晕征与反晕征

晕征与反晕征halosignandreversedhalosign结节与肿块CT表现：致密影直径＜5mm称微结节（2～3mm粟粒结节）直径5～10mm称小结节≥10mm者统称结节一般将小于等3cm者称为结节，大于3cm者称为肿块。基本概念是指肺部CT或薄层CT上，肺密度轻度增加，支气管和血管轮廓可见，形似磨玻璃，称磨玻璃密度影。意义——非特异，任何使肺实变、远端气腔内空气含量减少而又不使肺泡全部闭塞的因素都可产生磨玻璃影。磨玻璃密度影（GGO）基本概念晕征•CT表现——在CT上肺内结节或肿块周围的晕状磨玻璃密度影，低于中央结节，但高于正常肺组织，形似日晕。分类•一、出血性肺结节(一)感染性疾病中的出血性结节(毛霉菌病、念珠菌病、结核病、病毒性肺炎、侵袭性曲菌病)(二)非感染性疾病中的出血性结节（韦格纳肉芽肿病，Kabosi肉瘤，）•二、肿瘤细胞浸润性结节（细支气管肺泡癌，淋巴瘤、肺泡内肿瘤生长）•三、非出血性结节（肉状瘤病，机化性肺炎）晕征病因ArchBronconeumol.2008;44(7):386-92•免疫功能不全•侵袭性曲霉菌、毛霉菌、念珠菌及隐球菌一晕征-感染性疾病-真菌一晕征-感染性疾病-真菌KuhlmanJE1985Invasivepulmonaryaspergillosis.A:Computedtomography(CT)scanofapatientwithacutelymphoidleukemiaandneutropeniashowinganodulesurroundedbyahalointherightupperlobe,withadjacentacinarinvolvement(arrows).B:Macroscopicsagittalsliceofanotherpatient’slungshowingaroundnecroticlesion(asterisk)surroundedbyahemorrhagichalo(arrowheads),correspondingtoinvasivepulmonaryaspergillosis.C:MicroscopicimageofthemarginofthelesiondescribedinB,withvisiblepulmonarynecrosisandhemorrhage.TheimagealsoshowsthehyphaeofAspergillusfumigatus(arrows),whichareofregularcaliber,septate,andbranchingatacuteangles(hematoxylin-eosin,magnification×2).中国CT和磁共振杂志2014年6月12卷3期一晕征-感染性疾病-真菌•免疫功能不全•常见单纯疱疹病毒、巨细胞病毒、水痘带状疱疹病毒及粘病毒一晕征-感染性疾病-病毒•slow-resolvingbacterialpneumonia(吸收延迟性肺炎)•放线菌•结核分枝杆菌一晕征-感染性疾病-细菌1.64岁男，退休，咳嗽、间断咯血2月来诊。吸烟，既往健康，痰涂片革兰阴性菌，培养：卡他布兰汉菌；2.45岁，既往心梗，吸烟，咳嗽1月间断咯血10天，痰培养：流感嗜血杆菌中国实用内科杂志20097月29卷增刊1一晕征-感染性疾病-细菌•立克次体•寄生虫一晕征-感染性疾病-其他•肾上腺嗜铬细胞瘤•血管肉瘤转移瘤•肾细胞癌•绒毛膜癌•肺血管肉瘤•Kaposi肉瘤二晕征-肿瘤性疾病-出血性瘤结节Hemorrhagicmetastasisinapatientwithchoriocarcinoma（绒毛膜癌）whopresentedwithmassivehemoptysis.A:Computedtomographyscanofthechestshowsmultiplehemorrhagicpulmonarynoduleswithahalosignthathavecoalescedintheposteriorsegmentsoftherightlung.B:Macroscopiclungsliceshowingseveralroundhemorrhagiclesions.C:Macroscopicimageofnodulescontaininghemorrhagicareas,fibrin,andtumorcells(hematoxylin-eosin,magnification×10).二晕征-肿瘤性疾病-出血性瘤结节•细支气管肺泡癌•消化系、胰腺、肺腺癌•淋巴瘤二晕征-肿瘤性疾病-瘤细胞浸润Bronchioloalveolarcarcinomainapatientwithchroniccough.A:Computedtomographyscanofthechestshowsnoduleswithahalosignintherightlung,withsomepseudocavitation(arrow).Alsovisibleisaconsiderableareaofconsolidationintheleftlung.B:Microscopicimageshowingthickenedalveolarwalls(asterisks)duetoinfiltrationbytumorcells(arrows)ematoxylin-eosin,magnification×10).