ct gioi thieu_hrct_7952
TRANSCRIPT
May 30, 2012 1
H R C T(High Resolution CT)
BS.Leâ Văn Dũng
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• Ñ a ï i c ö ô n g :• HR CT cuõa phoåi kyõ thuaät söû duïng roäng raõi
vaø coù giaù trò lôùn .• Noù duøng khi XQ v aø LS nghi ngôø moät beânh
phoåi lan toaû.
• K y õ t h u a ä t :
• HRCT goàm nhöõng laùt caét moûng 1-1,5mm (CT quy öôùc thì 8-10mm).
• Thöôøng khaûo saùt trong caùc beänh ñöôøng daãn khí vaø moâ keõ.
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Caáu truùc chuøm pheá nang.
-Goàm taát caû caáu truùc taän cuûa moãi tieåu pheá quaûn.
-Kích thöôùc khoaûng 7mm.-Chuøm pheá nang khoaûng 400
pheá nang.
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Phaân thuøy phoåi thöù caáp.
-Kích thöôùc khoaûng 1,5-2cm-Chöùa khoaûng 35 chuøm pheá
nang.-HRCT:+Trung taâm tieåu pheá quaûn vaø ñoäng maïch.+Tónh maïch vaø baïch huyeát ngoaïi bieân
trong vaùch.
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Caáu truùc phoåi treân HRCT-Hình aûnh ôû trung taâm:+B où maïch maùu-P Q ñi song song vaø xung quanh moâ
keõ(moâ lieân keát)+C aét ngang K hí quaûn thaønh moûng caïnh beân laø ñoäng
Ñ M (sau-ngoaøi)-Ngoaïi bieân: +N hieàu chaám vaø nhaùnh cuûa Ñ M (phaân nhaùnh goùc
nhoïn)vaø TM (phaân nhaùnh vuoâng) +1/3 ngoaøi khoâng thaáy P Q .-Maøng phoåi:Lieân thuyø naèm ngang moûng, coøn ngoaøi
bieân moûng khoâng thaáy.
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Nguyeân nhaânDaøy vaùch lieân tieåu thuøy(Baïch huyeát ,TM,teá
baøo),vaùch PN, moâ keõ do:+Dòch:NöôùcPhuø phoåi; Chaát protein Daõn
baïch huyeát +Vieâm nhieãm:Nhieãm truøng:Vi ruùt, u haït(lao,naám),PCP(carini)Töï phaùt:Beänh maïch maùu colagen:RA,xô cöùng bì,AS.Taùc nhaân ngoaïi lai:Buïi phoåi,thuoác.U: lan theo baïch huyeát, moâ keõ (u haït ö axít), taïo
xô tö phaûn öùng cuûa u.
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Caùc bieåu hieän beänh moâ keõ
1. M ô ø ñ ö ô ø n g -lö ô ù i : D aøy thaønh lieân tieåu thuøy vaø xô.2 . M ô ø n o á t lö ô ù i :V ieâm moâ keû quanh maïch maùu-pheá quaûn.3 . N o á t .4 . M ô ø k ín h ñ u ïc :Giai ñoaïn caáp, daøy moâ keû quanh pheá nang.M aïch maùu thaáy trong ñaùm nhu moâ phoåi “lôø môø”5 . T o å o n g :Giai ñoaïn cuoái beänh lyù ,daïng voøng
2-10mm.
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Vuøng chi phoái
+Thuyø treân:AS,buïi phoåi,sarcoid,u haït öa axit, lao,
nang xô (khoâng phaûi beänh moâ keõ)..
+Thuøy döôùi:Hít,thuoác,DIP,asbestosis,xô bì,beânh
mm collagen.daûnPQ(Khoâng phoåi moâ keõ)
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Sö phaùt trieãn
C a á p :Vieâm PN dò öùng (taêng maãn
caûm),phuø ,taêng saûn baïch huyeát, viruùt..
M a ïn : Lan traøn u trong baïch huyeát,vieâm
nhieãm ,xô phuø.
