胸部常見(jiàn)CT征象認(rèn)讀.小葉支氣管、終末細(xì)支氣管肺動(dòng)脈pulmonaryartery

小葉間隔interlobularsepta

肺靜脈pulmonaryvein

腺泡pulmonaryacini

正常HRCT.中央肺動(dòng)脈。支氣管與相鄰肺動(dòng)脈直徑大致相等。肺動(dòng)脈常分為兩個(gè)直徑相當(dāng)?shù)姆种А?/p>

肺靜脈常分成許多細(xì)小的分支,這些分支與主支構(gòu)成直角。

葉間裂（厚度小于1mm，邊緣光滑，均一厚度）常見(jiàn)偽影雙側(cè)下肺近心臟處，肺血管脈動(dòng)偽影。低密度區(qū)，可以錯(cuò)當(dāng)作擴(kuò)大的支氣管。常見(jiàn)偽影主葉裂偽影。常見(jiàn)偽影血管雙重偽影。正常小葉間隔normalsepta

正常小葉中心動(dòng)脈正常小葉中心動(dòng)脈centrilobularartery2肺靜脈Pulmonaryveins

肺間質(zhì)病變發(fā)生于：慢性間質(zhì)性肺炎、彌漫性間質(zhì)纖維化、結(jié)節(jié)病、癌性淋巴管炎、結(jié)締組織病（紅斑狼瘡、類風(fēng)濕性關(guān)節(jié)炎、硬皮病、皮肌炎）、塵肺（矽肺、煤矽肺、石棉肺）、組織細(xì)胞?。?、淋巴管平滑肌瘤病。ＣＴ：界面征、小葉間隔增厚、小葉中心結(jié)構(gòu)增厚、胸膜下線、長(zhǎng)疤痕線（扭曲肺結(jié)構(gòu)）、蜂窩樣改變、結(jié)節(jié)影、牽拉性支擴(kuò)、磨玻璃樣改變。Case1F/60y乳腺癌術(shù)后，現(xiàn)呼吸困難。分析：（1）小葉間隔增厚分析：（2）支氣管血管周圍間質(zhì)增厚支氣管袖口癥：分析：(3)斜裂增厚分析：（4）大結(jié)節(jié)影網(wǎng)狀陰影：病理上主要為小葉間隔增厚、小葉內(nèi)間隔增厚、小葉核心增厚、胸膜下線影、蜂窩肺和支氣管血管周圍間質(zhì)增厚等改變?？梢?jiàn)于特發(fā)性間質(zhì)性肺炎、結(jié)節(jié)病、癌性淋巴管炎、特發(fā)性含鐵血黃素沉積、感染性疾病等。雙肺網(wǎng)狀陰影多見(jiàn)與特發(fā)性間質(zhì)性肺炎、結(jié)締組織病肺浸潤(rùn)、結(jié)節(jié)病等。單側(cè)以癌性淋巴管炎和放射性肺炎為主。上病例為癌性淋巴管炎。Case279歲、淋巴瘤病史小葉間隔增厚？(a)Yes(b)No雙側(cè)光滑增厚的小葉間隔支氣管血管間質(zhì)是否增厚？(a)Yes(b)No增厚的支氣管血管間質(zhì)胸膜下間質(zhì)增厚？(a)Yes(b)No斜裂增厚Whatisthemostlikelydiagnosis?最可能的診斷？？？(a)Pulmonaryedema(肺水腫）(b)Interstitialfibrosis（間質(zhì)纖維化）(c)Lymphangiticspreadoflymphoma（癌性淋巴管炎）Diagnosis:Lymphangiticspreadoflymphoma,withinterlobularseptalthickening。癌性淋巴管炎（小葉間隔增厚）lymphocyticinterstitialpneumonitis(LIP)淋巴間質(zhì)局限性肺炎Case358-year-oldmanwithheartdisease小葉間隔增厚？？？(a)Yes(b)No雙側(cè)小葉間隔增厚支氣管血管間質(zhì)增厚？？？(a)Yes(b)No支氣管血管間質(zhì)增厚Istherethickeningofthesubpleuralinterstitium?(胸膜下間質(zhì)增厚？)(a)Yes(b)NoNO!!!Whatisthemostlikelydiagnosis?(最可能的診斷？)(a)Pulmonaryedema肺水腫(b)Interstitialfibrosis間質(zhì)纖維化(c)Lymphangiticspreadofcarcinoma癌性淋巴管炎(a)Pulmonaryedema肺水腫Correct.Becauseofthehistoryofheartdisease心臟病史,characteristicabnormalities典型的異常,ymmetry對(duì)稱,andthepredominanceofseptalthickeningindependentlung,thisdiagnosismustbeconsidered考慮mostlikely.文獻(xiàn)：間質(zhì)性肺水腫（1）肺血重新分布：左心衰--肺淤血。（2）支氣管周圍袖口癥：正常厚度約1mm—結(jié)締組織內(nèi)液體存積—增厚。X-肺紋理及肺門血管增粗、模糊.（3）肺透過(guò)度下降：液體分布到支氣管血管周圍、小葉間隔、小葉內(nèi)支氣管血管周圍、肺泡間隔—透過(guò)度下降。（4）間隔線：KerleyB線—x上與肋膈角處與胸膜垂直。（5）胸膜增厚：液體—入臟層胸膜下薄層結(jié)締組織—胸膜下結(jié)締組織水腫--水腫位于臟層胸膜與結(jié)體組織間，不隨體位移動(dòng)。（６）胸腔積液：胸膜腔內(nèi)液體來(lái)自壁層胸膜。不同原因的肺水腫心源性肺水腫：左心衰（見(jiàn)于心梗、二尖瓣病變。腎性肺水腫：急慢性腎功能衰竭，可合并尿毒癥－－水鈉潴留、左心衰－肺水腫－－上腔靜脈、奇靜脈增寬。肺微血管損傷性肺水腫：除肺水腫外，還可見(jiàn)出血及細(xì)胞滲出–肺血分布正常、無(wú)袖口癥、間隔線。肺泡實(shí)變斑片狀，肺野外為分布。毒性氣體吸入、胃液吸入、藥物、溺水、顱內(nèi)壓升高、高原性肺水腫、復(fù)張性肺水腫。Case4a53-year-oldwomanwithandabnormalchestradiographandmildshortness（短缺）ofbreath（異常胸片，氣短）

