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Rheumatoid Arthritis 类风湿性关节炎
Pub Date : 2019-07-01 DOI: 10.1093/med/9780199858064.003.0059
Felipe Martinez
Rheumatoid arthritis (RA) is a progressive chronic systemic autoimmune disorder characterized by symmetric deforming erosive synovitis. Pulmonary involvement may occur in 18% of all patients with RA, is one of the most common extra-articular manifestations of the disease and is a major cause of morbidity and mortality. The most common pleuropulmonary manifestations of RA are rheumatoid-associated interstitial lung disease (RA-ILD), drug related lung disease, infection secondary to immunosuppression, necrobiotic nodules, organizing pneumonia, upper and lower airway disease, pulmonary vascular disease and serositis. A normal chest radiograph does not exclude RA-ILD. As disease progresses, radiographic abnormalities may become more apparent. Thin-section or high resolution computed tomography (HRCT) remains the study of choice to assess RA-ILD. Patients with RA-ILD have a slightly increased incidence of lung cancer, and radiologists must carefully scrutinize images looking for discrete nodules and masses.
类风湿性关节炎(RA)是一种进行性慢性系统性自身免疫性疾病,其特征是对称变形糜烂性滑膜炎。18%的类风湿性关节炎患者可能出现肺部受累,这是该疾病最常见的关节外表现之一,也是发病率和死亡率的主要原因。RA最常见的胸膜肺表现为类风湿相关性间质性肺病(RA- ild)、药物相关性肺病、免疫抑制继发感染、坏死性结节、组织性肺炎、上、下气道疾病、肺血管疾病和浆液炎。正常胸片不能排除RA-ILD。随着疾病进展,影像学异常可能变得更加明显。薄层或高分辨率计算机断层扫描(HRCT)仍然是评估RA-ILD的首选研究方法。RA-ILD患者的肺癌发病率略有增加,放射科医生必须仔细检查图像,寻找离散的结节和肿块。
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引用次数: 0
Thoracostomy Tubes and Mediastinal Drains 开胸管和纵隔引流管
Pub Date : 2019-07-01 DOI: 10.1093/MED/9780199858064.003.0010
T. Ternes
The Thoracostomy and Mediastinal Drains chapter addresses a group of medical devices used to drain intrathoracic collections of fluid or air. A chest (thoracostomy) tube is a broad term used for a variety of hollow catheters used for pleural drainage. Occasionally, the drain is placed in the mediastinum, and in these instances the term mediastinal drain is preferred. Thoracostomy tubes are typically placed in the pleural space for treatment of pneumothorax or pleural fluid. Tube sizes range from 6F to 40F, depending on the clinical scenario. Small catheters are often placed with Seldinger technique, whereas larger tubes are usually placed with blunt dissection. The tube is typically directed towards the apex in the setting of pneumothorax and towards the posterior base for treatment of pleural fluid collections. When interpreting radiographs following chest tube placement, the radiologist should ensure that the tube and sideport are positioned within the pleural space or the desired anatomic location. It is also imperative to exclude intraparenchymal or intrafissural tube placement and tube kinking.
胸腔造口术和纵隔引流章节介绍了一组用于引流胸腔内液体或空气的医疗设备。胸(开胸)管是用于胸腔引流的各种中空导管的总称。偶尔,引流管放置在纵隔,在这些情况下,首选术语纵隔引流。为了治疗气胸或胸腔积液,通常将开胸管置于胸膜间隙。根据临床情况,试管尺寸从6F到40F不等。小导管通常采用Seldinger技术放置,而较大的导管通常采用钝性夹层放置。在气胸的情况下,管通常指向顶点,在治疗胸腔积液时,管通常指向后底。在解释胸管置入后的x线片时,放射科医生应确保胸管和侧口位于胸膜间隙内或所需的解剖位置。排除实质内或裂隙内置管和管扭结也是必要的。
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引用次数: 0
Amyloidosis 淀粉样变
Pub Date : 2019-07-01 DOI: 10.1093/med/9780199858064.003.0064
Felipe Martinez
Amyloidosis is a group of disorders characterized by over expression and extracellular deposition of amyloid with resultant organ dysfunction. The disease produces significant morbidity and mortality and its prevalence is increasing. Amyloidosis becomes clinically significant when organ function is impaired either due to loss of normal cell structure or mass effect from accumulating amyloid. The current classification of amyloidosis is based on the different types of fibrillar proteins which define organ involvement and disease manifestations. The heart is the most commonly involved organ in the chest, and progressive systolic dysfunction in a patient with ventricular hypertrophy is common. Pulmonary involvement is relatively rare and is more common in the localized form of the disease. There are systemic and localized forms of the disease, with systemic disease being more common. High resolution computed tomography (HRCT) is the modality of choice to evaluate patients with suspected tracheopulmonary amyloidosis. Cardiac MRI is the imaging modality of choice for evaluating patients with suspected amyloid cardiomyopathy.
