几种特殊 X 线影像学征象ContentsnSigns in chest imagingnTree-in-bud PatternnCrazy-paving patternnHalo signnAir crescent signnFinger-in-glove signnTree-In-Bud Pattern树芽征 tree-in-bud patternnHRCT 上细支气管周围炎，小叶中央支气管及其远端气道扩张、粘液嵌塞，在不同的截面组合一起，形似“春天发芽”的征象n树芽征最初用于描述肺结核并支气管播散，但也见于其他疾病n最经典的是弥漫性泛细支气管炎（DPB）n满肺的树芽征作为诊断依据之一n树芽征常见原因n感染n细菌、真菌、病毒n先天性疾病n囊性纤维化、Kartagener 综合征n特发性疾病n闭塞性细支气管炎、弥漫性泛细支 气管炎n误吸或异物吸入n免疫性疾病nABPAn结缔组织疾病n类风湿性关节炎、干燥综合征n外周肺血管性疾病nHigh-resolution CT scan (far left) and drawings of the lung (middle left), a budding tree (middle right),and tree buds (far right) show the tree-in-bud pattern.nNote the similarity of the obstructed bronchioles to the objects used in the game of jacks.nThin-section CT scan obtained in a 29-year-old man with acute myeloid leukemia after bone marrow transplantation. The patient had a history of fever and cough.nImage shows multiple, small,centrilobular nodules of soft-tissue attenuation connected to linear branching opacities (arrows). Note the morphologic similarities to the photograph of the tree in bud. At serologic examination,an infection with Mycoplasma pneumoniae was confirmed.n18-year-old man with active tuberculosis.nHigh-resolution CT scan shows severe changes of bronchiolar dilatation and impaction. Tree-in-bud pattern is seen in right lower lobe (arrow) and represents endobronchial spread of tuberculosis. Direct signs of bronchiolar involvement are also seen in left upper and lower lobes.弥漫性泛细支气管炎（DPB） n东亚的地区病，影像学上特征明显n临床诊断标准n症状：咳嗽、咳较多脓痰、活动后胸闷、气短n体征：中细湿性罗音，可有哮鸣音n影像学：弥漫性树芽征n肺功能：阻塞性通气功能障碍，通常无弥散功能下降；低氧血症n冷凝集试验效价升高，64 倍以上升高n慢性鼻窦炎DPB 确诊标准n确诊有赖于组织病理学检查 (3 条中 2 条以上)n淋巴组织增生，表现为淋巴滤泡肥大增生，淋巴细胞 和浆细胞浸润n泡沫细胞n细支气管周围纤维化n诊断中的困惑n冷凝集试验医院不做n如此小的细支气管中心性病变，经皮肺穿的阳性率低nDPB、支气管扩张和树芽征Crazy-paving patternnPhotograph of a colonial-era pavement street in Buenos Aires, Argentina (left), drawings of the lungs (center) and lung tissue (top right), and close-up high-resolution CT scan (bottom right) show the crazy-paving pattern.Causes of the crazy-paving patternnAdult respiratory distress syndrome in a 27-year-old man who developed barotrauma and pulmonary interstitial emphysema.nHigh-resolution CT scan shows scattered ground-glass attenuation and thickening of the intra- and interlobular septa (crazy paving pattern). Note the air within the areas of interlobular thickening, a finding indicative of pulmonary emphysema. nHematopoietic stem cell transplantation (HSCT)n38-year-old man with adenovirus pneumonianHRCT scan at level of upper lobes shows bilateral areas of ground-glass attenuation with superimposed interlobular septal thickening (“crazy- paving” pattern)Halo signnInvasive pulmonary aspergillosis in a 39-year-old man with acute myelogenous leukaemia and neutropenia.nThin-section CT at the level of the lung apex shows multiple nodules surrounded by a halo of ground glass opacity in both upper lobes.nCytomegalovirus pneumonia in a 45-year-old woman with rapidly progressive glomerulonephritis.nThin-section CT of the right lung base demonstrates multiple tiny nodules (arrows) with the CT halo sign in the right lower lobenKaposi sarcoma in a 29-year-old woman with a history of renal transplantation.nThin-section CT at the level of the carina shows multiple nodules with a surrounding halo of ground glass opacity in both lungs, which are dissimilar to flame-shaped lesions, the classic findings of Kaposi sarcomana The most common condition showing the CT halo sign in immunocompromised patients.nb The most common condition showing the CT halo sign in immunocompetent patients.Air crescent signnAspergilloma (round mass in the left upper lobe) visualized by computed tomography in a young man. The etiology of the underlying cavity was unknown in this case.nCT halo sign. This first thoracic CT scan (day 0) was performed in a patient with febrile neutropenic leukemia. The ground glass attenuation surrounding the nodule was considered a typical halo sign. The diagnosis of IPA was considered highly likely, and antifungal treatment was started.Caillot et al. J Clin Oncol 2001; 19:253-9.nInvasive aspergillosis in a febrile neutropenic patient.nSequential cone-down views of the left upper lobe show progression from rounded consolidation to development of the classic air crescent sign (arrows).The air crescent sign A clue to the etiology of chronic necrotizing pneumonianThe most common cause is the fungus ball of angioinvasive aspergillosisnThe ball can be large or small, solitary or multiplenIt may move when the patients position changes or remain fixednAdditional causesnPulmonary hydatid cyst 肺包囊虫囊肿nOther fungi,blood clot or Rasmussen aneurysm in a tuberculous cavity拉斯 穆森瘤nLung abscess with inspissated pus 浓缩了的粘稠脓液nStaphylococcal pneumonia 金葡菌肺炎nNocardial infectionnCarcinoma of the lungnPulmonary gangrene or hematoma 肺坏疽或血肿Finger-in-glove signn(A) Postoanterior radiograph showing a branching opacity in the left upper lung (finger-in-glove sign)n(B) Axial CT image with tubular opacity