這期說說空洞肺結(jié)核與個別肺疾病的鑒別：

Talk about the distinction between vacuous tuberculosis and individual lung diseases:

       該類型的繼發(fā)性肺結(jié)核多為肺結(jié)核病變的中晚期，以單發(fā)或多發(fā)的各種形態(tài)的空洞性病變?yōu)橹饕跋駥W(xué)表現(xiàn)特點，同時還伴有其他多形性與多樣性的肺部病變表現(xiàn)，如干酪化病變、增殖病變、纖維化與鈣化等，其中引流支氣管征是肺結(jié)核空洞的重要伴發(fā)征像，多在空洞近心側(cè)出現(xiàn)一條或多條壁增厚或略擴張的支氣管影，同時，支氣管播散也是結(jié)核性空洞易伴發(fā)的征像，表現(xiàn)為同側(cè)或?qū)?cè)肺野沿支氣管分布的斑片或小葉中心結(jié)節(jié)與分支狀影，即樹芽征?？斩床∽儼橛兄夤懿ド⒉≡钋曳谓Y(jié)核病變表現(xiàn)不典型時應(yīng)與以下幾種疾病進行鑒別，如肺膿腫、癌性空洞、韋格納肉芽腫等。

        This type of secondary pulmonary tuberculosis for tuberculosis lesions in middle-late, with various forms of single or multiple hollow venereal disease is a major characteristic imaging findings, but also with other polymorphism and diversity of lung disease, such as caseation lesion, proliferation, fibrosis, and calcification lesion, drainage of bronchial tuberculosis cavity is important with character, more than in the hole near the heart side wall of one or more slightly expansion or thickening of bronchial shadow, at the same time, endobronchial spread and tuberculous cavity is easy with a character like, show the ipsilateral or contralateral lung field distribution along the bronchi patch or lobules centre of nodules and branching, tree-in-bud namely. Vacuolar lesions with bronchial disseminated lesions and atypical manifestations of pulmonary tuberculosis should be identified with the following diseases, such as pulmonary abscess, cancerous vacuoles, wegener granuloma, etc.

       肺膿腫是一種伴有肺組織壞死的炎性病變，常見的致病菌主要為金黃色葡萄球菌、肺炎球菌和溶血性鏈球菌等。該病起病較急，多為高熱、畏寒、咳嗽、咳大量膿痰等癥狀。常見的感染途徑為吸入性肺膿腫，血源性肺膿腫亦非少見。急性期肺膿腫影像學(xué)上主要表現(xiàn)為肺實變、厚壁空洞（多含有較大的氣液平面）以及周圍的磨玻璃密度影，一般無支氣管播散病灶；CT增強掃描后，膿腫壁可見強化，反映了洞壁內(nèi)富含微血管的肉芽組織。如治療及時和有效，則膿腫逐漸吸收，空洞閉合，局部可殘留條索樣陰影。如病程遷延超過3個月，則可出現(xiàn)慢性肺膿腫的表現(xiàn)，可出現(xiàn)多發(fā)空洞，空洞形態(tài)不規(guī)則，可為薄壁或厚壁，腔內(nèi)多無液面，洞壁周圍可見多發(fā)條索樣陰影，鄰近胸膜多有粘連和肥厚，有時與慢性肺結(jié)核空洞鑒別較為困難，但慢性肺膿腫的鈣化與支氣管播散病灶少見。

       Pulmonary abscess is an inflammatory disease with pulmonary necrosis. The common pathogenic bacteria are staphylococcus aureus, pneumococcus and streptococcus hemolyticus. This disease starts a disease more urgent, it is high fever, fear cold, cough, cough a lot of purulent phlegm wait for a symptom more. Aspiration pulmonary abscess is a common route of infection, and hematogenic pulmonary abscess is not uncommon. In the acute phase, lung abscess is mainly manifested by pulmonary consolidation, thick-walled cavity (mostly containing large gas-liquid plane), and the surrounding glass density shadow. After enhanced CT scanning, the wall of the abscess was enhanced, reflecting the granulation tissue rich in microvessels in the wall of the cave. If the treatment is timely and effective, the abscess is gradually absorbed, the cavity is closed, and local residual cord like shadow can be left. Such as illnesses out more than 3 months, can develop chronic lung abscess, there may be multiple hole, hole shape is irregular, can is a thin or thick wall, cavity without the liquid level, more shadow around the cave walls are visible by samples, many adjacent pleural adhesion and hypertrophy, sometimes with chronic pulmonary tuberculosis cavity identification more difficult, but the calcification with endobronchial spread of chronic lung abscess lesions.

↑急性肺膿腫

右肺上葉可見大片狀實變病灶，其內(nèi)可見兩個厚壁空洞，空洞內(nèi)可見氣液平面，空洞外壁周圍可見磨玻璃密度應(yīng)。

Large flaky solid lesions can be seen in the upper lobe of the right lung. Two thick wall voids can be seen in the voids, and gas-liquid plane can be seen in the voids. Glass density should be observed around the voids' outer wall.

↑血源性肺膿腫

兩肺多發(fā)結(jié)節(jié)與肺實變病灶，其內(nèi)可見空洞，有的壁菲薄似囊腔；多數(shù)病灶可見有肺血管影相連。

There are multiple nodules and lung consolidation lesions in both lungs, with cavities visible, and some walls are thin like cystic cavities. Most lesions can be seen with pulmonary angiography.

↑右上肺鱗癌空洞

X線平片與CT可見右上肺形態(tài)不規(guī)則的腫塊中的厚壁空洞，外壁呈分葉狀，可見長短不等的毛刺征與胸膜凹陷征。

 X-ray plain film and CT showed the thick wall cavity in the irregular mass of the right upper lung, and the outer wall was lobulated, with different lengths of burr and pleural depression.

↑韋格納肉芽腫

肺部CT可見愛你右下肺厚壁空洞及遠側(cè)少許磨玻璃密度影，鼻竇CT可見左側(cè)鼻旁竇炎改變。   

The lung CT showed the thick-walled cavity of the right lower lung and a little glass density shadow on the far side. The sinus CT showed the changes of the left paranasal sinusitis.