforandringer EmfysemMosaik attenuation
Differential Diagnosis of Consolidation
Diagnosis CT Appearance of Consolidation- Acute pneumonia (bacterial, fungal, viral, Pneumocystis carinii)
Patchy, nodular, lobular, or diffuse
- Pulmonary edema, acute Perihilar, diffuse of dependent distribution- Pulmonary edema, acute Perihilar, diffuse of dependent distribution
- Pulmonary hemorrhage, acute Patchy or diffuse
- Acute respiratory distress syndrome (ARDS)
Patchy or diffuse; mainly dependent lung
- Chronic interstitial pneumoniaUsually peripheral and lower lobe distribution
- Alveolar proteinosis Patchy
Ground-Glass Opacity Lungekonsolidering
Differential Diagnosis of Cystic Lung Disease
Diagnosis CT Appearance of Cystic Disease
- Pulmonary Langerhans cell histiocytosisThin-walled cysts; mid and upper lung zones, relative sparing of lung bases
- Tuberous sclerosis, Marfan syndrome, neurofibromatosis
Cysts and bullaeneurofibromatosis- Idiopathic pulmonary fibrosis(usual interstitial pneumonia)
Honeycombing; peripheral, basilar, and subpleural predominance
- Hypersensitivity pneumonitis, chronicHoneycombing in advanced disease; middle lung zones predominance common
- Idiopathic pulmonary hemosiderosis Honeycombing in advanced disease
- Collagen vascular disease, chronic Honeycombing, basilar distribution
- Pneumonias(bacterial pneum., Pneumocystis carinii)
Cysts
- Lymphocytic interstitial pneumonia Thin-walled cysts
Pneumocystis carinii
Emfysem:Alfa 1-antitripsin-mangel
Eksempler
Sygdomme med linere eller retikulre forttninger
Pulmonal dem
Pulmonal lymfangiektasi
Bronkopulmonal dysplasi (BPD)
Sickle cell sygdom
Idiopatisk interstitiel pneumoni
Lymfangitis carcinomtosa
Pulmonal lymfangiektasi Bronkopulmonal dysplasi
Linere eller retikulreforttninger
Interstitiel pneumoni
Linere eller retikulreforttninger
Sygdomme mednodulre forttninger
Sarcoidose Wegeners granulomatose
Sygdomme medGround-Glass / Konsolidering
Pulmonal dem
ARDS (Acute Respiratory Distress Syndrome)
Pulmonal alveolr proteinose
Pulmonal Hmosidrose Pulmonal Hmosidrose
Hypersensitivitets pneumoni
Kollagene-Vaskulre sygdomme
COP/BOOP (Cryptogen Organizing Pneumonia)
(Brocholitis Obliterans Organizing Pneumonia)
dem
Alveolr proteinose
Sygdomme medGround-Glass / Konsolidering
Akut Hypersensitivitets Peumoni
Sygdomme medGround-Glass / Konsolidering
Sygdomme medcyster eller emfysem
Langerhans celle histiocytose
Tubers sklerose
Marfans Syndrom
Neurofibromatosis (Type 1) Neurofibromatosis (Type 1)
Langerhans histiocytose
Sygdomme medcyster eller emfysem
Tubers skleroseMarfan
Sygdomme medtt lungestruktur og mosaik
perfusion
Cystisk fibrose
Alfa-1-antitripsin-mangel
Bronkiolitis: Bronkiolitis: Proliferativ Obliterativ
Swyer-James Syndrom
Cystisk fibrose
Bronkiolitis obliterans
B- EkspirationA- Inspiration
Swyer-James Syndrom
Postinfektis bronkolitisobliterans
Vksthmmet syge lunge
Ekspiration
Air trapping
Pulmonale infektioner
Tuberkulose
Milir TBPrimr TB
Absces
Aspergillus
Allergisk bronkopulmonal
aspergilloseAspergillom
Cryptococcus infektion
Cytomegalovirus infektion
Sprgsml ?
66
Gratien AndersenOverlge
Billeddiagnostisk Afd. Aarhus Universitetshospital, Skejby
Email: [email protected]