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上期试题：关于结核病化疗原则，下列哪项不恰当a a．应坚持早期、联用、足量、规律、全程用药 b．临床有结核中毒症状，X线病灶有炎性成分，需用化疗 c．利福平对杀灭被吞噬在细胞内的结核菌有效 d．对病灶部分硬结，痰菌阴性者，可先观察，暂不用化疗 e．初治病例如条件允许，尽量采用短程化疗(6个月) 结核性纵隔和（或）左肺门淋巴结炎多见于儿童原发综合征。近年来，在成年人，尤其是老年人中，纵隔淋巴结结核日渐增多，该类人群多合并免疫功能低下。肺部淋巴回流及右侧纵隔组织松软可能为发病的主要因素，以淋巴结多发为主，单侧多于双侧，右侧多于左侧。 Tuberculous mediastinal and (or) left lung lymph node phlogistic how primary syndrome in children. In recent years, in adults, particularly in the elderly, an increasing incidence of mediastinal lymph node tuberculosis, such people more merge a weakened immune system. Lung lymph circumfluence and mediastinal soft tissue on the right side as the main factors of the disease, with multiple lymph node is given priority to, more than bilateral unilateral, right more than left. 成人纵隔淋巴结结核好发部位为气管周围，可合并或不合并肺结核，文献报道约61%的患者有肺内结核病的证据。淋巴结结核在病理上分4期： Mediastinal lymph node tuberculosis in adults around a good location for the trachea, can merge or not amalgamative tuberculosis, literature reported that about 61% of the patients with pulmonary tuberculosis in evidence. Lymph node tuberculosis points in pathology. 4: 第1期为淋巴组织样增生，镜下见淋巴滤泡增大、淋巴管增生、网状内皮细胞增生，形成结节和肉芽肿。 （1） for lymphoid tissue hyperplasia, microscopically, the lymph follicle increased, lymphatic hyperplasia, reticular endothelial cell proliferation, and granuloma formation nodules. 第2期为淋巴结出现干酪样坏死，并出现液化，此期包膜尚完整。 （2） period for lymph node of caseous necrosis, liquefaction and appear, this period envelope is complete. 第3期诶淋巴结包膜破坏，多个坏死淋巴结融合、粘连。 (3) based on lymph node capsule, multiple necrotic lymph node fusion, adhesion. 第4期为干酪样坏死物质破裂，形成空洞或侵入周围组织和器官。 （4） for caseous necrosis material, form the cavity or invading the surrounding tissue and organs. 在胸部正位X线片上，较小的纵隔淋巴结结核病灶可能为阴性。位于右上纵膈且淋巴结较大时，表现为右上纵膈阴影增宽、密度增高，部分可呈分叶状或波浪状，有时可见钙化影；发生于隆突下者，可见气管分叉角度增大和气管受压等。 On the chest is a X ray film, smaller mediastinal lymph node tuberculosis kitchen may be negative. Located in the upper right of mediastinal lymph nodes and larger, characterized by upper widened mediastinum shadow, higher density, part can be showed lobulated or wavy, sometimes calcification shadow; Occurred in juga nobody, visible tracheal bifurcation Angle increases and trachea compression, etc. 纵隔淋巴结结核最常见部位为中纵膈淋巴结区，依次是右上气管旁淋巴结，右气管、支气管淋巴结和隆突下淋巴结，也可累及支气管肺淋巴结，前纵隔与后纵隔一般不受累。肿大的淋巴结可单发，也可累及多组淋巴结。CT平扫表现为等密度或中央低密度结节影，界限多清楚，多发融合者界限可不清晰。CT增强扫描，当淋巴结最大径小于1.0cm时，淋巴结之间可见清楚的脂肪间隙，淋巴结呈轻度均匀强化，提示淋巴结处于增生期；当淋巴结最大径为1.0—2.0cm时，则易出现淋巴结包膜强化或环形强化，中央呈低密度区，提示淋巴结处于干酪样坏死期；当肿大的淋巴结最大径大于2.0cm时，则边缘模糊，脂肪间隙消失，提示有淋巴结包膜破溃；当多个淋巴结融合成团块状，则表现为分隔样或多房样强化。巨大的淋巴结可导致腔静脉受压狭窄。破溃的淋巴结可穿透纵隔胸膜或邻近气管引起相应肺部结核的表现。 