肺部感染-影像学和病理

细菌性-小叶性肺炎
病原菌：Staphylococcus aureus Escherichia coli Pseudomonas aeruginosa Anaerobes
Haemophilus influenzae
病理生理：
A:病原菌到达细支气管形成小叶中心结节和分枝斑 片 B，C:支气管周围实变，小叶或部分小叶分布， 呈多中心，实变不跨国小叶间裂
Chest radiograph shows areas of consolidation in the right upper and left lower lobes. The patient was a 23-year-old man With bronchopneumonia
High-resolution computed tomography (CT) scan shows centrilobular nodules (arrows) and lobular areas of consolidation (arrowhead) and ground-glass opacity (curved arrow). The patient was a 53-year-old man with bronchopneumonia.
并发症-肺脓肿
病原菌：anaerobic bacteria ，S. aureus, P. aeruginosa, and K. pneumoniae
Inflammatory mass with central purulent necrosis Frequently cavitate Smooth or shaggy inner margins Air-liquid levels common Maximal wall thickness usually <15 Low-attenuation central region and rim enhancement on CT scan
Necrotizing pneumonia. Chest radiograph (A) shows inhomogeneous and dense consolidation in the right lung. Computed tomography (CT) (B) image shows a large cavity and sloughed lung within the cavity (arrow). The patient was a 42year-old alcoholic man with necrotizing pneumonia secondary to Klebsiella pneumoniae and anaerobic organisms.
并发症-坏死性肺炎
Bulging fissure sign. Posteroanterior chest radiograph shows dense right upper lobe airspace consolidation with downward bulging of the minor fissure. The patient was a 66-year-old man with pneumococcal pneumonia.
Round pneumonia due to Streptococcus pneumoniae
Bronchiolitis and bronchopneumonia due to Streptococcus pneumoniae
肺部感染影像学和病理
流行病学 影像学 病理学
Outline
细菌性-大叶性肺炎
病原菌：Streptococcus pneumoniae ，CAP(35%), Klebsiella pneumoniae Legionella pneumophila
病理生理：如下图
early (A) and advanced (B) stages of lobar pneumonia caused by Streptococcus pneumoniae. In (A), the airspaces are filled with edema fluid; only occasional neutrophils are evident. In (B), neutrophils predominate.
Acute bronchopneumonia. Low magnification photomicrograph shows several small foci of consolidation located around the lumens of small bronchioles (arrows).
并发症-气瘤
病原菌：金葡菌（儿童），PCP（免疫抑制的成人） 特点：薄壁含气空洞，数天或周内扩大，可导致气胸，数周或数月吸收
肺脓栓
来源：心内膜炎，血栓性静脉炎，静脉置 管，起搏器导线。
影像学特点：空洞小结节，Feeding vessel sign
பைடு நூலகம்
image (A) shows two vessels apparently coursing into a nodule (feeding vessel sign ） image (B) demonstrates that the only vessel in close contact with the nodule is a draining vein (arrow).
肺炎链球菌肺炎
CAP的主要致病菌（40%） 危险因素：高龄，慢性心肺疾病 主要影像学表现：均一实变，毗邻脏层胸
膜 次要表现：小叶性肺炎（20-35%），球形
实变（圆肺炎），叶间裂膨出高密度实变 其他：胸腔积液（10%），同侧淋巴节肿大
（CT上50%）。 CT价值：明确有无空洞或积脓
Lobar pneumonia due to streptococcus pneumonia