淀粉样变性是一组以淀粉样蛋白过度表达和细胞外沉积并导致器官功能障碍为特征的疾病。该病的发病率和死亡率都很高,其流行率正在上升。当器官功能因正常细胞结构的丧失或淀粉样蛋白积累引起的团块效应而受损时,淀粉样变性就变得具有临床意义。目前淀粉样变性的分类是基于不同类型的纤维蛋白来定义器官受累和疾病表现。心脏是胸部最常见的受累器官,进行性收缩功能障碍在心室肥厚患者中很常见。肺受累是相对罕见的,更常见的是在局部形式的疾病。该病有全身性和局部性两种形式,其中全身性疾病更为常见。高分辨率计算机断层扫描(HRCT)是评估疑似气管肺淀粉样变患者的首选方式。心脏MRI是评估疑似淀粉样心肌病患者的首选成像方式。
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引用次数: 0
Pulmonary Metastases 肺转移
Pub Date : 2019-07-01 DOI: 10.1093/med/9780199858064.003.0051
T. Ternes
Pulmonary metastases represent spread of malignancy to the lung parenchyma. Patients with metastatic disease may present with dyspnea, cough, or hemoptysis. Alternatively, affected patients may be asymptomatic. The lungs are a common site for metastatic disease. Relatively common primary malignancies (breast, colon, lung, and kidney cancers) are the most common causes of pulmonary metastases. However, less common primary malignancies (choriocarcinoma, testicular cancers, melanoma, and sarcomas) have a higher likelihood to produce lung metastases. The vast majority of pulmonary metastases spread via the bloodstream. Hematogenous metastases are typically basilar predominant lung nodules. Metastatic nodules may be very small (miliary, < 3mm), or very large (cannonball), and may rarely be solitary. The presence of surrounding ground-glass attenuation (CT-Halo sign) often indicates surrounding hemorrhage. Some metastases may be cavitary or calcified. Pulmonary metastases may spread via the lymphatics. Asymmetric smooth or nodular interlobular septal thickening should raise concern for lymphangitic carcinomatosis. An uncommon mechanism is spread within the airways, which may result in an endobronchial lesion or post obstructive atelectasis.
肺转移表示恶性肿瘤向肺实质扩散。转移性疾病患者可能出现呼吸困难、咳嗽或咯血。或者,受影响的患者可能是无症状的。肺是转移性疾病的常见部位。相对常见的原发性恶性肿瘤(乳腺癌、结肠癌、肺癌和肾癌)是肺转移最常见的原因。然而,不太常见的原发性恶性肿瘤(绒毛膜癌、睾丸癌、黑色素瘤和肉瘤)有更高的可能性产生肺转移。绝大多数肺转移瘤通过血流扩散。血液转移是典型的基底区为主的肺结节。转移性结节可以很小(粟粒,< 3mm),也可以很大(炮弹状),很少是孤立的。周围磨玻璃衰减(ct晕征)常提示周围出血。一些转移灶可能是空洞或钙化的。肺转移瘤可经淋巴管扩散。不对称的平滑或结节状小叶间隔增厚应引起对淋巴管癌的关注。一种罕见的机制是在气道内传播,这可能导致支气管内病变或阻塞性肺不张。
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引用次数: 0
Systemic Sclerosis 系统性硬化病
Pub Date : 2019-07-01 DOI: 10.1093/med/9780199858064.003.0060
Felipe Martinez
Systemic sclerosis (SSc), or scleroderma is a chronic autoimmune disorder of small vessels and connective tissue characterized by organ fibrosis, small vessel vasculopathy and disease-specific antibodies. It results in multi system organ fibrosis. The skin, lungs, heart, gastrointestinal tract and kidneys are frequently affected. Skin involvement is typical. Clinically evident pulmonary disease is seen in 25% of affected patients, but autopsy reports demonstrate some degree of pulmonary involvement in all patients with the systemic form of the disease. Pulmonary disease is second only to esophageal fibrosis and has surpassed renal disease as the leading cause of death. Systemic sclerosis associated-interstitial lung disease (SSc-ILD) and pulmonary vascular disease are the two major lung manifestations of SSc. Pulmonary hypertension is the leading cause of death. A normal chest radiograph does not exclude SSc-ILD. High resolution CT (HRCT) should be part of the initial evaluation of patients with SSc, even when pulmonary symptoms are not present. The radiologist should be able to recognize signs of early pulmonary fibrosis and pulmonary hypertension on radiography and HRCT due to the proven benefit of adequate therapy in overall outcome and mortality.