Isseptalthickeningpresent?(a)Yes(b)No小葉間隔增厚嗎？增厚的小葉間隔Aretheseptasmoothornodularinappearance?(a)Smooth(b)Nodular

小葉間隔增厚是結(jié)節(jié)狀還是光滑增厚？小葉間隔結(jié)節(jié)狀增厚胸膜下間質(zhì)結(jié)節(jié)影支氣管袖口癥Possiblediagnosesinclude:(a)pulmonaryedema肺水腫(b)interstitialfibrosis間質(zhì)纖維化(c)sarcoidosis結(jié)節(jié)病最可能的診斷？sarcoidosis結(jié)節(jié)病Correct.Nodularthickeningofinterlobularseptaandfissurescanbeseeninthisdiseaseandlymphangiticspreadofcarcinoma.（小葉間隔結(jié)節(jié)狀改變可見(jiàn)于結(jié)節(jié)病、癌性淋巴管炎、塵肺）。支氣管血管間質(zhì)、胸膜下間質(zhì)結(jié)節(jié)狀改變—對(duì)結(jié)節(jié)病有特征性的診斷。Case5

a42-year-oldmanwithmildshortnessofbreathforanumberofyears（氣促多年）Isseptalthickeningvisible?(a)Yes(b)No

NextPage

小葉間隔增厚嗎？增厚的小葉間隔扭曲的肺結(jié)構(gòu)葉間裂的扭曲Diagnosis:End-stagesarcoidosiswithfibrosisandinterlobularseptalthickening.結(jié)節(jié)病伴隨征象：肺結(jié)構(gòu)扭曲、小葉間隔結(jié)節(jié)狀增厚、牽拉性支擴(kuò)、蜂窩肺等。文獻(xiàn)：肺間質(zhì)病變界面征：支氣管血管間質(zhì)增厚—支氣管血管束增粗、支氣管袖口癥；液體—邊緣光滑、腫瘤或肉芽組織—結(jié)節(jié)狀界面。胸膜下線：近胸膜面1cm內(nèi)弧線狀影—為肺纖維化征象。長(zhǎng)疤痕線：蜂窩肺：結(jié)節(jié)影：小結(jié)節(jié)—2-5mm，肉芽、腫瘤、纖維組織。肺結(jié)構(gòu)扭曲變形及牽拉支擴(kuò)：磨玻璃樣改變：Case6a68-year-oldwomanwithrheumatoidarthritis（風(fēng)濕性關(guān)節(jié)炎）andprogressive累計(jì)shortness短缺ofbreathovera2-yearperiodThepredominantabnormalfindingonthesescansis?(a)interlobularseptalthickening小葉間隔增厚。(b)honeycombing蜂窩肺主要的異常表現(xiàn)？蜂窩肺部分層面小葉間隔增厚Whatdoeshoneycombingreflecthistologically?(a)Interstitialedema肺間質(zhì)水腫(b)Interstitialinfiltration滲透bycells(c)Interstitialfibrosis蜂窩肺的組織學(xué)—肺間質(zhì)纖維化的后期表現(xiàn)。Diagnosis:Rheumatoidlungdisease,withfibrosisandhoneycombing.風(fēng)濕性肺疾病，肺纖維化、蜂窩肺。壁厚0.8-1MM，胸膜下3-4cm范圍內(nèi)或近葉裂處；早期囊腔小而少；囊壁為折疊破壞的肺泡壁及氣道壁。Case7a74-year-oldwomanwithprogressiveshortnessofbreathover6months

