碎石路征—83例薄层CT表现

目的：通过列举导致碎石路征表现各类疾病,比较其薄层CT的表现与组织病理学表现的关系。方法：回顾性的分析309医院放射科CT扫描数据库有关碎石路征报道的胸部薄层CT83例患者资料,对碎石路征表现的病例进行研究。结果：83例均表现为碎石路征的病例,包括感染35例（细菌感染6例,病毒性感染16例,真菌感染1例,混合感染12例）;急性呼吸窘迫综合征（ARDS）4例;急性肺水肿3例;间质性肺疾病（UIP,NSIP）18例;腺癌3例;淋巴管癌病3例;淋巴瘤肺浸润2例;放射性肺炎5例;结节病1例;肺泡蛋白沉积症4例;肺泡出血4例;类脂性肺炎1例。结论：碎石路征是一种非特异性的薄层CT征象,可见于感染性、肿瘤性以及一些原因不明的疾病。如果缩小鉴别诊断范围,则可提示某种疾病的诊断。     

CT pathologic correlative study of diffuse panbronchiolitis

We studied CT-pathologic correlations of diffuse panbronchiolitis. The CT images of five DPB patients were compared with inflated lung specimens taken from three open lung biopsy, one lobectomy and one autopsy. The specimens were observed using a stereomicroscope, contact radiographs and histological section. All cases were diagnosed histologically by the presence of unit lesion of panbronchiolitis. The CT findings of DPB were: 1. diffuse small rounded and linear opacities, 2. dilation of small bronchi and bronchioles, 3. bronchial wall thickening. Because small rounded opacities on the CT images were usually separated from the pleura and PV shadows (the edge of secondary lobules) as a constant distance (2 to 3 mm), they were distributed in centrilobular regions. They corresponded to the collection of foamy histiocytes and lymphoid cells, where the unit lesion of panbronchiolitis were included. Although peripheral airways could never be seen in normal CT images, small linear opacities or enlarged peripheral vascular opacities just continuous with small rounded opacities corresponded to bronchioles dilated with intrabronchial secretion. In addition, peripheral airways were sometime seen to be dilated in CT images. Cylindrical airway dilation was more prominent in the peripheral portion of airways in both CT images and lung specimens. Thickening of bronchial wall observed in CT of a case could not be confirmed in lung specimen, in which probably intrabronchial secretion might contribute to bronchial wall thickening. From the viewpoint of diagnosis, the problem is that small nodular shadows are too large to show respiratory bronchiolitis itself. Moreover, because bronchiectasis is often found in the cases of DPB, the relationship between DPB and other causes of bronchiectasis should be evaluated.     

Imaging diagnosis of diffuse infiltrative lung diseases--the role of conventional chest X-ray

The conventional chest X-ray is still useful tool for the diagnosis and evaluation of the diffuse infiltrative lung diseases. The basic approach to the diagnosis by chest X-ray includes the pattern recognition of the abnormal shadows in the lungs, the predominant distribution of them and the presence of volume loss or of overinflation in addition. Typical cases of the idiopathic interstitial pneumonia show diffuse small nodules or ground glass densities in the beginning and proceed to reticulonodular shadows, and further to the coarse reticular shadows or honeycombing. These changes have the preponderance of lower lobe distribution as well as outer zone distribution. Bullous formation is also frequent findings. The characteristic findings of diffuse panbronchiolitis are diffuse small nodular shadows, overinflation and tram-lines. Middle lobe atelectasis is also associated in considerable number.     

小儿支原体肺炎CT表现分析

目的探讨小儿支原体肺炎的CT表现,提高对本病的认识和诊断水平。方法搜集笔者所在医院经临床和实验室检查证实为小儿支原体肺炎116例CT胸部资料进行分析。结果（1）间质浸润51例,表现为肺纹理增厚、增多、模糊或呈网点状阴影;（2）节段或大叶型实质浸润42例;（3）小斑片或扇形浸润型23例,病变自肺门向肺野外呈扇形分布,并发肺门淋巴结肿大7例。结论小儿支原体肺炎CT呈多样性表现,易与小叶性肺炎、大叶性肺炎和病毒性肺炎相混淆,认真分析CT等影像征象,结合临床及实验室检查,有助于作出准确诊断。     

