1、支原体肺炎病例讨论支原体肺炎病例讨论 1.2.3.4.5.6.7.8.9.10.11.12.13.14.AB40-year-old woman with Mycoplasma pneumoniae pneumonia.A, Chest radiograph reveals patchy areas of nonsegmental air-space opacification in both lower lobes.B, HRCT (1.5-mm collimation) shows focal areas of air-space consolidation in nonsegmental
2、distribution and multiple, partly confluent air-space nodules in centrilobular distribution.15.30-year-old man with Mycoplasma pneumoniae pneumonia.A, Chest radiograph reveals coarse reticulation and thickening of bronchovascular bundles in right lower lobe.B, HRCT (1.5-mm collimation) shows nonsegm
3、ental subpleural air-space consolidation (curved arrow), centrilobular nodules(straight arrow), extensive areas of ground-glass attenuation, and interlobular septal thickening.AB16.17-year-old boy with M. pneumoniae pneumonia. HRCT(1.0-mm collimation) reveals nodules smaller than 10mm in diameter (a
4、rrows) in predominantlycentrilobular distribution and areas of GGO. Note sharp demarcation between normal and abnormal secondary pulmonary lobules, consistent with lobular pneumonia.17.55-year-old man with M. pneumoniae pneumonia. HRCT (1.0-mm collimation) at level of right upper (A) and lower (B) l
5、obes show poorly defined nodular and branching opacity with predominantly centrilobular distribution (straight arrow, B) and bronchial wall thickening (curved arrow,A and B).AB18.30-year-old woman with M. pneumoniae pneumonia. CT shows bronchial wall thickening (arrows). Lobular areas of consolidati
6、on and GGO are also seen.BMC Medical Imaging 2009, 9:7 BMC Medical Imaging 2009, 9:7 doi:10.1186/1471-2342-9-7 (1)doi:10.1186/1471-2342-9-7 (1)19.24-year-old man with M. pneumoniae pneumonia. CT shows centrilobular nodules (tree-in-bud, arrows), bronchial wall thickening is also seen.BMC Medical Ima
7、ging 2009, 9:7 BMC Medical Imaging 2009, 9:7 doi:10.1186/1471-2342-9-7 (2)doi:10.1186/1471-2342-9-7 (2)20.Radiology : Volume 238 : Number 1January 2006 (5)Radiology : Volume 238 : Number 1January 2006 (5)Thin-section CT scan demonstrates M.pneumoniae bronchopneumonia in 23-year-old man. Branching ce
8、ntrilobular nodules (tree-in-bud , arrowheads) are seen on a background of faint GGO. Bronchial wall thickening (arrow) is also noted.21.影像学鉴别诊断影像学鉴别诊断 肺炎链球菌肺炎：炎症主要在肺泡腔，呈大片实变，段性支 气管很少进展性病变，少见支气管壁增厚和树芽征金葡菌肺炎：密集的气腔实变，呈小叶性分布或融合成大 片，多发，空洞干酪性肺炎、支气管内膜结核：虫蚀样空洞、多发播散灶巨细胞病毒性肺炎：双侧无数小结节，多见于免疫受损患者卡氏肺孢子菌病：双肺斑片状或大
9、片GGO，呈地图样分布，边 界常清楚，多见于免疫受损患者肺炎衣原体肺炎：小叶中心性结节，支气管扩张、壁增厚， 带状实变；难鉴别结节病： 广泛支气管血管周围结节样增厚22.23.24.25.39-year-old man with S. pneumoniae pneumonia. CT shows air-space consolidation in left lower lobe.BMC Medical Imaging 2009, 9:7 BMC Medical Imaging 2009, 9:7 doi:10.1186/1471-2342-9-7 (3)doi:10.1186/1471-23
10、42-9-7 (3)26.A 49-year-old man with S. pneumoniae pneumonia. HRCT (1-mm collimation) reveals non-segmental air-space consolidation involving the right lower lobe. GGO is only detected around areas of air-space consolidation (arrows)Eur RadiolEur Radiol (2003) 13:515521 (2003) 13:515521DOI 10.1007/s0
11、0330-002-1490-3 (1)DOI 10.1007/s00330-002-1490-3 (1)27.Thin-sectionCT scan demonstrates S.pneumoniae pneumonia in 54-year-old man.Segmental consolidation with air bronchograms (arrows) is seen in right middle lobe. Focal area of GGO (arrowhead) is noted in right lower lobe.Radiology : Volume 238 : N
12、umber 1January 2006Radiology : Volume 238 : Number 1January 2006 (4)(4)28.Axial CT image shows bilateral consolidation and ground-glass densities in a 61-year-old bone marrow recipient with myelodysplastic syndrome. Staphylococcus aureus was cultured from bronchoalveolar lavage.Diagn Interv Radiol 2