Themostsignificantabnormalfindinginthisstudyis:(a)interlobularseptalthickening小葉間隔增厚(b)honeycombing蜂窩肺(c)subpleuralemphysema胸膜下肺氣腫主要的異常表現(xiàn)？蜂窩肺Whatisthemostlikelydiagnosis?(a)Idiopathicpulmonaryfibrosis(IPF)特發(fā)性肺間質(zhì)纖維化(b)Autoimmunedisease(e.g.,rheumatoidlungdisease)自身免疫性疾病(c)End-stagehypersensitivitypneumonitis過(guò)敏性肺炎(d)Asbestosis石棉肺(e)Drug-relatedlunginjury麻醉藥物肺損害(f)Sarcoidosis結(jié)節(jié)病最可能的診斷？IPF:特發(fā)性肺間質(zhì)纖維化磨玻璃密度：肺野周圍—活動(dòng)性肺泡炎癥。網(wǎng)狀改變：小葉間隔、小葉中心結(jié)構(gòu)增厚—蜂窩狀改變的前期。蜂窩狀改變：胸膜下間質(zhì)纖維化：胸膜下弧線狀影、臟層胸膜及葉間胸膜增厚。肺氣腫：小葉中心型肺氣腫。肺實(shí)變：支擴(kuò)：蜂窩肺牽拉性支擴(kuò)小葉間隔增厚Case8

86-year-oldmanwithchronicmyelogenousleukemia骨髓性的白血病,treatedusingmethotrexate化療,nowcomplainsofshortnessofbreath氣短.DoesthismanshowevidenceoffibrosisandUIP?(a)Yes(b)No顯示明顯的纖維化和普通間質(zhì)性肺炎？？屑性間質(zhì)性肺炎（DIP）、普通性間質(zhì)性肺炎（UIP）。(a)Yes

Correct.Findingsindicativeofusualinterstitialpneumonitis(UIP)visibleinthispatientinclude:honeycombing;蜂窩肺irregularfissures;葉裂扭曲irregularinterlobularseptalthickening;小葉間隔不規(guī)則增厚。tractionbronchiectasis.牽拉性支擴(kuò)蜂窩肺葉裂扭曲不規(guī)則小葉間隔增厚牽拉性支擴(kuò)Themostlikelydiagnosisis:可能的診斷？(a)idiopathicpulmonaryfibrosis(IPF)(b)lunginvolvementbyleukemia白血病肺浸潤(rùn)。(c)drug-relatedlunginjury化療藥物肺損害。(c)drug-relatedlunginjury

Correct.Thepatternoffibrosisseeninthispatientisnonspecific,andcouldbecausedbyIPF.Therecenthistoryoftreatmentwithmethotrexatemakesdrug-relatedfibrosismostlikely.Lunginvolvementbyleukemiawouldlikelyresultinanappearancesimilartothatoflymphangiticspreadofcarcinomawithseptalthickeningbeingthepredominantfinding.IPF一可有同種表現(xiàn)，但患者有最近化療史，白血病肺浸潤(rùn)小葉間隔增厚明顯。Case9

ina63-year-oldmanwithahistoryofscleroderma硬皮病andprogressiveshortnessofbreath進(jìn)行性喘憋