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Theå tích phoåiT a ê n g t h e å t íc h : U haït öu axit(traøn khí maøng phoåi 20%) Lymphagioleiomyomatosis (traøn khí maøng
phoåi) Nang xô(keát hôïp nhöng khoâng phaûi
beânh moâ keõ).G ia û m t h e å t íc h : IFF,xô cöùng bì
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B e ä n h m a ø n g p h o å i :Maûng maøng phoåi:AbestosisDòch maøng phoåi:CHF,di caên baïch
huyeát,RA
N o á t ly m p h o :Lôùn:Haïch aùc tính,lao,naám,sarcoidVoâi hoaù;Nhieãm buïi
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Moâ keõ-Moâ keõ bình thöôøng treân HRCT khoâng
thaáy ñöôïc, nhöng khi beänh lyù thì bieåu hieän roõ treân HRCT
-Nhöõng ngaên moâ keõ cuûa phoåi. +Q uanh boù P Q -maïch maùu. +Trung taâm tieåu thuyø(Ñ oaïn xa cuûa boù P Q -
mmaùu). +M oâ keõ vaùch lieân tieåu thuøy(Thöôøng thaáy
ñöôøng vuoâng goùc maøng phoåi). +M oâ keõ döôùi maøng phoåi. +M oâ keõ vaùch P N
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Daøy vaùch lieân tieåu thuøy.-Do phuø, u, xô.-Thöôøng ôû ngoaïi bieân ñöôøng vuoâng
goùc maøng phoåi.Trung taâm hình ña giaùc.-Phuø phoåi hoaëc di caên theo baïch huyeát Daøy saéc neùt .Xô thì söï daøy khoâng ñoàng nhaát vaø caáu truùc cuûa phaân thuøy bò roái loaïn.
-Daøy saéc neùt trong di caên u baïch huyeát coù xu theá goø geà hoaëc daïng noát.
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Lymphangiosis carcinomatosa
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-Daøy moâ keõ quanh boù PQ-Mmaùu ôû caét ngang vaø caét doïc-Daøy moâ keõ vaùch lieân tieåu thuøy -Daøy moâ keõ trung taâm lieân thuøy treân caét ngang-Daøy moâ keõ döôùi maøng phoåi .
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Caùc hình thaùi toån thöông
-Daøy vaùch lieân tieåu thuøy.-Daïng löôùi.-Daïng noát.-Ñoâng ñaëc -Môø kính ñuïc.-Dang nang.
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Daïng löôùi
-Nhöõng ñöôøng maûnh khoâng ñoàng nhaát vaø söï baát thöôøng giöõa maïch maùu, pheá quaûn, maøng phoåi taïng vôùi nhu moâ xung quanh khi keát hôïp vôùi söï phaù huûy caáu truùc cuûa xô phoåi.
-Thöôøng trong xô phoåi töï phaùt, sarcoidosis vaø asbestosis.
-Thöôøng phoå bieát nhieàu döôùi maøng phoåi thuøy döôùi.
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Toån thöông daïng löôùi trong tieåu thuøy vaø phaù huûy tieåu thuøy
Keát hôïp xô phoåi.
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Daïng löôùi
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Toån thöông daïng noát treân HCRT
-Daïng noát troøn khoâng phaûi maïch maùu.Noù bieåu hieän caáu truùc troøn hoaëc ñöôøng treân caét ngang.
-Vò trí:Trung tieåu thuøy, töï do, moâ keõ.-Trung taâm tieåu thuøy:Vuøng trung taâm
tieåu thuøy,ôû ngoaïi bieân caùch maøng phoåi 5mm
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Tree-in-bud: Noát trung taâm chuøm PN vaø tieåu PQ
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Noát trung taâm tieåu thuøy
-ÔÛ trung taâm tieåu thuøy.-Kích thöôùc gioáng nhau.-Khoaûng caùch caùc noát khoaûng 1-2.5cm.-Caùch maøng phoåi khoaûng 5-10mm.-Thöôøng keát quaû caáp hoaëc maïn do vieân
tieåu PQ.-HRCT trong vieâm tieåu PQ vaø PQ:Noát
trung taâm giôùi haïn roõ hoaëc môø, daïng “Tree-in-bud”, daøy thaønh PQ
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Noát töï do
-Moâ taû noát phaân boá lung tung trong phoåi doïc theo maøng phoåi, raõnh lieân thuøy vaø coù trong trung taâm tieåu thuyø (nhöng noù ñôn ñoäc).