13、008;14:75-82Diagn Interv Radiol 2008;14:75-8229.A 38-year-old man with Staphylococcus aureus pneumonia. HRCT scan (1-mm collimation) shows patchy areas of air-space consolidation, consistent with bronchopneumoniaEur RadiolEur Radiol (2003) 13:515521 (2003) 13:515521DOI 10.1007/s00330-002-1490-3 (4)D
14、OI 10.1007/s00330-002-1490-3 (4)30.31-year-old man with severe M. pneumoniae pneumonia with respiratory failure requiring mechanical ventilation. CT shows bilateral air-space consolidation and pleural effusion.BMC Medical Imaging 2009, 9:7 BMC Medical Imaging 2009, 9:7 doi:10.1186/1471-2342-9-7 (4)d
15、oi:10.1186/1471-2342-9-7 (4)31.31-year-old man with severe M. pneumoniae pneumonia with respiratory failure requiring mechanical ventilation. CT shows bilateral air-space consolidation and pleural effusion.BMC Medical Imaging 2009, 9:7 BMC Medical Imaging 2009, 9:7 doi:10.1186/1471-2342-9-7 (4)doi:1
16、0.1186/1471-2342-9-7 (4)32.33.Axial CT image shows consolidation and ill-defined nodules in the posterior segment of right upper lobe in a neutropenic patient with tuberculous infection.Diagn Interv Radiol 2008;14:75-82Diagn Interv Radiol 2008;14:75-8234.35.36.Axial CT image shows bilateral centrilo
17、bular nodules and pleural effusion in Cytomegalovirus infection in a 38-year-old bone marrow recipient.Diagn Interv Radiol 2008;14:75-82Diagn Interv Radiol 2008;14:75-8237.A 31-year-old woman with cytomegalovirus pneumonia after bone marrow transplantation. HRCT scan (1.5-mm collimation) demonstrate
18、s numerous small nodules (arrows)Eur RadiolEur Radiol (2003) 13:515521 (2003) 13:515521DOI 10.1007/s00330-002-1490-3 (5)DOI 10.1007/s00330-002-1490-3 (5)38.24-year-old man with M. pneumoniae pneumonia. CT shows centrilobular nodules (tree-in-bud appearance,arrows). Bronchial wall thickening is also
19、seen.BMC Medical Imaging 2009, 9:7 BMC Medical Imaging 2009, 9:7 doi:10.1186/1471-2342-9-7 (4)doi:10.1186/1471-2342-9-7 (4)39.Pneumonia due to cytomegalovirus in a 45-year-old man who underwent liver transplantation.(a) Chest radiograph obtained 4 weeks after liver transplantation shows patchy air-s
20、pace consolidation in both lungs.An endotracheal intubation tube, a pigtail drainage catheter in the right pleural space, a chest tube in the left pleural space, and a central venous catheter are seen. (b) Thin-section (1-mm collimation) CT scan obtained at the level of the right upper lobe bronchus
21、 2 days before a shows multifocal patchy ground-glass attenuation in both lungs. Note the consolidation (white arrow) and the small, poorly defined nodules (black arrows). There are associated bilateral pleural effusions.40.41.42.A 28-year-old man with AIDS and Pneumocystis carinii pneumonia. HRCT s
22、can (1.5-mm collimation) reveals extensive bilateral areas of GGO in a geographic distribution with sharp demarcation between normal and abnormal lungEur RadiolEur Radiol (2003) 13:515521 (2003) 13:515521DOI 10.1007/s00330-002-1490-3 (2)DOI 10.1007/s00330-002-1490-3 (2)43.P carinii pneumonia in a 32
23、-year-old man with acquired immunodeficiency syndrome. High-resolution CT scan shows areas of ground-glass attenuation with intralobular lines. 1512 November-December 2003 RG f Volume 23 1512 November-December 2003 RG f Volume 23 Number 6 Number 6RadioGraphicsRadioGraphics44.45.46. Transverse thin-s
24、ection CT scan demonstrates C.pneumoniae pneumonia with GGO predominance in 23-year-old man.Extensive areas of GGO are seen in the left lower lobe, which demonstrates thickened bronchovascular bundles(arrows) and fine reticular framework(ie,crazy-paving appearance).Radiology : Volume 238 : Number 1J
