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  • CT skanning af Lunger

    Billeddiagnostisk kursus i Pdiatrisk Pulmonologi

    Onsdag den 14. april 2010

    Gratien Andersen, overlgeBilleddiagnostisk Afdeling

    rhus Universitetshospital, Skejby

  • Bronkiektasier

    Definition:Bronko-artieriel ratio >1.2Bronkier, der er strre end den ledsagende arterier (praktisk definition)ledsagende arterier (praktisk definition)

    3 typer:Cylindriske, varikse og cystiske

    Diagnostisk njagtighed ved HRCT: 95%

  • Cylindriske

  • Varikse

  • Cystiske

  • Atelektaser

  • Atelektase

  • Kongenitte forandringer

    Anomalier med normal vaskulatur Kongenit lobrt emfysem Bronkogen cyste CCAM (Congenital Cystic Adenomatoid Malformation) Pulmonal agenesi og hypoplasi Pulmonal agenesi og hypoplasi Segmentr bronkial atresi

    Anomalier med abnorm vaskulatur Pulmonal sekvester Pulmonale arteriovense malformationer Pulmonary Varix

  • Kongenit lobrt emfysem

  • Bronkogen cyste

  • CCAM(Congenital Cystic Adenomatoid Malformation)

    Type I: 50% En eller flere cyster >2cm

    Type II: Type II: 40%Multiple cyster 1-10 mm i diameter

    Type III: 10%Multiple mikroskopiske cyster (

  • CCAM(Congenital Cystic Adenomatoid Malformation)

  • CCAM(Congenital Cystic Adenomatoid Malformation)

  • Persisterende interstitiel emfysem

    CCAM(Congenital Cystic Adenomatoid

    Malformation)

  • Segmentr bronkial atresi

    Kongenit bronkocele/mykocele

  • Pulmonal sekvester

    Intralobr: 70% Erhvervet sekvestrering? (Kroniske infektioner) Arterie fra aorta Vene drnage til lungevene / ve. Atrium

    Ekstralobr Kongenit sekvestrering Arterie fra aorta Vene drnage til cava inf., azygous, portae, Ledsagende anomalier: Diafrgmaeventration/hernia, fistler til GI system,

  • Pulmonal sekvester

  • Pulmonal sekvester

  • Pulmonal varix

  • AVM

    Multiple 35 50% Bilat. 10 - 20%

    I 60% associeret med Osler-Weber-Rendu syndrom (Hereditr hmoragisk telangiektasi)

  • Pulmonale tumorer

    Benign tumor: Laryngotrakeal papilom Hamartom Hmangiom, Leiomyom, lipom

    Malign tumorPrimr

    Bronkial carcinom Bronkial carcinom Pulmonal blastom Rabdomyosarkom Leiomyosarcom, hmangiopericytom, bronkogensarkom etc

    Sekundr (Metastaser): F.eks. fra Wilms tumor, osteogen sarkom, rabdomyosarkom, lymfom etc

  • Diffuse infiltrativelungeforandringer

    Interstitiellelungeforandringer

    HRCT

  • Interstitial lung disease

    Chestradigraphy

    HRCTradigraphy

    Accuracy 34% 61%

    Confidence in diagnosis 18% 42%

  • Diagram shows anatomy and dimensions of secondary lobule and pulmonary acinus.

    Webb W R Radiology 2006;239:322-338

    2006 by Radiological Society of North America

  • Rntgen af 1 mm snit

    Centrilobulr B=Bronkiole A=Arterie

    V=Vene S=Interlobr septum

  • Interlobr septal fortykkelseInterstitiel pulmonal dem

  • Interlobr septal fortykkelseLymfangiektasi:

    Nodulr septal fortykkelse

  • Differential Diagnosis of Interlobular Septal Thickening

    Diagnosis CT Appearance of Thickening

    Pulmonary edema Smooth

    Congenital lymphangiectasia Smooth or nodular

    Sickle cell disease Smooth

    Idiopathic pulmonary fibrosis IrregularIdiopathic pulmonary fibrosis Irregular

    Lymphangitic carcinoma Smooth or nodular

    Lymphocytic interstitial pneumonia Smooth or nodular

    Sarcoidosis Nodular or irregular

    Alveolar proteinosis Smooth

    Idiopathic pulmonary hemosiderosis Smooth

    Hypersensitivity pneumonitis Smooth or nodular

  • Subleurale fortykkelser

  • Honeycombing

    Fibrose + destruktive forandringerSm subpleurale cyster og sm bronkiektasier

  • Nodulre forandringer

  • Differential Diagnosis of Peribronchial Nodules

    Congenital lymphangiectasia SarcoidosisCongenital lymphangiectasia Sarcoidosis

    Lymphangitic carcinomatosis Lymphocytic interstitial

    Langerhans cell histiocytosis Pneumonia

  • Peribronkiale forttningerSarcoidose

    A: Centrale og perifere B:Centrale

  • Differential Diagnosis of Centrilobular Nodules

    Diagnosis CT Appearance of Nodules- Langerhans cell histiocytosis Well defined; mid and upper lung zone

    predominance, relative sparing of lung bases

    - Idiopathic pulmonary Well or poorly defined; often central - Idiopathic pulmonaryhemosiderosis

    Well or poorly defined; often central distribution

    - Hypersensitivity pneumonitis Poorly defined; bilateral symmetric; patchy or diffuse; mid and lower lung predominance