-Trong boù PQ-mm thì ôû ñoaïn cuoái ÑM nhoû coøn noát trong di caên baïch huyeát vaø sarcoid thì ôû trung taâm boù PQ-mm
-Noát naøy phaân boá raõi raùc hai beân vaø khoâng coù vò trí öu theá
(Noát töï do Raõi raùc coøn noát trung taâm thì ñoàng ñeàu)
-Toån thöông theo ñöôøng maùu (di caên hoaëc nhieãm truøng)
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Noát thaáy nhieàu ôû vuøng giöõ phoåi (T)ñaùm môø lôùn (A) vaø noát nhoû doïc theo boù PQ-mm (B)
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Noát moâ keõ trong sarcoid
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Môø kính ñuïc
-N höõng vuøng môø vöøa phaûi raûi raùc coøn thaáy ñöôïc maïch maùu .
-Thöôøng bieåu hieän giai ñoaïn ñaàu cuûa caùc toån thöông.
-V ieâm pheá nang di öùng,vieâm phoåi moâ keû, xô phoåi töï phaùt,phuø phoåi…
-D o vieâm hoaëc daøy vaùch P N , laáp moät phaàn trong khoaûng khí P N ,hoaëc keát hôïp caû hai.
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•
Ñoâng ñaëc phoåi -Môø ñoàng nhaát khoâng thaáy maïch maùu trong vuøng toån thöông.
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Nang khí
- Trong IPF vôùi nhöng nang khí xuaát hieän giai ñoaïn cuoái vôùi daïng toå ong.Xu höôùng döôùi maøng phôûi vaø ñaùy.
-Trong Histiocytosis X Thöôøng ôû treân phoå vaø motä ít ñaùy phoåi.Nhöõng keùn khí naøy thay ñoåi kích trhöôùc vaø khoâng coù hình thuø roõ.
-Trong Iymphangioleiomyomatosis laø nang khí thaønh moûng vôùi xung quanh nhu moâ phoåi bình thöôøng. Kích thöôùc töø 0,2 5cm vaø thaønh nang coù theå raát moûng 2mm
-Khí pheá thuõng: Thöôøng nhöõng giaû nang khí khoâng coù vaùch. Chuù yù khi khí pheá thuõng toaøn tieåu thuøy coù theå nhaàm vaùch lieân tieåu thuøy vôùi thaønh.
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IPF - Typical Peripheral Disease Pattern On HRCT
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B a s ic H R C T P a t t e r n sLAM
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of Histiocytosis X,
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Di caên theo baïch huyeát-Söï lan traøn moâ aùc tính trong moâ keõ(boù pheá
quaûn maïch maùu,vaùch lieân tieåu thuøy, khoaûng döôùi maøng phoåi, baïch huyeát phoåi).
-Nguoàn goác töø k pheá quaûn,vuù,daï daøy, giaùc tuïy,ctc…
-Beänh hoïc:phuø,xô,giaõn baïch huyeát,teá baøo trong moâ keõ.
-Thöôøng hai beân phoåi(1 beân sau k phoåi).*Xq:B ình thöôøng(ít),daïng löôùi,daøy boù pheá-maïch,K erley
A ,B ,giaûm theå tích phoåi, haïch roán phoåi.*HRCT:D aøy vaùch lieân tieåu thuøy, noát trong vaùch lieân
tieåu thuyø,daøy boù maïch trung taâm lieân tieåu thuøy,D aøy döôùi maøng phoåi.
Phaân bieät:V ieâm xô pheá nang(ngoaïi bieân),V ieâm pheá nang dò öùng(K hoâng daøy lieân tieåu thuøy),Sarcoid(Thuøy treân)
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L y m p h a n g it ic S p r e a d D ia g r a m
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41b41b41b41b41b41b
42b42b
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NoátDaøy khoâng ñoàng nhaát boù PQ-mm (A) daøy vaùch lieân tieåu thuøy(B)
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Daáu hieäu beänh moâ keû caáp tính
1. Daøy vaùch lieân tieåu thuøy.2. Ñöôøng Kerley.3. Daøy thaønh pheá quaûn vaø bao
quanh PQ.4. Môø ôû roán phoåi.5. Môø maïch maùu phoåi.6. Taêng ñaäm ñoä vuøng ñaùy phoåi.7. Traøn dòch maøng phoåi löôïng ít.