Mediastinal lymph node tuberculosis, the most common site for mediastinal lymph nodes in the area, in turn, is next to the upper airway lymph nodes, trachea, bronchi and subcarinal lymph node lymph node right, can also drag in bronchial lung lymph nodes, mediastinum after anterior mediastinum and is generally not affected. An enlarged lymph nodes can be single, multiple sets of lymph nodes can also be affected. CT scan is characterized by low density or the central density nodular shadows, boundaries clear, multiple fusion boundary is not clear. CT enhanced scan, when the lymph nodes maximum diameter less than 1.0 cm, clearly visible fat space between the lymph nodes, lymph node was mild homogeneous reinforcement, prompt lymph node hyperplasia stage; When the lymph nodes maximum diameter of 1.0 -- 2.0 cm, is easy to appear lymph node capsular reinforcement or circular reinforcement, the central show low density area, prompt lymph nodes in caseous necrosis stage; When an enlarged lymph nodes maximum diameter greater than 2.0 cm, edge blur, fat gap disappeared, suggesting the capsule burst; When multiple lymph nodes fusion conglobation block, is characterized by separation of samples or multilocular reinforcement. Enlarged lymph nodes can cause compression of vena cava stenosis. Burst of lymph nodes can penetrate mediastinal pleura or trachea caused corresponding adjacent pulmonary tuberculosis. ↑本例成人纵隔淋巴结结核 CT平扫可见支气管隆突前间隙多个肿大的淋巴结，边界清晰 CT增强可见多个肿大淋巴结呈环状及分隔样强化，与周围的界限清楚 （本期图片质量不太好，后期会找些近期图片显示，抱歉！） MRI横轴位与冠状位图像在显示纵隔淋巴结肿大方面十分敏感和有效。成人纵隔淋巴结结核的MRI形态学表现与CT类似，其MRI信号在T1WI上表现为等或略低信号，T2WI上呈中等或略高信号，信号可以不均匀；增强扫描时，依据淋巴结结核中病理成分的不同可表现为结节状、环状及分隔状强化，后者对诊断淋巴结结核具有重要的提示作用。 MRI transverse position with coronary image on the display is very sensitive and effective mediastinal lymph node enlargement. MRI morphological manifestation of mediastinal lymph node tuberculosis in adults with CT, MRI signal in performance such as or slightly low signal on T1WI, T2WI in the middle or slightly high signal, the signal can be uneven; Enhanced scan, according to the pathological characteristic of the lymph node tuberculosis in different nodular, annular and separated reinforcement, which has important implications for diagnosis of lymph node tuberculosis. 医学博士专栏 第十四期：来自马坎托尼欧博士的建议之保持心理健康 健康步入老年阶段的最重要的因素之一就是与其它人保持联系，而且坚持每天运动。这样不仅能够促进免疫系统的发展，而且能够帮助大脑建立新的连接。 Healthy ageing phase of one of the most important factors is to keep in touch with other people, and stick to exercise every day. This can not only promote the development of the immune system, but also can help the brain to establish a new connection. 那些不断培养新的爱好、去不同的地方旅游、结交新朋友的人看起来似乎比那些什么都不做的人要健康得多。你可以通过参加一些课程、看书、玩猜谜游戏或者在社区当志愿者 等方式保持大脑的健康。任何能让大脑处于活跃状态的额事情都有利于你保持心理健康。 Those who constantly develop new hobbies, to travel to different places and meeting new friends seem to be more healthy than those who do nothing more. You can take some lessons, read a book, play guessing game, or in the community volunteer and keep your brain healthy. Any thing can let the brain active is good for you to keep mental health. 本期试题： 关于颈部淋巴结核的处理，下列哪项是错误的 a．活动的淋巴结应完整手术切除 b．形成寒性脓肿尚未破溃时，可穿刺吸脓 c．继发感染形成脓肿后，需行切开引流术 d．寒性脓肿破溃者，刮除感染灶，缝合伤口 e．口服抗结核药物2年 |
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来自： zskyteacher > 《西航港之临床影像学习平台》