An autopsy case of acute interstitial pneumonia

An autopsy case of a 77-year-old male with acute interstitial pneumonia (AIP) is reported. The patient died of respiratory failure in the extremely rapid course of 8 days. The histogenesis of the thickening of the alveolar wall and the intraluminal lesions were noticed. Incorporation of the hyaline membrane as well as the intraseptal edema and septal cell proliferation played an important role in the fibrous thickening of the alveolar wall. The intraluminal granulation tissue was observed in the alveolar space and the alveolar duct, often extending into the respiratory bronchioles. Intraluminal granulation tissues in the alveoli frequently had the appearance of intraluminal buds of mesenchymal cells, so-called Masson's bodies, and there was little remodeling of pulmonary structures in this case. These findings suggest an acute, diffuse and severe damage of the peripheral respiratory tract and are consistent with bronchiolitis obliterans with classical interstitial pneumonia (BIP) by Liebow and AIP by Katzenstein. This patient had suffered from suspected "Bronchiolitis obliterans organizing pneumonia" (BOOP) one and half years ago. The relationship between AIP, BIP and BOOP is discussed.     

Persistent infiltrative pulmonary disease

Two patients, a woman aged 63 and a man aged 64 years, were admitted with pulmonary complaints and persistent infiltrative lung abnormalities as revealed in chest X-rays. Routine diagnostic analysis did not lead to a diagnosis. However, a pathological examination of biopsies acquired by means of video-assisted thoracoscopic surgery (VATS), revealed bronchiolitis obliterans organising pneumonia (BOOP). In the first patient the BOOP manifested itself as a rapidly progressive disease with fever, pulmonary complaints and X-ray abnormalities. There was no response to standard antibiotic treatment. The other patient had suffered from rheumatoid arthritis for a considerable time and gradually developed BOOP. Both patients recovered following adequate therapy with high doses of oral corticosteroids. BOOP is a pathological-anatomical entity. It is a nonspecific excessive repair response to a variety of stimuli, such as infection, drugs, collagen vascular diseases, inflammatory disorders, transplantation, intoxication and irradiation. BOOP can also occur idiopathically. A high-resolution CT-scan is useful in distinguishing BOOP from interstitial pulmonary fibrosis and other interstitial lung diseases. An open lung biopsy is necessary for the diagnosis BOOP and is best performed by means of VATS. The treatment of BOOP consists of administering high doses of corticosteroids (prednisone 1 mg/kg/day) and if treated adequately, the prognosis is fairly good. Due to the extensive variety in aetiology, the specific diagnostic procedures and the good response to necessary treatment, BOOP should be considered in the differential diagnosis of patients with persistent infiltrative lung disease.     

Can radiologic features of community-acquired pneumonia presume etiologic agents?

During a one-year and nine months (from June 1987 to February 1989) survey of community-acquired pneumonia, we investigated in 130 patients if radiologic features presume etiologic agents. Incidences of etiologic agents are 21 (16%) pneumococcus, 18 (14%) mycoplasma, 14 (11%) tuberculosis, 12 (9%) hemophilus, and 54 (42%) unknown agents, respectively. In correlates of radiologic features and etiologic agents, alveolar shadows spreading bilateral lungs presume tuberculosis and pneumococcal pneumonia. Lobar distributing alveolar shadows presume pneumococcal, mycoplasmal tuberculous diseases and other agents, equally. Segmentally distributing shadows presume pneumococcal and mycoplasma pneumonia. Radiologic subgrouping features of alveolar shadows composed of acinar, lobular, and lobar shadows did not presume specific agents. Centrilobular (peribronchiolar) shadows suspect hemophilus infections. Pleural fluid accumulations suspect tuberculosis and anaerobic infections and cavitary shadows, tuberculosis, respectively. Radiologic features can presume etiologic agents.     