Findingsinclude:

interlobularseptalthickening;小葉間隔增厚。tractionbronchiectasis;牽拉性支擴(kuò)subpleuralhoneycombing;胸膜下蜂窩肺irregularfissures.葉裂扭曲小葉間隔增厚牽拉性支擴(kuò)胸膜下蜂窩肺斜裂扭曲Canyoubeconfidentthatlungfibrosisispresent?(a)Yes(b)No你能確定肺纖維化存在？YesCorrect.Thepresenceofhoneycombingisdiagnosticoffibrosis.Tractionbronchiectasisisalsostronglysuggestiveoffibrosis.Interlobularseptalthickeningandirregularfissuresarenonspecific,andcannotbereliedupontodiagnosefibrosis.蜂窩肺、牽拉性支擴(kuò)—肺纖維化存在。小葉間隔增厚、斜裂扭曲對(duì)肺纖維化的診斷意義不大。Diagnosis:Scleroderma,withlungfibrosis,honeycombing,andtractionbronchiectasis硬皮病—肺纖維化：蜂窩肺、牽拉性支擴(kuò)。結(jié)締組織病及肺血管炎—主要為肺間質(zhì)病變。肺內(nèi)實(shí)變—肺泡內(nèi)滲出、肉芽腫形成、肺泡內(nèi)出血、水腫。肺內(nèi)多發(fā)結(jié)節(jié)—肺內(nèi)血管炎、肉芽腫、肺栓塞所形成。常見(jiàn)于：wengner\類風(fēng)濕性關(guān)節(jié)炎。肺間質(zhì)病變—肺間質(zhì)性肺炎、肺泡炎—間質(zhì)纖維化、蜂窩肺。Case10

ina61-year-oldwomanwithprogressiveshortnessofbreath進(jìn)行性喘憋.Whichofthefollowingfindingsareshownonthisscan?上圖包含癥像:(a)Honeycombing蜂窩肺(b)Asubpleuralline胸膜下線(c)Aperipheralandsubpleuraldistribution外圍胸膜下分布(d)Alloftheabove以上全包括Alloftheabove

Correct.Smallsubpleuralcystsarepresenttypicalofmildhoneycombing.輕度的蜂窩肺Anirregularlineparallelsthepleuralsurface,termedasubpleuralline.胸膜下線Whichofthefollowingismostlikelyinthiscase?最符合的診斷？(a)Idiopathicpulmonaryfibrosis(IPF)特發(fā)性間質(zhì)纖維化(b)Autoimmunedisease(e.g.,rheumatoidlungdisease)自身免疫性疾病(c)End-stagehypersensitivityPneumonitis過(guò)敏性肺炎(d)Asbestosis石棉肺(e)Drug-relatedlunginjury藥物肺損害(f)Sarcoidosis結(jié)節(jié)病Idiopathicpulmonaryfibrosis(IPF)

Correct.Idiopathicpulmonaryfibrosis(IPF).Intheabsenceahistorytosuggestoneofthespecificdiagnosesonthislist,IPFismostlikely.Itaccountsfor60%ofcaseshavingthisappearance.IPF在該病例無(wú)特異性，60%有該表現(xiàn)。Case11a34-year-oldmanwithprogressiveshortnessofbreath喘憋Thepredominantabnormalityinthiscaseis:明顯的異常表現(xiàn)(a)honeycombing蜂窩肺(b)intralobularinterstitialthickening小葉間質(zhì)增厚intralobularinterstitialthickening

Correct.Honeycombingisnotvisibleinthispatient.Afineirregularreticular不規(guī)則的網(wǎng)狀改變patternispresentinthelungperiphery,representingintralobularinterstitialthickening.小葉間質(zhì)增厚Insomepatientswithpulmonaryfibrosis,thisfindingwillpredominate.Otherfindingsoffibrosisinthispatientincludetractionbronchiectasis.牽拉性支擴(kuò)Thedifferentialdiagnosisofthisappearanceisidenticalasthatforhoneycombing.小葉間質(zhì)增厚牽拉性支擴(kuò)Diagnosis:Idiopathicpulmonaryfibrosis特發(fā)性間質(zhì)纖維化,withintralobularinterstitialthickening.Case12a71-year-oldmanwithprogressiveshortnessofbreathThepredominantabnormalityinthiscaseis:突出的表現(xiàn)(a)honeycombing蜂窩肺(b)intralobularinterstitialthickening小葉間質(zhì)增厚intralobularinterstitialthickening