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Daáu hieäu beänh moâ keõ maõn tính
1. Khoâng ñoàng nhaát maøng phoåi taïng.2. Daïng löôùi:Nhoû, thoâ.3. Noát:Nhieãm truøng hoaëc khoâng.4. Ñöôøng:Phuø moâ keõ töø tim hoaëc
khoâng, beänh baïch huyeát aùc tính, beänh thaønh pheá quaûn.
5. Daïng toå ong:Noát thaáu quang troøn döôùi 1cm (Giai ñoaïn cuoái beänh phoåi)
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Khí pheá thuõng-Toaøn tieåu thuyø:Thuøy döôùi,thieáu alpha1-antitrypsin, lan roäng, ñoàng nhaát.
• -Trung taâm tieåu thuyø:Thuøy treân,caïnh tieåu P Q , raõi raùc.
• -Caïnh vaùch:• N goaïi bieân,lieân quan maøng phoåi taïng vaø vaùch lieân
tieåu thuøy.• C où theå H ôïp hai daïng treân, bieåu hieän daïng boùng
khí.• -20%Bình thöôøng.• -40% baát thöôøng HRCTChöùc naêng bình
thöôøng.
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Khí pheá thuõng toaøn tieåu thuøy
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Panacinar emphysymaÍ t maïch maùu thuøy treân.K hoaûng nang khí toaøn tieåu thuyø
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Khí pheá thuõng.-10mm:taêng saùng, ít mm-Hrct:Trung taâm tieàu thuøy
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Môø daïng löôùi vuøng ñaùy.Khí pheá thuõng caän vaùch.
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Khí pheá thuõng caän vaùch(boùng)
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Khí pheá thuõng caän vaùchBoùng lôùnXeïp phoåi.
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emphysema
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-Daõn daïng tuùi, thoi, choåi haït.• -HRCT:• +P Q thaáy ôû 1/3 ngoaøi phoåi, P Q lôùn hôn maïch
maùu ñi keøm• +D aøy thaønh P Q ( Signet ring)• -Thôû raKhí pheá thuõng öùa khí trong
boùng coøn daõn PQ thì xeïp.• -Daïng tuùi Thuyø döôùi coøn nang trong
IPF khoâng coù möùc dòch
Daõn pheá quaûn
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Daõn PQ
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Daõn PQDaøy thaønhChaát nhaày trong PQ
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Toùm laïi
• -Phaân thuyø thöù caáp.• -Beänh lyù moâ keõ.• -Beänh ñöôøng daãn.
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M o â k e õ .Moâ keõ bình thöôøng treân HRCT khoâng nhìn
thaáy.Caùc ngaên moâ keõ phoåi:+Moâ keõ quanh boù pheá quaûn-maïch maùu.+Moâ keõ trong taâm tieåu thuøy(Quanh boù
pheá quaûn-maïch maùu xa).+Moâ keõ lieân tieåu thuøy(Thöôøng thaáy
nhöõng ñöôøng vuoâng goùc maøng phoåi).+Moâ keõ döôùi maøng phoåi.+Moâ keõ quanh pheá nang.
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Beänh xô phoåi töï phaùt(IPF)
-Vieâm tieán trieån, xô vaø hö haïi moâ phoåi (vieâm phoåi moâ keû vaø vieâm xô pheá nang)
-Öu theá phía döôùi vaø ngoaïi bieân.-Môø kính ñuïc LöôùiToå ong.-Daõn pheá quaûn (gôïi yù xô).-Khaùc:Taêng aùp phoåi vôùi tim to, daøy maøy
phoåi, traøn khí maøng phoåi…
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Beänh lyù moâ keû töø tónh maïch phoåi.
Do söï taêng aùp löïc tónh maïch phoåi.
2. Suy tim traùi.3. Beänh taéc tónh maïch.
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Beänh lyù moâ keõ theo heä chính baïch huyeát.