误诊为肺部感染的抗中性粒细胞胞浆抗体相关性小血管炎的CT表现

目的探讨以肺部症状为首发的抗中性粒细胞胞浆抗体(ANCA)相关性小血管炎误诊为肺部感染的CT表现,旨在提高对该类疾病的肺部影像学认识,减少误诊率。方法回顾10例经穿刺活检及临床证实的以肺部症状为首发的ANCA相关性小血管炎误诊为肺部感染的CT表现,结合文献进行分析。结果在10例以肺部症状为首发的ANCA相关性小血管炎中,肺内弥漫性磨玻璃影两例,占20.0%,弥漫粟粒影1例,占10.0%;间质性改变3例,占30.0%,其中网格状2例,蜂窝状1例,小叶间隔增厚两例;多发斑片及片状影4例,占40.0%,边缘模糊,密度不均,其中充气支气管征3例、伴多发结节3例、形成空洞两例;伴有纵隔淋巴结肿大3例、胸腔积液3例、心包积液1例;误诊为普通间质性肺炎3例、细菌性肺炎3例、粟粒型肺结核、浸润型肺结核、卡氏肺孢子虫肺炎及真菌性肺炎各1例。结论以肺部症状为首发的ANCA相关性小血管炎肺部CT表现复杂多样,易误诊为感染性病变,应结合临床实验室及病理检查作出正确诊断。     

136例小儿支原体肺炎肺部影像学改变的临床分析

目的 探讨小儿支原体肺炎的肺部影像学改变,为临床小儿支原体肺炎的诊断提供依据.方法 选取2009年10月-2010年2月在医院就诊的136例支原体肺炎患儿及同期体检的100名健康儿童作为研究对象,136例支原体肺炎患儿设为患儿组,100名健康体检儿童设为健康组,所有入组患儿及健康儿童均行胸部正位X线检查,比较患儿组治疗前与健康组儿童的胸部正位片结果、患儿组治疗前及治疗后胸部正位片结果,总结支原体肺炎儿童的肺部影像学改变特点.结果 支原体肺炎患儿的X线影像学较健康儿童有明显的特异性,肺部均出现阴影,78.7％的患儿表现为单侧下叶肺部阴影,45.6％患儿肺部纹理增多,根据病程的不同,阴影形状亦不同;健康组儿童肺部仅7.0％出现阴影,且都具有支原体肺炎史,患儿治疗前的肺部阴影发生率为100.0％,治疗后肺部阴影发生率为25.0％,治疗前后比较,差异有统计学意义(P＜0.05).结论 小儿支原体肺炎早期临床症状较易和病毒性、细菌性肺炎混淆,但支原体肺炎患儿X线胸片显示,其肺部有明显的影像学特征,可作为诊断的重要证据之一.     

Role of computed tomography in evaluating asbestos related lung disease

To find how computed tomography (CT) may be effectively used in individuals with suspected asbestos related lung disease 30 men with a history of exposure to asbestos were studied. All subjects underwent high kilovoltage posteroanterior and left lateral chest radiographs and chest CT. Eighteen were randomly selected asbestos workers referred for routine surveillance. The remaining 12 were patients who had been referred for investigation of respiratory symptoms or abnormal routine chest radiograph, or both, and found to have chest radiographic changes compatible with asbestos related lung disease. In the group referred for routine surveillance both pleural shadowing and pulmonary shadowing were shown on CT but not chest radiographs in only one case. Five were thought to have pleural shadowing on chest radiographs but this was confirmed on CT in only one case. All 12 patients referred for investigation showed pleural shadowing on chest radiographs; this was confirmed in all cases on CT which also showed unsuspected pulmonary shadowing in five cases. These findings suggest that it is not appropriate to use chest CT routinely in all asbestos workers referred for routine surveillance. When CT is used selectively in those with pleural shadowing on plain chest radiography, however, it is helpful in refuting or confirming the presence of pleural disease and may show unsuspected pulmonary shadowing.     

Role of computed tomography in evaluating asbestos related lung disease.

To find how computed tomography (CT) may be effectively used in individuals with suspected asbestos related lung disease 30 men with a history of exposure to asbestos were studied. All subjects underwent high kilovoltage posteroanterior and left lateral chest radiographs and chest CT. Eighteen were randomly selected asbestos workers referred for routine surveillance. The remaining 12 were patients who had been referred for investigation of respiratory symptoms or abnormal routine chest radiograph, or both, and found to have chest radiographic changes compatible with asbestos related lung disease. In the group referred for routine surveillance both pleural shadowing and pulmonary shadowing were shown on CT but not chest radiographs in only one case. Five were thought to have pleural shadowing on chest radiographs but this was confirmed on CT in only one case. All 12 patients referred for investigation showed pleural shadowing on chest radiographs; this was confirmed in all cases on CT which also showed unsuspected pulmonary shadowing in five cases. These findings suggest that it is not appropriate to use chest CT routinely in all asbestos workers referred for routine surveillance. When CT is used selectively in those with pleural shadowing on plain chest radiography, however, it is helpful in refuting or confirming the presence of pleural disease and may show unsuspected pulmonary shadowing.     