25、anuary 2006 (1)Radiology : Volume 238 : Number 1January 2006 (1)47.Thin-section CT scan demonstrates C. pneumoniaebronchopneumonia in 66-year-old man. Centrilobular nodules (arrows) and lobular consolidation with bilateral airway dilatation (arrowheads). Note the associated areas of linear opacity.R
26、adiology : Volume 238 : Number 1January 2006 (1)Radiology : Volume 238 : Number 1January 2006 (1)48.49.50.51-year-old man with CT finding of nodular peribronchovascular interstitial thickening (arrow). Results of transbronchial biopsy were positive for multiple epithelioid granuloma in alveolar pare
27、nchyma and bronchial wall, suggesting sarcoidosis. Results of special stains for acid-fast bacilli and fungi were negative.AJR:191, October 2008 (3)AJR:191, October 2008 (3)51.Sarcoidosis in a 25-year-old asymptomatic man. High-resolution CT scan shows scattered bilateral areas of ground-glass atten
28、uation associated with inter and intralobular lines. 1512 November-December 2003 RG f Volume 23 1512 November-December 2003 RG f Volume 23 Number 6 Number 6RadioGraphicsRadioGraphics52.Hilar adenopathy in a 27-year-old man with Heerfordt syndrome. (a) Chest radiograph demonstrates typical bilateral
29、hilar adenopathy. Adenopathy in the right paratracheal and left aortic-pulmonary window nodes (arrowheads)is also identified. (b) Contrast materialenhanced computed tomographic (CT) scan clearly depicts the bilateral hilar adenopathy (arrowheads).RG f Volume 24 RG f Volume 24 Number 1 Number 153.54.
30、Fig. a, b 1-year-old girl with M. pneumoniae pneumonia.a. Axial contrast-enhanced CT scan (5-mm collimation) shows a lobar consolidation in the left upper lobe with pleural effusion (arrowheads). Mild mediastinal shifting suggests mild volume decrease of the left lung. Note another subsegmental cons
31、olidation in the right upper lobe (arrow). b. 18 months after a shows complete resolution of the previously noted consolidations. A focal region of mosaic oligemia is seen in the right upper lobe (arrows), suggestive of constrictive bronchiolitis. The entire left upper lobe also shows diffuse region
32、s of lucency with oligemia, suggestive of Swyer-James syndrome. Note a linear atelectasis inthe left upper lobe (arrowhead)Eur RadiolEur Radiol (2006) 16: 719725 (2006) 16: 719725DOI 10.1007/s00330-005-0026-DOI 10.1007/s00330-005-0026-z z55.Fig. a, b 2-year-old girl with M. pneumoniae pneumonia.a. A
33、xial contrast-enhanced CT scan (5-mm collimation) shows a lobar consolidation in the left lower lobe. The air bronchogram within the consolidation shows diffuse mild narrowing (white arrow). Small subpleural areas of low attenuation are seen within the otherwise homogeneous consolidation, suggestive
34、 of focal necrosis (black arrows). Note a moderate-sized, ipsilateral pleuraleffusion with diffuse enhancing pleural thickening (arrowheads).b. CT image obtained at a higher level to a shows an enlarged hilar lymph node (arrow)Eur RadiolEur Radiol (2006) 16: 719725 (2006) 16: 719725DOI 10.1007/s0033
35、0-005-0026-DOI 10.1007/s00330-005-0026-z z56.Fig. a, b 14-year-old boy with M. pneumoniae pneumonia.a. Axial contrast-enhanced CT scan (5-mm collimation) shows a segmental consolidation in the right lower lobe with a small amount of pleural effusion. The air bronchogram is well delined within the co
36、nsolidation. b. Lung window image of HRCT (1-mm collimation) shows patchy lobular consolidations with centrilobular and acinar nodules (arrows) around the segmental consolidationEur RadiolEur Radiol (2006) 16: 719725 (2006) 16: 719725DOI 10.1007/s00330-005-0026-DOI 10.1007/s00330-005-0026-z z57.小小 结结58.59.