1. Beänh baïch huyeát aùc tính
2. Giaõn baïch huyeát baåm sinh (hieám)
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Beänh lyù moâ keõ töø heä moâ lieân keát khaùc.
1. Phuø moâ keõ.2. Vieâm moâ keõ maõn tính.3. Buïi phoåi.4. Xô moâ keõ.5. Thaâm nhieãm moâ u trong moâ lieân
keát.6. Phaûn öùng xô töø u.7. Khaùc: Beänh maïch maùu
collagen,Amyloid
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Sarcoid-Beänh u haït heä thoáng(phoåi,da,maét,gan-
laùch,khôùp,thaàn kinh trung öông..).-Xq:+H aïch lôùn ñoái xöùng hai roán,khí quaûn,pheá quaûn.(coù
theå ñoùng voâi) +H aïch lôùn keøm môø daïng noát löôùi,ñaùm,noát lôùn. +X ô phoåi,boùng thuøy treân. +K haùc:D òch M P ,voâi haïch voû soø, traøn khí,naám.-CT:+N hu moâ phoåi:N oát doïc theo baïch huyeát,daïng ñöôøng,
môø kính ñuïc, daøy döôùi maøng phoåi. +H aïch lôùn. +P heá quaûn:baát thöôøng thaønh, daõn . +C uoái:X ô thuøy treân,boùng khí,daõn pheá quaûn.
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K pheá quaûn thaâm nhieãm moâ U vaøo maïch baïch huyeát trong mo keõ cuûa phaân thuøy thöù
caáp.
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-Caùc nhaùnh TM vuoâng goùc -Caùc nhaùnh ÑM goùc nhoïn.
•
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Noát trung taâm tieåu thuøy(daøy moâ keõ quanh tieåu pheá quaûn –maïch maùu) thöôøng thaáy trong u baïch maïch .Nhuõng noát caùch nhau khoaûng 1—2,5cm,caùch maøng phoåi khoaûng 5-10mm.
•
Hình beân daøy vaùch lieân tieåu thuøy vaø noát trung taâm
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Phía tröôùc phoåi beân (P) daøy vaùch lieân tieåu thuøy vaø boù tieåu pheá quaûn-maïch maùu trung taâm
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B a s ic H R C T P a t t e r n s
•
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Lymphangiosis carcinomatosa in chest x-ray p.a. and lateral. Radiating pattern from the hili into the periphery
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Lymphangiosis carcinomatosa. Right bronchial carcinoma with atelectasis of right upper lobe
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Diffuse, small, miliary Metastases..
May 30, 2012 77IP F - N o r m a l C X R A n d M in im a l D is e a s e O n H R C T
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L y m p h a n g i t ic S p r e a d - S e p t a l P a t t e r n O n H R C T
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Lymphangiosis carcinomatosa
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H y d r o s t a t ic E d e m a D ia g r a m
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IPF(Idiopathic Pulmonary Fibrosis)
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IPF - Severe Form On HRCT
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P u lm o n a r y F ib r o s is D ia g r a m
Pulmonary Fibrosis Diagram
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L y m p h a n g i t ic S p r e a d A lo n g B r o n c h o v a s c u la r B u n d le s O n H R C T
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L y m p h a n g it ic S p r e a d - S e p t a l P a t t e r n O n H R C T
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Sarcoidosis - Ground Glass Densities on HRCT
May 30, 2012 94Sarcoidosis - Spectrum Of Abnormalaties On HRCT
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Sarcoidosis - Distribution Of Nodules On HRCT
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LAM (Lymphangiomyomatosis)- Cysts On HRCT
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H-X Differential Of Cystic Lung Lesions
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P u lm o n a r y L y m p h a n g io le io m y o
m a t o s is L A M
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P u lm o n a r y H is t io c y t o s is X
( E o s in o p h i l ic G r a n u lo m a )
H ig h r e s o lu t io n C T u s u a l ly
d e m o n s t r a t e s a c o m b in a t io n o f
c y s t s a n d n o d u le s e v e n
w h e n t h e r a d io g r a p h
s h o w s a r e t ic u lo -n o d u la r p a t t e r n . T h e c o m b in a t io n
o f n o d u le s a n d t h in -w a l le d c y s t s
i s h ig h ly s u g g e s t iv e o f H X
in t h e p r o p e r c l in ic a l s e t t in g .
