1、肺部感染- 影像学和病理,Outline,流行病学 影像学 病理学,细菌性-大叶性肺炎,病原菌：Streptococcus pneumoniae ，CAP(35%), Klebsiella pneumoniae Legionella pneumophila 病理生理：如下图,early (A) and advanced (B) stages of lobar pneumonia caused by Streptococcus pneumoniae. In (A), the airspaces are filled with edema fluid; only occasional neutro
2、phils are evident. In (B), neutrophils predominate.,细菌性-小叶性肺炎,病原菌：Staphylococcus aureus Escherichia coli Pseudomonas aeruginosa Anaerobes Haemophilus influenzae,病理生理：A:病原菌到达细支气管形成小叶中心结节和分枝斑片 B，C:支气管周围实变，小叶或部分小叶分布，呈多中心，实变不跨国小叶间裂,Acute bronchopneumonia. Low magnification photomicrograph shows several
3、small foci of consolidation located around the lumens of small bronchioles (arrows).,Chest radiograph showsareas of consolidation inthe right upper and left lower lobes. The patient was a 23-year-old man With bronchopneumonia,High-resolution computed tomography (CT) scan shows centrilobular nodules
4、(arrows) and lobular areas of consolidation (arrowhead) and ground-glass opacity (curved arrow). The patient was a 53-year-old man with bronchopneumonia.,并发症-肺脓肿,病原菌：anaerobic bacteria ，S. aureus, P. aeruginosa, and K. pneumoniae Inflammatory mass with central purulent necrosis Frequently cavitate S
5、mooth or shaggy inner margins Air-liquid levels common Maximal wall thickness usually 15 Low-attenuation central region and rim enhancement on CT scan,并发症-坏死性肺炎,Bulging fissure sign. Posteroanterior chest radiograph shows dense right upper lobe airspace consolidation with downward bulging of the min
6、or fissure. The patient was a 66-year-old man with pneumococcal pneumonia.,Necrotizing pneumonia. Chest radiograph (A) shows inhomogeneous and dense consolidation in the right lung. Computed tomography (CT) (B) image shows a large cavity and sloughed lung within the cavity (arrow). The patient was a
7、 42-year-old alcoholic man with necrotizing pneumonia secondary to Klebsiella pneumoniae and anaerobic organisms.,并发症-气瘤,病原菌：金葡菌（儿童），PCP（免疫抑制的成人）特点：薄壁含气空洞，数天或周内扩大，可导致气胸，数周或数月吸收,肺脓栓,来源：心内膜炎，血栓性静脉炎，静脉置管，起搏器导线。 影像学特点：空洞小结节，Feeding vessel sign,image (A) shows two vessels apparently coursing into a nodul
8、e (feeding vessel sign ） image (B) demonstrates that the only vessel in close contact with the nodule is a draining vein (arrow).,肺炎链球菌肺炎,CAP的主要致病菌（40%） 危险因素：高龄，慢性心肺疾病 主要影像学表现：均一实变，毗邻脏层胸膜 次要表现：小叶性肺炎（20-35%），球形实变（圆肺炎），叶间裂膨出高密度实变 其他：胸腔积液（10%），同侧淋巴节肿大（CT上50%）。 CT价值：明确有无空洞或积脓,Lobar pneumonia due to stre
9、ptococcus pneumonia,Round pneumonia due to Streptococcus pneumoniae,Bronchiolitis and bronchopneumonia due to Streptococcus pneumoniae,Extensive bilateral pneumonia due to Streptococcus pneumoniae,葡萄球菌肺炎,肺脓肿,Coccal colonies are densely surrounded by neutrophils (HE). Strong basophilia of the bacteri
10、a in H&E preparation indicates Gram positivity,Incidental terminal aspiration of MRSA colonies into the lung, leading to a culture-positive result (HE). Morphologic study can easily distinguish MRSA-induced infection from the carrier state of MRSA without provoking clinical manifestation.,S. aureus
