课外学习肺结核的X线表现 ymyaoEpidemiology Very common in developing countries Morbidity rate:157.8/106 Mortality rate: 9.8/106 Worldwide incidence is rising HIV coinfection Resistance to antibiotics Transmission Airborne droplets, person to personDefinition A communicable disease caused by Mycobacterium tuberculosis Can involve any organs, esp. lung, skin, lymph nodes Typical pathological change is tuberculous granulomas with the centers of caseous necrosisCausesMycobacteria can be classified into 3 main groups: Mycobacterium tuberculosis complex which can cause tuberculosis: M. tuberculosis, M. bovis, M. africanum, M. microti and M. canetti. M. leprae which causes Hansens disease or leprosy. Nontuberculous mycobacteria (NTM) are all the other mycobacteria which can cause pulmonary disease resembling tuberculosis, lymphadenitis, skin disease, or disseminated disease. Mycobacterium tuberculosis The main cause of TB, Mycobacterium tuberculosis (MTB). a small aerobic non-motile bacillus. acid-fast bacillusTuberculosisPulmonary tuberculosisProliferative change(Tubercle, Tuberculous granuloma)Necrotic change Exudative change (Caseous necrosis) (Serum/fibrin)Basic Pathological Change Depends on the number, the virulence of bacteria, individual immunity and allergy responses.Basic pathological changes（基本病变变 ）坏死（Necrosis）:干酪样样病变变(caseation)增殖（Proliferation ）：结结核结节结节 (tuberculous tubercle）or 结结核性肉芽肿肿（tuberculous granuloma) 渗出（Exudation ）： 小叶性渗出性病变变：干酪性肺炎 肺段性结结核浸润润：超出小叶范围围，见见于浸润润性肺结结核、 原发综发综 合征。Serum/fibrinDepends on the number, the virulence of bacteria, individual immunity and allergy responses.TubercleLanghans巨细胞由多个上皮样细胞融合而成，核排列 在胞浆周围呈花环状、马蹄形或密集在胞体一端。Caseous necrosisPathological evolution（病理演变变 ）吸收好转转 (Improve)恶恶化 (Aggravation)消散纤维纤维 化硬结结、钙钙化血型播撒急性粟粒性肺结结核骨、关节节、 肾肾、脑脑膜等Role of imaging in the diagnosis of tuberculosis (TB)If there was a reliable, cheap, and fast clinical test to diagnose tuberculosis (TB), then imaging would probably be relegated to looking for complications and providing alternative diagnoses in nonresponders. Clinical classification结结核病分类类和诊诊断要点（1）原发型肺结核： （2）血行播散型肺结核： （3）继发型肺结核： 浸润性肺结核 空洞性肺结核 结核球 干酪性肺炎 纤维空洞型肺结核 （4）结核性胸膜炎 （5）肺外结核Radiological Lymph node TB Air-space parenchymal TB Tuberculoma Miliary TB Cavities Pleural TB Fibrosis and destructionPrimary pulmonary Primary pulmonary tuberculosistuberculosisSecondary pulmonary Secondary pulmonary tuberculosistuberculosisClinicalclassificationPrimary pulmonary tuberculosisPrimary pulmonary tuberculosisClinical Features Primary infection (exogenic organism) Almost always begins from the lungs Commonly seen in children 95% recover The rest transform into other typesLymph node TB (gangliopulmonary TB)原发综发综 合征(Primary Complex)： 由肺原发发病灶、局部淋巴结结病 变变、两者相联联的淋巴管炎组组 成。 局部炎性淋巴结结相对较对较 大，肺部 原发发灶相对较对较 小是原发发肺结结核特 征。支气管淋巴结结结结 核： 以胸腔内肿肿大的淋巴结结为为主。 肺门门影增浓浓，是小儿原发结发结 核在X 线线胸片最常见见改变变。Lymph node TB (gangliopulmonary TB)Calcified Ghon (Ranke) complex. Primary complex(dumb- bell form) Ghon focus Lower (upper) part of upper (lower) lobe Close to pleura, 1-2cm Central caseous necrosis Inflammation of lymphatic vessels of lung Tuberculosis of Hilar lymph nodesLymph node TB (gangliopulmonary TB) A normal hilar point should show a V on its side, convex outward. Filling of this point, failure to identify it, or an outwardly convex or lobulated margin may represent a mass, including lymphadenopathy.Lymph node TB (gangliopulmonary TB)Hilar lymphadenopathy (gangliopulmonary TB) in a child. Air-space parenchymal TB (consolidation)silhouette sign 轮轮廓征 Air-space disease： an adult with primary infection；Typical primary infection in a child Air-space parenchymal TB (consolidation)Air-space disease in a child with primary infection.Indirect sign: airway displacement or compression. Secondary pulmonary tuberculosisSecondary pulmonary tuberculosisPathological 30(4):717-44. http:/es.wikipedia.org/wiki/TuberculosisRadiological classification Pleural TB6Miliary TB4Cavities5Lymph node TB1Air-space parenchymal TB2Tuberculoma3Fibrosis and destruction7