Health hazard of poorly regulated exposure during manufacture of cemented tungsten carbides and cobalt.

Forty two of 125 former workers in a factory in Syracuse, New York, which manufactured hard metal parts from tungsten carbide and cobalt, were studied by chest radiographs, spirometry, and plethysmographically determined lung volumes. The plant was closed in 1982 and the studies were performed in 1983-5. Recorded measurements of carbide dust concentrations were only mildly excessive by modern standards, but deceitful efforts to reduce the apparent concentration of dust were known to have occurred during an inspection by the Occupational Safety and Health Administration. Lung biopsies in four cases in the study and necropsy in one of the 83 cases not studied during life showed giant cell interstitial pneumonia and appreciable concentrations of tungsten carbide. This information indicates that exposure was substantial. Four workers had evidence of pulmonary fibrosis by chest radiographs; two of these workers had normal pulmonary function. Fourteen had abnormal pulmonary function, five of whom had a restrictive pattern, eight a pattern of air trapping, and one a combined pattern. Thus radiographic, or functional abnormalities, or both occurred in 16 of the 42 cases studied. No correlation with duration of exposure was established. Progressive clinically important disease (one fatal) has been found in four ex-workers, two in each of the restrictive and air trapping groups. These findings suggest that poorly regulated dust concentrations in a hard metals factory possibly cause pulmonary abnormalities and sometimes severe illness.     

High resolution computed tomography of diffuse interstitial pneumonia during treatment

HRCT was carried out in twenty patients with diffuse interstitial pneumonia: 13 cases of IIP, 3 of BOOP, 2 of drug-induced pneumonia, 1 of rheumatoid lung and acute interstitial pneumonia of unknown origin. With special attention to inflammatory activity, the patients underwent HRCT periodically during the treatment. Correlative investigation between HRCT image and grade of accumulation in 67Ga scintigraphy was also performed. Response to steroid therapy was clearly reflected on HRCT image, that was shown as decreasing pulmonary density or thinning of honeycomb wall. HRCT is considered to be useful in assessing the activity of diffuse interstitial pneumonia.     

Lung radiology and pulmonary function of children chronically exposed to air pollution

We analyzed the chest radiographs (CXRs) of 249 clinically healthy children, 230 from southwest Mexico City and 19 from Tlaxcala. In contrast to children from Tlaxcala, children from southwest Mexico City were chronically exposed to ozone levels exceeding the U.S. National Ambient Air Quality Standards for an average of 4.7 hr/day and to concentrations of particulate matter (PM) with aerodynamic diameters 相似文献   

Health hazard of poorly regulated exposure during manufacture of cemented tungsten carbides and cobalt.

Forty two of 125 former workers in a factory in Syracuse, New York, which manufactured hard metal parts from tungsten carbide and cobalt, were studied by chest radiographs, spirometry, and plethysmographically determined lung volumes. The plant was closed in 1982 and the studies were performed in 1983-5. Recorded measurements of carbide dust concentrations were only mildly excessive by modern standards, but deceitful efforts to reduce the apparent concentration of dust were known to have occurred during an inspection by the Occupational Safety and Health Administration. Lung biopsies in four cases in the study and necropsy in one of the 83 cases not studied during life showed giant cell interstitial pneumonia and appreciable concentrations of tungsten carbide. This information indicates that exposure was substantial. Four workers had evidence of pulmonary fibrosis by chest radiographs; two of these workers had normal pulmonary function. Fourteen had abnormal pulmonary function, five of whom had a restrictive pattern, eight a pattern of air trapping, and one a combined pattern. Thus radiographic, or functional abnormalities, or both occurred in 16 of the 42 cases studied. No correlation with duration of exposure was established. Progressive clinically important disease (one fatal) has been found in four ex-workers, two in each of the restrictive and air trapping groups. These findings suggest that poorly regulated dust concentrations in a hard metals factory possibly cause pulmonary abnormalities and sometimes severe illness.     