11、bronchopneumonia, is characterized histologically by predominantly peribronchiolar inflammation,Bronchopneumonia due to Staphylococcus aureus. Chest radiograph shows bilateral poorly defined nodular opacities and patchy areas of consolidation. Also noted is a central venous line. The patient was a 7
12、0-year-old man withMRSA pneumonia.,Empyema due to Staphylococcus aureus. The patient was a 44-year-old man and an intravenous drug user. He had no radiologic evidence of septic embolism.,Septic embolism due to Staphylococcus aureus . The patient was a 43-year-old man with positive blood cultures for
13、 Staphylococcus aureus.,克雷白肺炎,CAP占1%-5%，HAP占15% 危险因素：嗜酒，慢性支气管肺病，ICU病人 常见影像学表现：CAP:均一大叶实变(右肺上叶多见）HAP:多中心单侧（60%），双侧（40%）实变（小叶性肺炎） 其他常见发现叶间裂膨出（30%），胸腔积液（60-70%），肺脓肿，脓胸 CT价值：明确空腔或脓肿,Autopsied lung with severe pneumonia in a patient with degenerative neuronal Disorder。Numerous large and long pathogens ar
14、e dispersed within the edematousalveolar space. The pathogens are not phagocytized by neutrophils (HE, low power).,Lobar pneumonia due to Klebsiella pneumoniae. The patient was a 73-year-old woman with K. pneumoniae pneumonia.,Klebsiella pneumoniae pneumonia and abscess formation 。The patient was a
15、53-year-old man .C ,D(3 days later),大肠埃希氏菌肺炎,CAP(4%), HAP 的5-20% 危险因素：操劳过度病人 常见影像学表现：多中心单侧或双侧实变（支气管肺炎），下叶为主 其他表现：胸腔积液,Bronchopneumonia due to Escherichia coli .Chest radiograph shows poorly defined nodular opacities (arrows) in the right upper lobe and small bilateral foci of consolidation.,铜绿假单胞菌肺炎
16、,HAP占20% 危险因素：COPD,机械通气，抗生素运用，囊型纤维化定植菌 常见影像学表现：小叶性肺炎，所有肺叶受累，CT提示小叶中心结节和tree-in-bud 其他常见表现：肺脓肿（20%），胸腔积液（60%）,左上，右上:Perivascular cuffing 征， 左下：美兰细菌染色。右下：痰图片染色（胶质铁染色）,痰染色,左：胶质铁染色 右：革兰染色,Severe pneumonia due to Pseudomonas.,流感嗜血杆菌肺炎,5-20%的CAP病原菌 危险因素：COPD,嗜酒，高龄 常见影像学表现：小叶性肺炎（50-60%）大叶性肺炎（30-40%） 非常见表现：
17、CT示小结节和树芽征，圆肺炎，空洞（不超过15%），胸腔积液（50%）,图左：Neonatal pneumonia caused by Haemophilus influenzae infection 图右：阳性痰涂片,Bronchiolitis and bronchopneumonia due to Haemophilus influenza . The patient was a 50-year-old man with H. influenza pneumonia.,军团菌肺炎,2-5%CAP 危险因素：高龄，男性，肿瘤或器官移植 主要影像学表现：大叶性肺炎，进展至多叶受累 少见表现：球
18、形实变（圆肺炎），单个或多个结节或者肿块样实变 并发症：空洞（免疫抑制病人），肺门淋巴结肿大(免疫抑制病人），胸腔积液（35-60%）,Fatal hospital-acquired pneumonia seen in a premature infant。 left）The lung is massively infiltrated by macrophages (HE) right）Numerous short rods are seen in the cytoplasm of alveolar macrophages,痰涂片,希门尼斯染色，巨噬细胞胞浆可见军团菌,Lobar pneumo
19、nia due to Legionella pneumophila.The patient was a 77-year-old man with legionella pneumonia.,Mass-like consolidation due to Legionella micdadei Contrast-enhanced computed tomography (CT) scan image shows dense focal consolidationin the left upper lobe adjacent to the aortic arch.,厌氧菌肺炎,20-35%需住院的CAP,35%的HAP 危险因素：各种原因引起的意识障碍 常见影像学表现：小叶性肺炎，好发上肺的后段和下肺的尖段 并发症：肺脓肿（20-60%），胸腔积液（50%）,