二晕征-肿瘤性疾病-瘤细胞浸润Pulmonarylymphomaina73-year-oldpatientwhovisitedtheemergencyservicewithdyspnea.A:Anaxialscanofthelowerpulmonarylobesshowsmultiplepulmonarynoduleswithahalosignandatendencytocoalesceintheposteriorsegments.Thereisalsobilateralpleuraleffusion,somewhatgreaterontherightside.Thepatientdied3weeksafteradmission.B:Lowmagnificationimageofpulmonarynoduleshowingmainlyperibronchovasculartumorcellinfiltrationandmarkednecrosis(hematoxylin-eosin,magnification×4).C:Ahigher-magnificationimageoftheperipheryofthenoduleshowstheinfiltrationoftumorcellsalongthealveolarwalls(arrows)(hematoxylineosin,magnification×10).•出血性结节•非出血性结节三晕征-非感染性疾病三晕征-非感染性疾病-出血性结节•韦格纳肉芽肿•子宫内膜异位症•活检Wegenergranulomatosis.A:Computedtomographyscanshowing2pulmonarynodulessurroundedbyahalo(arrows)andanareaofconsolidationintheleftlowerlobe(asterisk),alsowithahalosign.Thepatient,whosefirstsymptomwashemoptysis,alsohadrapidlyprogressingglomerulonephritis肾小球肾炎B:Microscopicimageshowinginflammatoryinfiltrationofthearterialwallwithamultinucleatedgiantcell(arrow)andendothelialdestruction(arrowheads)(hematoxylin-eosin,magnification×20).三晕征-非感染性疾病出血性结节•结节病•机化性肺炎•闭塞性细支气管炎•嗜酸细胞肺炎•肺淀粉样变三晕征-非感染性疾病非出血性结节反晕征•是CT肺窗，中心为磨玻璃样密度影，周围是高密度新月形或环形条带，与晕征的周围稍低密密度磨玻璃影相反，称反晕征。Voloudakietal1996cop反晕征病因一反晕征-感染性疾病-真菌•肺曲菌•接合菌属（Zygomycetes包括根霉和毛霉）•地方性真菌感染（南美芽生菌病-拉丁美洲-巴西）•隐球菌•早期征象Invasivepulmonaryaspergillosisina54-year-oldfemalewithmultiplemyelomaandsecondaryplasmacellleukaemiawhohadundergonechemotherapy.(a)High-resolutionCTimageatthelungbaseshowsarightlower-lobepulmonarynodule(arrow)andthereversedhalosign(RHS)intheleftlowerlobe(curvedarrow)withadjacentground-glassopacities.(b)CTimagewithmediastinalwindowsettingsshowstheperipheralconsolidationoftheRHS(asterisks).Noteasmallrightpleuraleffusion.Pulmonaryzygomycosisina22-year-oldmalewithprecursorB-cellacutelymphocyticleukaemia.(a)CTimageshowsthereversedhalosign(RHS)intheleftupperlobe(arrows).(b)CTscanperformed2monthslatershowsintervaldevelopmentofcavitation(aircrescentsign).ThepresenceofRHSinanimmunosuppressedpatientishighlysuggestiveofpulmonaryzygomycosis,especiallyifthepatientisreceivingprophylaxisforaspergillosis.Paracoccidioidomycosisina49-year-oldmale,residentofaruralareainBrazil.CTimageshowsreversedhalosign(RHS)lesions(arrows)andbilateralsmallpoorlymarginatedpulmonarynodules.ThepresenceofRHSinapatientfromanendemicregionforfungalinfectionshouldraiseconcernforthatspecificfungalinfection.一反晕征-感染性疾病-结核Tuberculosisina59-year-oldfemale.High-resolutionCTimageshowsbilateralsmallcentrilobularnodules,tree-in-budopacitiesandareasofreversedhalosign(RHS).NotethenodularappearanceoftheringofconsolidationoftheRHSlesions(arrows),whichmaybehelpfulinthedifferentiationbetweenactivegranulomatousdiseasean