系统性硬化症(SSc)或硬皮病是一种小血管和结缔组织的慢性自身免疫性疾病,其特征是器官纤维化、小血管病变和疾病特异性抗体。它会导致多系统器官纤维化。皮肤、肺、心脏、胃肠道和肾脏经常受到影响。皮肤受累是典型的。临床表现明显的肺部疾病见于25%的受影响患者,但尸检报告显示,所有患有全身性疾病的患者都有一定程度的肺部病变。肺部疾病是仅次于食道纤维化的第二大死因,并已超过肾脏疾病成为导致死亡的主要原因。系统性硬化症相关间质性肺病(SSc- ild)和肺血管病是SSc的两种主要肺部表现。肺动脉高压是导致死亡的主要原因。正常胸片不能排除SSc-ILD。即使没有肺部症状,高分辨率CT (HRCT)也应作为SSc患者初步评估的一部分。放射科医生应该能够在x线摄影和HRCT上识别早期肺纤维化和肺动脉高压的迹象,因为充分的治疗对总体结果和死亡率有好处。
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引用次数: 0
Congenital Bronchial Atresia 先天性支气管闭锁
Pub Date : 2019-07-01 DOI: 10.1093/MED/9780199858064.003.0089
R. Benson
Congenital bronchial atresia (CBA) is a benign congenital abnormality in which there is focal atresia of a segmental bronchus with resultant distal endobronchial mucocele (bronchocele) and surrounding hyperlucent lung. Affected patients are typically young and asymptomatic, and the diagnosis is usually incidental. CBA is an imaging diagnosis that may be suspected on radiography but is usually confirmed on chest CT. The typical imaging appearance is a round, tubular or branching, non-enhancing mucocele with surrounding localized hyperlucent lung. Asymptomatic patients require no further imaging or treatment. However, surgical resection of the affected lung can be considered for symptomatic patients with recurrent pulmonary infections.
先天性支气管闭锁(CBA)是一种良性先天性异常,其表现为局灶性支气管闭锁,导致远端支气管内粘液囊肿(支气管)和周围高透光肺。受影响的患者通常年轻且无症状,诊断通常是偶然的。CBA是一种影像学诊断,在x线摄影上可能有怀疑,但通常在胸部CT上得到证实。典型的影像学表现为圆形、管状或分支状、无强化的粘液囊肿,周围有局限性高透光肺。无症状患者无需进一步影像学检查或治疗。然而,对于有症状的反复肺部感染患者,可以考虑手术切除受影响的肺。
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引用次数: 0
Cystic Lung Disease 囊性肺病
Pub Date : 2019-07-01 DOI: 10.1093/MED/9780199858064.003.0074
J. Bueno
A lung cyst is a round parenchymal lucency or low-attenuating area with a well-defined interface with adjacent normal lung and surrounded by an epithelial or fibrous wall that is often less than 2 mm in thickness. Diseases that manifest with lung cysts comprise a limited but well known group of entities. Classic diseases manifesting with diffuse lung cysts include pulmonary Langerhans cell histiocytosis (PLCH), lymphangioleiomyomatosis (LAM), lymphocytic interstitial pneumonia (LIP) and Birt-Hogg-Dubé syndrome. However, it is important to recognize other conditions that may mimic cystic lung disease, such as pneumatoceles, tracheobronchial papillomatosis, cavitary disease (e.g. tuberculosis, fungal infection), bronchiectasis, and emphysema. Differentiation between true cysts and cyst mimics may be difficult, and may rely on identification of ancillary findings.