Correct.Honeycombingisnotclearlyseeninthispatient.Afinebutirregularreticularpattern不規(guī)則的網(wǎng)狀改變ispresentinthelungperiphery外圍,representingintralobularinterstitialthickening小葉間質(zhì)增厚.Insomepatientswithpulmonaryfibrosis,thisfindingwillpredominate.Otherfindings其他征象offibrosisinthispatientincludetractionbronchiectasis牽拉性支擴(kuò),andirregularinterlobularseptalthickening不規(guī)則小葉間隔增厚.Thedifferentialdiagnosisofthisappearanceisidenticaltothatforhoneycombing.小葉間質(zhì)增厚牽拉性支擴(kuò)不規(guī)則小葉間隔增厚Diagnosis:Idiopathicpulmonaryfibrosis特發(fā)性間質(zhì)纖維化,withintralobularinterstitialthickening.Case1334-year-oldwomanwithlupuserytematosus狼瘡紅斑Canyoudiagnosefibrosis?能診斷纖維化？(a)Yes(b)No

Yes

Correct.HRCTobtainedinthesupineandpronepositions仰臥和俯臥位showsanumberoffindingsindicatingfibrosis指示,including:honeycombingwhichismildindegree;輕度蜂窩肺tractionbronchiectasis;牽拉性支擴(kuò)intralobularinterstitialthickening;小葉間質(zhì)增厚interlobularseptalthickening小葉間隔增厚;andasubpleuraldistribution.胸膜下分布輕度蜂窩肺牽拉性支擴(kuò)小葉間質(zhì)增厚小葉間隔增厚Diagnosis:Systemiclupuserythematosus（SLE系統(tǒng)性紅斑狼瘡肺部表現(xiàn)—肺結(jié)締組織病,withfibrosisandhoneycombing.Case14

a65-year-oldwomanwithrheumatoidarthritis風(fēng)濕性關(guān)節(jié)炎andmilddyspnea

輕度呼吸困難Canyoudiagnosefibrosis?能診斷纖維化？(a)Yes(b)NoCorrectincluding:tractionbronchiectasis;牽拉性支擴(kuò)intralobularinterstitialthickening;小葉間質(zhì)增厚asubpleuralline.胸膜下線牽拉性支擴(kuò)小葉間質(zhì)增厚胸膜下線Diagnosis:Rheumatoidlungdisease肺結(jié)締組織病,withmildpulmonaryfibrosis輕度肺纖維化andintralobularinterstitialthickening小葉間質(zhì)增厚.Case15a26-year-oldwomanwithmixedconnectivetissuedisease混合結(jié)締組織病,basilarcracklesonphysicalexamination雙肺底水泡音,andrestrictivediseaseonpulmonaryfunctiontests

肺功能受限Canyoudiagnosefibrosis?能診斷纖維化？(a)Yes(b)NoYes

Correct.Including:tractionbronchiectasis;牽拉性支擴(kuò)intralobularinterstitialthickening小葉間質(zhì)增厚;asubpleuraldistribution胸膜下分布牽拉性支擴(kuò)小葉間質(zhì)增厚Diagnosis:Mixedconnectivetissuedisease混合結(jié)締組織病,withpulmonaryfibrosis,andintralobularinterstitialthickeningCase16a81-year-oldmanwithsignificantoccupationalexposuretoasbestos石棉職業(yè)史Ispulmonaryfibrosispresent?肺纖維化存在？(a)Yes(b)NoYes

Correct.Findingsoffibrosisinclude:tractionbronchiectasis;牽拉性支擴(kuò)intralobularinterstitialthickening;小葉間質(zhì)增厚asubpleuraldistribution.胸膜下分布irregularinterlobularseptalthickening不規(guī)則的小葉間隔增厚牽拉性支擴(kuò)小葉間質(zhì)增厚胸膜下分布小葉間隔增厚Diagnosis:石棉肺Asbestosiswithtractionbronchiectasis牽拉性支擴(kuò)andintralobularinterstitialthickening小葉間質(zhì)纖維化.縱隔窗pleuralthickeningandcalcification胸膜增厚、鈣化椎旁區(qū)域橫膈胸膜肥厚鈣化Case17a58-year-oldmanwithahistoryofasbestosexposure石棉史

可見(jiàn)椎旁胸膜增厚、不規(guī)則線狀影Thepleuralthickeningistypicalofasbestosexposure胸膜增厚是典型的石棉肺表現(xiàn).Wouldyoudiagnoseasbestosis診斷石棉肺嗎?(a)Yes(b)NoNo