Enhanced expression of angiotensin II type 1 receptor in usual interstitial pneumonia

BACKGROUND: Angiotensin II, a potent vasoconstrictor, has been considered to be involved in various fibrotic disorders including idiopathic interstitial pneumonias. To clarify whether this agent contributes to the development and progression of usual interstitial pneumonia, a major entity of idiopathic interstitial pneumonias, we immunohistochemically examined expression of its specific receptor, angiotensin II type 1 receptor, in human normal and diseased lung tissues. METHODS: Video-assisted thoracoscopic lung biopsy specimens obtained from patients with usual interstitial pneumonia (n=8) were sectioned and stained using single or double immunostaining techniques with specific antibodies against angiotensin II type 1 receptor and smooth muscle actin. Lung tissues of desquamative interstitial pneumonia (n=2) and normal lung tissues (n=6) were also examined for comparative analyses. RESULTS: Expression of angiotensin II type 1 receptor was limited in vascular and bronchial smooth muscle cells in normal lungs. In contrast, the receptor-positive mesenchymal cells, most of which were also positive for smooth muscle actin and arranged like a bundle, were markedly increased in association with dense collagen deposition in thickened alveolar walls of usual interstitial pneumonia. In desquamative interstitial pneumonia, the fibroproliferative change, including angiotensin II type 1 receptor-positive mesenchymal cell proliferation, was milder than that in usual interstitial pneumonia. CONCLUSIONS: These findings suggest that angiotensin II and its type 1 receptor play a profibrogenic role in idiopathic interstitial pneumonias, particularly in usual interstitial pneumonia. Furthermore, angiotensin II type 1 receptor-positive smooth muscle cells increased in diseased lung tissues may be contractile and may contribute to reduction of airspaces in usual interstitial pneumonia.     

Clinical, radiological, and pathological investigation of asbestosis

By the radiological examination, differential diagnosis of asbestosis from chronic interstitial pneumonia such as IPF/UIP is difficult. The pathological features of asbestosis show the peribronchiolar fibrosis which suggest that asbestos fibers cause the inflammation of bronchioli. Therefore, the criteria for pathological diagnosis of asbestosis in 2010, contain the finding of peribronchiolar fibrosis again. Chest CT scanning including HRCT for total of 38 cases clinically diagnosed asbestosis were reviewed by 3 radiologists and one pulmonologist. On the other hand, the histology of lung tissues obtained by surgery or autopsy were examined by 4 pulmonological pathologists. Furthermore, the content of asbestos bodies in the lung was counted by phase-contrast microscopy. Thirteen cases were definitely diagnosed of asbestosis in the image including HRCT and 17 cases were diagnosed by the histopathological examination showing lung fibrosis with peribronchiolar fibrosis. Only 10 cases were indicated asbestosis by both the radiological and histopathological examinations. The mean value of asbestos bodies for these cases, was 2,133,255 per gram of dry lung tissue.     

Computed tomography in the early detection of asbestosis.