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-Trung taâm:PA(tieåu ÑM phoåi) TB(tieåu pheá quaûn) coøn baïch huyeát khoâng thaáyNgoaïi bieân: IS(vaùch lieân tieåu thuøy), PV(tieåu TM phoåi).-Vuøng giöõa vaùch lieân tieåu thuøy vaø boù PQ-maïch maùu laáp bôûi pheá nang vaø mao maïch
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• S e p t a l L in e s : • Lymphatic spread of tumor • Pulmonary edema • I r r e g u la r L in e a r P a t t e r n : • Idiopathic pulmonary fibrosis • Asbestosis • Sarcoidosis
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• C y s t ic P a t t e r n : • Idiopathic pulmonary fibrosis • Lymphangioleiomyomatosis • Pulmonary histiocytosis X • N o d u la r P a t t e r n : • Sarcoidosis • Silicosis • Coalworker's pneumoconiosis • Extrinsic allergic alveolitis • Pulmonary histiocytosis X
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N o á t lô ù n v a ø n h o û t r o n g n u m o â v a ø k e á t h ô ïp t h a ø n h ñ a ù m q u a n h b o ù P Q -M M .
K e á h ô ïp n o á t n h o û v a ø d a ïn g ñ ö ô ø n g .
• M id d le : Combination of small nodules and linear opacities.
• R ig h t : Large indistinct opacities of "alveolar sarcoidosis" (A).
• L e f t L o w e r : Honeycombing in the periphery in a patient with sarcoidosis and progressive fibrosis. (B)
T it le P a g e
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Tree-in-bub
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Toån thöông daïng noát treân HCRT
-Daïng noát troøn khoâng phaûi maïch maùu.Noù bieåu hieän caáu truùc troøn hoaëc ñöôøng treân caét ngang.
-Vò trí:Trung tieåu thuøy, töï do, moâ keõ.-Trung taâm tieåu thuøy:Vuøng trung taâm tieåu
thuøy,ôû ngoaïi bieân caùch maøng phoåi 5mm-”Tree-in-bud”:Vaøi noát nhoû trong trung taâm tieåu
thuøy lieân keát caáu ñöôøng, nhaùnh moûngvieâm tieåu PQ
-Rosettes:Ñaùm noát trong tieåu thuøy,xuaát hieän lieân quan nhieàu chuøm PN
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Tree-in-bud: Noát trung taâm chuøm PN vaø tieåu PQ
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Noát trung taâm tieåu thuøy
-ÔÛ trung taâm tieåu thuøy.-Kích thöôùc gioáng nhau.-Khoaûng caùch caùc noát khoaûng 1-2.5cm.-Caùch maøng phoåi khoaûng 5-10mm.-Thöôøng keát quaû caáp hoaëc maïn do vieân
tieåu PQ.-HRCT trong vieâm tieåu PQ vaø PQ:Noát
trung taâm giôùi haïn roõ hoaëc môø, daïng “Tree-in-bud”, daøy thaønh PQ
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Noát töï do
-Moâ taû noát phaân boá lung tung trong phoåi doïc theo maøng phoåi, raõnh lieân thuøy vaø coù trong trung taâm tieåu thuyø (nhöng noù ñôn ñoäc).