    - Cryptogenic organizing pneumonia Ill-defined; subpleural or central

    - Bronchiolitis obliterans, proliferative type

    Well defined

    - Endobronchial spread of tuberculosis

    Well or ill-defined nodules or tree-in-bud pattern

  • Centrilobulre forttninger

    5-10 mm fra overfladen

    Fra 2-3 mm til 1cm i strrelse

    Patient med astma: Dilaterede, vskefyldte bronkioler

    strrelse

    Med forgreninger Tree-in-bud

    Tree-in-bud = small airway disease

  • Diffuse forttninger

    Veldefinerede, diffuse og/eller symetriskeforttninger

    Langerhans histiocytose

    Fordelingen er uden sammenhng med lungens arkitektur

    Eksempler: -Milir tuberkulose-Svampeinfektioner-Metastaser-Langerhans histiocytose

  • Lunge-attenuation

    getMat-glas konfiguration (Ground-Glass Opacity) Konsolideret lungevv

    Nedsat Cystiske lungeforandringer EmfysemMosaik attenuation

  • Differential Diagnosis of Consolidation

    Diagnosis CT Appearance of Consolidation- Acute pneumonia (bacterial, fungal, viral, Pneumocystis carinii)

    Patchy, nodular, lobular, or diffuse

    - Pulmonary edema, acute Perihilar, diffuse of dependent distribution- Pulmonary edema, acute Perihilar, diffuse of dependent distribution

    - Pulmonary hemorrhage, acute Patchy or diffuse

    - Acute respiratory distress syndrome (ARDS)

    Patchy or diffuse; mainly dependent lung

    - Chronic interstitial pneumoniaUsually peripheral and lower lobe distribution

    - Alveolar proteinosis Patchy

  • Ground-Glass Opacity Lungekonsolidering

  • Differential Diagnosis of Cystic Lung Disease

    Diagnosis CT Appearance of Cystic Disease

    - Pulmonary Langerhans cell histiocytosisThin-walled cysts; mid and upper lung zones, relative sparing of lung bases

    - Tuberous sclerosis, Marfan syndrome, neurofibromatosis

    Cysts and bullaeneurofibromatosis- Idiopathic pulmonary fibrosis(usual interstitial pneumonia)

    Honeycombing; peripheral, basilar, and subpleural predominance

    - Hypersensitivity pneumonitis, chronicHoneycombing in advanced disease; middle lung zones predominance common

    - Idiopathic pulmonary hemosiderosis Honeycombing in advanced disease

    - Collagen vascular disease, chronic Honeycombing, basilar distribution

    - Pneumonias(bacterial pneum., Pneumocystis carinii)

    Cysts

    - Lymphocytic interstitial pneumonia Thin-walled cysts

  • Pneumocystis carinii

    Emfysem:Alfa 1-antitripsin-mangel

  • Eksempler

  • Sygdomme med linere eller retikulre forttninger

    Pulmonal dem

    Pulmonal lymfangiektasi

    Bronkopulmonal dysplasi (BPD)

    Sickle cell sygdom

    Idiopatisk interstitiel pneumoni

    Lymfangitis carcinomtosa

  • Pulmonal lymfangiektasi Bronkopulmonal dysplasi

    Linere eller retikulreforttninger

  • Interstitiel pneumoni

    Linere eller retikulreforttninger

  • Sygdomme mednodulre forttninger

    Sarcoidose Wegeners granulomatose

  • Sygdomme medGround-Glass / Konsolidering

    Pulmonal dem

    ARDS (Acute Respiratory Distress Syndrome)

    Pulmonal alveolr proteinose

    Pulmonal Hmosidrose Pulmonal Hmosidrose

    Hypersensitivitets pneumoni

    Kollagene-Vaskulre sygdomme

    COP/BOOP (Cryptogen Organizing Pneumonia)

    (Brocholitis Obliterans Organizing Pneumonia)

  • dem

    Alveolr proteinose

    Sygdomme medGround-Glass / Konsolidering

  • Akut Hypersensitivitets Peumoni

    Sygdomme medGround-Glass / Konsolidering

  • Sygdomme medcyster eller emfysem

    Langerhans celle histiocytose

    Tubers sklerose

    Marfans Syndrom

    Neurofibromatosis (Type 1) Neurofibromatosis (Type 1)

    Langerhans histiocytose

  • Sygdomme medcyster eller emfysem

    Tubers skleroseMarfan

  • Sygdomme medtt lungestruktur og mosaik

    perfusion

    Cystisk fibrose

    Alfa-1-antitripsin-mangel

    Bronkiolitis: Bronkiolitis: Proliferativ Obliterativ

    Swyer-James Syndrom

  • Cystisk fibrose

  • Bronkiolitis obliterans

    B- EkspirationA- Inspiration

  • Swyer-James Syndrom

    Postinfektis bronkolitisobliterans

    Vksthmmet syge lunge

    Ekspiration

    Air trapping

  • Pulmonale infektioner

  • Tuberkulose

    Milir TBPrimr TB

  • Absces

  • Aspergillus

    Allergisk bronkopulmonal

    aspergilloseAspergillom

  • Cryptococcus infektion

  • Cytomegalovirus infektion

  • Sprgsml ?

    66

    Gratien AndersenOverlge

    Billeddiagnostisk Afd. Aarhus Universitetshospital, Skejby

    Email: [email protected]