肺囊肿是一个圆形的实质透明或低衰减区,与邻近的正常肺有明确的界面,被上皮或纤维壁包围,厚度通常小于2mm。以肺囊肿表现的疾病包括一组有限但众所周知的实体。以弥漫性肺囊肿为表现的典型疾病包括肺朗格汉斯细胞组织细胞增生症(PLCH)、淋巴管平滑肌瘤病(LAM)、淋巴细胞间质性肺炎(LIP)和birt - hogg - dub综合征。然而,重要的是要认识到其他可能类似囊性肺病的疾病,如气肿、气管支气管乳头状瘤病、空洞病(如肺结核、真菌感染)、支气管扩张和肺气肿。区分真囊肿和囊肿模拟可能很困难,并且可能依赖于辅助发现的识别。
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引用次数: 0
Common Abnormalities on Portable Chest Radiography 便携式胸片常见异常
Pub Date : 2019-07-01 DOI: 10.1093/MED/9780199858064.003.0011
B. Little
Several acute pulmonary diseases are common in the inpatient setting including: Pneumonia, Aspiration, Pulmonary edema, Acute respiratory distress syndrome (ARDS), Atelectasis, and Pleural effusions or hemothorax. Appreciation of the clinical presentations and common imaging findings of these diseases is essential in interpreting bedside chest radiography. The chest radiograph is the most commonly performed radiographic examination, and bedside radiography plays an important role in assessing acute cardiopulmonary disease in the inpatient setting, particularly within intensive care units (ICUs). Radiologists must be aware of the range of abnormalities that manifest on bedside chest radiography in order to optimize patient care.
几种急性肺部疾病在住院患者中很常见,包括:肺炎、误吸、肺水肿、急性呼吸窘迫综合征(ARDS)、肺不张、胸腔积液或血胸。了解这些疾病的临床表现和常见影像学表现是解释床旁胸片的必要条件。胸部x线摄影是最常用的放射检查,床边x线摄影在评估住院患者的急性心肺疾病方面发挥着重要作用,特别是在重症监护病房(icu)。放射科医生必须意识到床边胸部x光片显示的异常范围,以便优化患者护理。
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引用次数: 0
Diffuse Infiltrative Lung Disease 弥漫性浸润性肺病
Pub Date : 2019-07-01 DOI: 10.1093/MED/9780199858064.003.0072
S. Martinez-Jiménez
Diffuse infiltrative lung disease refers to disorders with imaging abnormalities consisting of diffuse opacities that may manifest as reticular opacities, micronodules, hazy opacities or frank airspace disease. Diffuse infiltrative lung disease often refers to diffuse radiographic abnormalities that are optimally characterized on thin-section CT (e.g. interstitial lung disease such as UIP or NSIP). However, diffuse opacities on radiography may manifest with other findings on CT (e.g. cysts or emphysema). In addition, patients with diffuse infiltrative lung disease on CT may have normal radiographs (e.g. NSIP or pneumocystis pneumonia). The next chapters address pulmonary diseases manifesting with diffuse opacities on either chest radiography or CT, with an emphasis on the formulation of a narrow differential diagnosis.
弥漫性浸润性肺病是指影像学异常的疾病,包括弥漫性混浊,可表现为网状混浊、微结节、雾状混浊或frank空域疾病。弥漫性浸润性肺疾病通常是指在薄层CT上表现最佳的弥漫性影像学异常(如间质性肺疾病如UIP或NSIP)。然而,x线片上的弥漫性阴影可能与CT上的其他表现(如囊肿或肺气肿)同时表现。此外,CT表现为弥漫性浸润性肺疾病的患者可能有正常的x线片(如NSIP或肺囊虫性肺炎)。下一章讨论肺部疾病,表现为胸片或CT上的弥漫性混浊,重点是狭义鉴别诊断的制定。
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引用次数: 0
Introduction to Iatrogenic Conditions 医源性疾病导论
Pub Date : 2019-07-01 DOI: 10.1093/MED/9780199858064.003.0068
S. Bhalla
Post-therapy imaging interpretation can be challenging. In most practices, the main thoracic interventions include drug therapy, surgery and radiation therapy. In certain practices, especially in the absence of stereotactic radiation, radiofrequency ablation and cryoablation have gained a foothold. Post -therapeutic changes in the lung may be divided into two main categories: local and diffuse. Local changes are usually seen with radiation and percutaneous therapies. Diffuse changes mainly include organizing pneumonia and alveolar damage. The latter may be seen after both medical and surgical intervention. Two key questions must be answered when dealing with the treated patient: what was the prior therapy and when was the treatment. Both questions will help determine the significance of the imaging findings.
治疗后影像学解释可能具有挑战性。在大多数实践中,主要的胸部干预包括药物治疗、手术和放射治疗。在某些实践中,特别是在没有立体定向辐射的情况下,射频消融和冷冻消融已经获得了立足点。治疗后肺的改变可分为两大类:局部和弥漫性。局部病变通常在放疗和经皮治疗时可见。弥漫性改变主要包括组织性肺炎和肺泡损伤。后者可以在医学和外科干预后看到。在处理接受治疗的病人时,必须回答两个关键问题:先前的治疗是什么,治疗是什么时候。这两个问题将有助于确定成像结果的重要性。
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引用次数: 0
期刊
Chest Imaging
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