-Trong boù PQ-mm thì ôû ñoaïn cuoái ÑM nhoû coøn noát trong di caên baïch huyeát vaø sarcoid thì ôû trung taâm boù PQ-mm
-Noát naøy phaân boá raõi raùc hai beân vaø khoâng coù vò trí öu theá
(Noát töï do Raõi raùc coøn noát trung taâm thì ñoàng ñeàu)
-Toån thöông theo ñöôøng maùu (di caên hoaëc nhieãm truøng)
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D ia g n o s is : M i l ia r y m e t a s t a s is f r o m T h y r o id c a n c e r
C T o f c a s e 3 0
Papillary Carcinoma of thyroid is occured in 60% (20% follicular, 15% anaplastic, 1-5% medullary carcinoma) of all thyroid carcinomas, metastasize to regional lymph nodes in 40%, hematogenous to lung in 4%(early spread to lung and bone in follicular carcinoma). In papillary carcinoma, tumor usually concentrates radioiodine, but in follicular carcinoma, tumor usually concentrates pertechnetate. Of 731 patients with papillary thyroid cancer, 91 had metastases outside regional lymph nodes. The most common site was intrathoracic, occurring in 73 of the 91 patients. Miliary, micronodular pulmonary metastases, with iodine 131 (I-131) uptake and "curable" by I-131 treatment were encountered in 7 patients. (Hoie J, et. al. Cancer;1988(61)1-6 )
R e t u r n t o C a s e 3 0
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D ia g n o s is : P u lm o n a r y L y m p h a n g it ic C a r c in o m a t o s is HRCT findings in Pulmonary Lymphangitic Carcinomatosis 1. smooth or nodular peribronchovascular interstitial thickening ("peribronchial cuffing") 2. Smooth or nodular interlobular septal thickening 3. Smooth or nodular thickening of fissures 4. Normal lung architecture 5. Prominence of centrilobular structures 6. Diffuse, patchy, or unilateral distribution 7. Lymph node enlargement 8. Pleural effusion Although, peribronchovascular interstitial thickening and smooth septal thickening, as are often seen in patients with pulmonary lymphangitic carcinomatosis (PLC), can also be seen in association with pulmonary edema, the differentiation of these entities can usually be made on clinical grounds. Nodular or beaded interstitial thickening is characteristic of PLC, but not pulmonary edema. In the study by Ren et al, nodular septal thickening was not noted in any pathologic specimens of patients with pulmonary edema, fibrosis, or in normal lungs. However, it is clear that the presence of nodular septal thickening is a nonspecific finding that reflects a perilymphatic distribution of abnormalities, also commonly seen in patients with sarcoidosis and coal worker's pneumoconiosis or silicosis. In sarcoidosis and coal worker's pneumoconiosis, although nodules are commonly seen, the septal thickening is usually less extensive than that seen in a patients with lymphatic spread of tumor. Moreover, in sarcoidosis and coal worker's pneumoconiosis, distortion of lung architecture and secondary pulmonary lobular anatomy is common, particularly if septal thickening is present; this distortion is not seen in patients with PLC. On the other hand, the presence of pleural effusion would be more in keeping with PLC than sarcoidosis or silicosis. In pulmonary fibrosis, nodular septal thickening is uncommon and the margins of the thickened interlobular septa are irregular. Distortion of the lung architecture and lung destruction (honeycombing) are common in patients with fibrosis.
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Diagnosis: Primary lung cancer (adenocarcinoma) in RLL with miliary metastasis and pericardial seeding Radiologic FindingsChest PA shows innumerable multiple tiny nodules uniformly distributed throughout both lungs. Chest lateral shows suspicious ovoid opacity in lower lung zone. HRCT shows numerous miliary nodules in diffuse and random distribution in both lungs. Some linear densities are noted in peripheral portion suggesting interlobular and intralobular septal thickening.
Irregular spiculated ovoid mass is noted in RLL. Moderate amount of pericardial effusion is noted.
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DMLD (diffuse micronodular lung disease), each nodule being < 3mm in diameter and occupying more than two-thirds of lung volume on chest radiograph, can be differentiated by its distribution. Centrilobular distribution is seen in DPB (diffuse panbronchiolitis), infectious bronchiolitis, H. influenza, bronchogenic disseminated tuberculosis, pneumoconiosis, primary lymphoma, and foreign body-induced necrotizing vasculitis.
Perilymphatic distribution is noted in pneumoconiosis, sarcoidosis, amyloidosis.
Random distribution is found in miliary tuberculosis and pulmonary metastasis.
The nodules in pulmonary metastatic disease appeared to be slightly larger and are more variable in size than those in miliary tuberculosis. They show relatively well defined margins. Miliary metastases are most likely to be due to thyroid, renal carcinoma, bone sarcoma, trophoblastic disease, or melanoma.