Correct.Linearopacities線狀影asseeninthiscase(termedparenchymalbands肺實(shí)質(zhì)帶)arecommoninpatientswithpleuralthickening胸膜增厚,butarenotnecessarilyassociated不必須考慮withlungfibrosis肺纖維化.肺實(shí)質(zhì)帶parenchymalbands位于下肺部，肺內(nèi)條狀影；肺實(shí)質(zhì)內(nèi)的纖維化。盡管如此，結(jié)合病史，考慮Asbestosexposurewithpleuraldiseaseandparenchymalbands石棉至椎旁胸膜增厚、肺實(shí)質(zhì)帶。Case18a67-year-oldmanwithahistoryofasbestosexposure石棉史No

Correct.HRCTatlungwindowsshowsirregularlinearopacities不規(guī)則的線狀影(“crow‘sfeet”烏鴉腳),withoutevidenceofhoneycombing無(wú)蜂窩肺,intralobularinterstitialthickening小葉間質(zhì)增厚,ortractionbronchiectasis牽拉性支擴(kuò).Thisappearancedoesnotindicateasbestosis無(wú)石棉特征.Linearopacities,asseeninthiscase(parenchymalbands肺實(shí)質(zhì)帶)arecommoninpatientswithpleuralthickeningrelatedtoasbestosexposure,butarenotnecessarilyassociatedwithlungfibrosis不必須考慮肺纖維化.Theyrepresentfocalareasofatelectasis焦點(diǎn)為肺膨脹不全,associated聯(lián)系withthepleuralthickening,orfocalareasofscarring焦點(diǎn)區(qū)疤痕.烏鴉腳（"crow'sfeet"),即盡管如此，結(jié)合病史考慮Asbestosexposurewithpleuraldiseaseandparenchymalbands。另一病例：胸膜下線椎旁胸膜增厚Case19a56-year-oldmanwithsignificantoccupationalexposuretoasbestos石棉史Istherepleuralthickening胸膜增厚youwouldconsider考慮likely可能duetoasbestosexposure石棉?(a)Yes(b)NoYes

correct.Afocal焦點(diǎn),calcifiedpleuralplaque胸膜鈣斑isvisibleanteriorly,typicalofasbestosexposure石棉肺典型表現(xiàn).Althoughplaquesaremorelikelyposteriorinlocation常見(jiàn)后胸膜,thisappearanceishighlysuggestive高度提示.Canadefinitediagnosisofpulmonaryfibrosisonthepronelungwindowscansbemade?肺窗能明確診斷肺纖維化嗎？(a)Yes(b)NoNo

Correct.Thereismildseptalthickening輕度間隔增厚andreticulation

網(wǎng)狀intheposteriorsubpleuralregion后胸膜下ontheright.Thisisunassociated無(wú)聯(lián)系withadjacent臨近pleuralthickening.Thisisaverysubtleabnormality輕微的異常whichcouldrepresenttheearlieststageofasbestosis石棉肺早期表現(xiàn).However,intheabsenceofamoredefiniteabnormality明確的異常orsimilar類似findingsontheleft,itwouldbedifficult困難tomakeadefinitediagnosisoffibrosis石棉肺或肺纖維化的診斷orasbestosis.小葉間質(zhì)增厚—輕度網(wǎng)狀改變Diagnosis:Asbestosisexposure石棉肺.Possiblefibrosis可能纖維化.文獻(xiàn)：石棉肺[1]胸膜改變：胸膜斑、彌漫性胸膜增厚、胸腔積液。[2]肺改變：彌漫性肺間質(zhì)纖維化—HRCT胸膜下弧線、胸膜下點(diǎn)狀致密影、肺實(shí)質(zhì)帶、蜂窩狀改變、胸膜下磨玻璃表現(xiàn)（肺泡壁小葉間隔增厚）；圓形肺不張（支氣管血管結(jié)構(gòu)進(jìn)入-彗星尾征）。Case20a57-year-oldwomanwithyearsofprogressivedyspnea多年呼吸困難Ispulmonaryfibrosispresent?肺纖維化存在嗎？(a)Yes(b)NoYes

Correct.Thispatientshowsanumberof許多findingsindicativeofpulmonaryfibrosis肺纖維化征象.Theseinclude:Extensive廣泛的tractionbronchiectasis

牽拉性支擴(kuò)involvingbothupperlobes雙上葉;Irregularreticularopacities不規(guī)則的網(wǎng)狀anddistortionoflungarchitecture肺結(jié)構(gòu)扭曲associatedwithtractionbronchiectasis;andHoneycombingatthelungbas