Computed tomography (CT; both conventional (CCT) and high resolution (HRCT)) scans of the thorax were evaluated to detect early asbestosis in 61 subjects exposed to asbestos dust in Québec for an average of 22(3) years and in five controls. The study was limited to consecutive cases with chest radiographs of the International Labour Organisation categories 0 or 1 determined independently. All subjects had a standard high kilovoltage posteroanterior and lateral chest radiograph, a set of 10-15 1 cm collimation CCT scans and a set of three to five 2 mm collimation HRCT scans in the upper, middle, and lower lung fields. Five experienced readers independently read each chest radiograph and sets of CT scans. On the basis of three to five readers agreeing for small opacities of the lung parenchyma, 12/46 (26%) negative chest radiographs were positive on CT scans, but 6/18 (33%) positive chest radiographs were negative on CT scan. On the basis of four to five readers agreeing on a chest radiograph, 36/66 (54%) subjects were normal (group A), 17/66 (26%) were indeterminate (group B), and 13/66 (20%) were abnormal (group C). By the combined readings of CCT and HRCT, 4/31 (13%) asbestos exposed subjects of group A were abnormal (p < 0.001), 6/17 (35%) of group B were abnormal, and in group C, 1/13 (8%) was normal, 2/13 were indeterminate, and 10/13 (77%) were abnormal. Separate readings of CCT and HRCT on distinct films in 14 subjects showed that all cases of asbestosis were abnormal on both CCT and HRCT. Inter-reader analyses by kappa statistics showed significantly better agreement for the readings of CT than the chest radiographs (p < 0.001), and for the reading of CCT than HRCT (p < 0.01). Thus CT scans of the thorax identifies significantly more irregular opacities consistent with the diagnosis of asbestosis than the chest radiograph (20 cases on CT scans v 13 on chest radiographs when four to five readers agreed, 13% of asbestos exposed subjects with normal chest radiographs or 21% of asbestos exposed subjects with normal or near normal chest radiographs. It decreased the number of indeterminate cases significantly from 17 on chest radiographs to 13 on CT scans. All cases of asbestosis detected only on CT scans were similarly seen on CCT and HRCT and did not have significant changes in lung function. The CT scans significantly reduced the inter-reader variability, despite the absence of ILO type reference films for these scans.     

A new high resolution computed tomography scoring system for pulmonary fibrosis, pleural disease, and emphysema in patients with asbestos related disease.

The aim of this study was to describe a scoring system for high resolution computed tomographic (HRCT) scans analogous to the International Labour Office (ILO) scoring system for plain chest radiographs in patients with asbestos related disease. Interstitial fibrosis, pleural disease, and emphysema were scored, the reproducibility and the interobserver agreement using this scoring system were examined, and the extent of the various types of disease was correlated with measurements of lung function. Sixty asbestos workers (five women and 55 men) mean age 59 (range 34-78) were studied. The lungs were divided into upper, middle, and lower thirds. An HRCT score for the extent of pleural disease and pulmonary disease in each third was recorded in a way analogous to the International Labour Office (ILO) method of scoring pleural and parenchymal disease on chest radiographs. A CT score for the extent of emphysema was also recorded. Pleural disease and interstitial fibrosis on the plain chest radiographs were assessed according to the ILO scoring system. A chest radiographic score for emphysema analogous to that used for HRCT was also recorded. Two independent readers assigned HRCT scores that differed by two categories or less in 96%, 92%, and 85% compared with 90%, 78%, and 79% of cases for chest radiographs for fibrosis, emphysema, and pleural disease respectively. There was better intraobserver repeatability for the HRCT scores than for the chest radiograph scores for all disorders. Multiple regression analysis showed that scores for interstitial fibrosis, emphysema, and pleural disease on chest radiographs and HRCT correlated to a similar degree with impairment of lung function.     

A new high resolution computed tomography scoring system for pulmonary fibrosis, pleural disease, and emphysema in patients with asbestos related disease.

The aim of this study was to describe a scoring system for high resolution computed tomographic (HRCT) scans analogous to the International Labour Office (ILO) scoring system for plain chest radiographs in patients with asbestos related disease. Interstitial fibrosis, pleural disease, and emphysema were scored, the reproducibility and the interobserver agreement using this scoring system were examined, and the extent of the various types of disease was correlated with measurements of lung function. Sixty asbestos workers (five women and 55 men) mean age 59 (range 34-78) were studied. The lungs were divided into upper, middle, and lower thirds. An HRCT score for the extent of pleural disease and pulmonary disease in each third was recorded in a way analogous to the International Labour Office (ILO) method of scoring pleural and parenchymal disease on chest radiographs. A CT score for the extent of emphysema was also recorded. Pleural disease and interstitial fibrosis on the plain chest radiographs were assessed according to the ILO scoring system. A chest radiographic score for emphysema analogous to that used for HRCT was also recorded. Two independent readers assigned HRCT scores that differed by two categories or less in 96%, 92%, and 85% compared with 90%, 78%, and 79% of cases for chest radiographs for fibrosis, emphysema, and pleural disease respectively. There was better intraobserver repeatability for the HRCT scores than for the chest radiograph scores for all disorders. Multiple regression analysis showed that scores for interstitial fibrosis, emphysema, and pleural disease on chest radiographs and HRCT correlated to a similar degree with impairment of lung function.