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Cystic fibrosis (CF) is a hereditary disease of autosomal recessive transmission. The basic abnormality consists of abnormal secretions from variable exocrine glands including the salivary, sweat glands, pancreas (90%), large bowel and tracheobronchial tree. Infants who died of CF shows normal lung, by contrast, older patients who die of the disease invariably shows pulmonary changes, including airway mucus plugging, pneumonia, bronchiolitis obliterans, bronchiectasis, atelectasis and overinflation (1). The incidence is as high as 1 per 500 in Scotland, 1 per 2000-3500 in whites, 1 per 90,000 in Asian. Asians who have CF may have a more severe clinical course than whate controls (1). As a result of improved medical care, life expectancy has increased. Whereas the survival rate older than 17 years used to be about 5 % by the 1970s, for infants born today in the UK, the predicted mean life expectancy is 40 years. Chest radiography reveals extensive obstruction of medium-sized and small airways of the lungs, hyperinflation, cylindrical and cystic bronchiectasis, nodular and fingerlike shadows of mucoid impaction. CT can reveal pathologic changes not visible on conventional chest radiograms, particularly mucoid impaction, detailed scoring of bronchiectasis, peribronchial thickening, mucous plugging, atelectasis, consolidation, cysts, bullae and emphysematous change. Paranasal sinus opacification due to chronic sinusitis and polyposis is almost universal in patients with CF (1). The most common organisms of combined lung infection are P. aeruginosa, S aureus, H. influenza, B. cepacia. Allergic bronchopulmonary aspergillosis occurs in 5-10 % (serum precipitins against A. Fumigatus detected 51 % of patients) (1).
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Toån thöông daïng noát treân HCRT
-Daïng noát troøn khoâng phaûi maïch maùu.Noù bieåu hieän caáu truùc troøn hoaëc ñöôøng treân caét ngang.
-Vò trí:Trung tieåu thuøy, töï do, moâ keõ.-Trung taâm tieåu thuøy:Vuøng trung taâm tieåu
thuøy,ôû ngoaïi bieân caùch maøng phoåi 5mm-”Tree-in-bud”:Vaøi noát nhoû trong trung taâm tieåu
thuøy lieân keát caáu ñöôøng, nhaùnh moûngvieâm tieåu PQ
-Rosettes:Ñaùm noát trong tieåu thuøy,xuaát hieän lieân quan nhieàu chuøm PN
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Tree-in-bud: Noát trung taâm chuøm PN vaø tieåu PQ
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Noát trung taâm tieåu thuøy
-ÔÛ trung taâm tieåu thuøy.-Kích thöôùc gioáng nhau.-Khoaûng caùch caùc noát khoaûng 1-2.5cm.-Caùch maøng phoåi khoaûng 5-10mm.-Thöôøng keát quaû caáp hoaëc maïn do vieân
tieåu PQ.-HRCT trong vieâm tieåu PQ vaø PQ:Noát
trung taâm giôùi haïn roõ hoaëc môø, daïng “Tree-in-bud”, daøy thaønh PQ
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Noát töï do
-Moâ taû noát phaân boá lung tung trong phoåi doïc theo maøng phoåi, raõnh lieân thuøy vaø coù trong trung taâm tieåu thuyø (nhöng noù ñôn ñoäc).
-Trong boù PQ-mm thì ôû ñoaïn cuoái ÑM nhoû coøn noát trong di caên baïch huyeát vaø sarcoid thì ôû trung taâm boù PQ-mm
-Noát naøy phaân boá raõi raùc hai beân vaø khoâng coù vò trí öu theá
(Noát töï do Raõi raùc coøn noát trung taâm thì ñoàng ñeàu)
-Toån thöông theo ñöôøng maùu (di caên hoaëc nhieãm truøng)
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Môø kính ñuïc
-N höõng vuøng môø vöøa phaûi raûi raùc coøn thaáy ñöôïc maïch maùu .
-Thöôøng bieåu hieän giai ñoaïn ñaàu cuûa caùc toån thöông.
-V ieâm pheá nang di öùng,vieâm phoåi moâ keû, xô phoåi töï phaùt,phuø phoåi…
-D o vieâm hoaëc daøy vaùch P N , laáp moät phaàn trong khoaûng khí P N ,hoaëc keát hôïp caû hai.
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