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本着交流学习、公益教育的愿望，我们创办了这个公众号。希望各基层医生可以积极踊跃的参与我们，共同探讨和学习。公众号内容主要包括：湘雅二医院放射科典型、疑难、罕见病例讨论；英语小讲堂；科研进展和课件荟萃等。 感谢大家的关注，欢迎留言交流。 ● Clinical Presentation ● 临床表现 ● A 23-year-old man with recurrent pneumonia. ● 23岁男性，反复肺炎。 ● Further Work-up ● 进一步检查 ● See Images at Left ● 看左图 ● Imaging Findings ● 影像表现 ● Click on Annotated Thumbnail to reveal caption ● 点击缩略图显示注释 ● 1A - Annotated Caption ● 1A - 注释说明 ● (A–C) Contrast-enhanced thoracic computed tomography. Mediastinal window (A,B) and lung window (C) images demonstrate a well-defined cavitary lesion in the left lower lobe (black arrow, C) and an abnormal vessel arising from the lateral aspect of the distal descending thoracic aorta (white arrow, A), adjacent to the cavitary lesion. An abnormal vein anterior to the aorta is also present (white arrow, B). ● （A-C）对比增强胸部CT。纵隔窗（A，B）和肺窗（C）图像显示左下肺叶的边界清晰空洞病变（黑色箭头，C）和远端降主动脉外侧面邻近空洞病变区出现的异常血管（白色箭头 ，A）。主动脉前方的可见异常静脉（白色箭头，B）。 ● 1B - Annotated Caption ● 1B - 注释说明 ● (A–C) Contrast-enhanced thoracic computed tomography. Mediastinal window (A,B) and lung window (C) images demonstrate a well-defined cavitary lesion in the left lower lobe (black arrow, C) and an abnormal vessel arising from the lateral aspect of the distal descending thoracic aorta (white arrow, A), adjacent to the cavitary lesion. An abnormal vein anterior to the aorta is also present (white arrow, B). ● （A-C）对比增强胸部CT。纵隔窗（A，B）和肺窗（C）图像显示左下肺叶的边界清晰空洞病变（黑色箭头，C）和远端降主动脉外侧面邻近空洞病变区出现的异常血管（白色箭头 ，A）。主动脉前方的可见异常静脉（白色箭头，B）。 ● 1C - Annotated Caption ● 1C -注释说明 ● (A–C) Contrast-enhanced thoracic computed tomography. Mediastinal window (A,B) and lung window (C) images demonstrate a well-defined cavitary lesion in the left lower lobe (black arrow, C) and an abnormal vessel arising from the lateral aspect of the distal descending thoracic aorta (white arrow, A), adjacent to the cavitary lesion. An abnormal vein anterior to the aorta is also present (white arrow, B). ● （A-C）对比增强胸部CT。纵隔窗（A，B）和肺窗（C）图像显示左下肺叶的边界清晰空洞病变（黑色箭头，C）和远端降主动脉外侧面邻近空洞病变区出现的异常血管（白色箭头 ，A）。主动脉前方的可见异常静脉（白色箭头，B）。 ● Differential Diagnosis ● 鉴别诊断 ● Pulmonary sequestration (PS): A parenchymal mass or cavitary lesion in a lower lobe with systemic arterial supply and systemic venous drainage is characteristic of a PS. ● 肺隔离症（PS）：由系统动脉供血和系统静脉引流的下叶实质性肿块或空洞病变是PS的特征。 ● Lung abscess: A lung abscess in a lower lobe can present with an appearance similar to that of a PS. Key elements for differentiating between these conditions are the vascular supply and drainage of the abnormality. A pulmonary abscess in a previously normal lung should have a normal pulmonary supply and normal venous return. ● 肺脓肿：下叶的肺脓肿可呈现类似于PS的外观。区分这些情况的关键因素是异常的供血和引流血管。发生于正常肺组织的肺脓肿应具有正常的肺供血和静脉回流。 ● Intrapulmonary bronchogenic cyst: A bronchogenic cyst, when located in the pulmonary parenchyma, can also resemble a PS. Again, the vasculature helps in distinguishing between these abnormalities. ● 肺内支气管囊肿：位于肺实质内的支气管囊肿也可以类似于PS。再次，脉管系统有助于区分这些异常。 ● Essential Facts ● 基本事实 ● PS is an anomaly of tracheobronchial branching, with an abnormal bronchial connection or obstruction and abnormal systemic arterial supply to the affected lung. ● PS是气管支气管分支的异常，支气管连接或阻塞异常，并且病变肺是异常的系统动脉供血。 ● Common clinical presentations include pneumonia, recurrent infection, cough, and hemoptysis. ● 常见的临床表现包括肺炎，反复感染，咳嗽和咯血。 ● Bronchiectasis, atelectasis, air-fluid levels, and emphysema in the sequestered lung are common. ● 常并支气管扩张，肺不张，气液平面和肺气肿。 ● Classically, PS has been divided into two major categories: intralobar and extralobar. ● 传统上，PS被分为两大类：叶内型和叶外型。 ● Intralobar sequestration is the most common type (75%), may affect either lower lobe, and is likely congenital. ● 叶内型隔离是最常见的类型（75％），可能累及任何一个下叶，可能是先天性的。 ● Intralobar sequestration is probably acquired as a consequence of bronchial obstruction and receives arterial supply from the descending aorta. ● 叶内型肺隔离症可能源于支气管阻塞，并从降主动脉接受动脉供血。 ● Extralobar sequestration is likely congenital, is seen predominantly in males, and commonly presents relatively early in life. The vast majority of extralobar sequestrations are located in the left lower lobe (90%). ● 叶外型隔离症可能是先天性的，主要见于男性，并且通常在年幼时较早发病。绝大多数的叶外型隔离症位于左下叶（90％）。 ● An extralobar sequestration receives its arterial supply from either the thoracic or the abdominal aorta. ● 叶外型隔离症从胸主动脉或腹主动脉接受其动脉供血。 ● A large number of extralobar sequestrations are associated with other abnormalities, such as left posterior diaphragmatic hernia (80%), congenital heart disease, and congenital cystic adenomatoid malformation, or they may be connected to the gastrointestinal tract (esophagus or stomach). ● 大量的叶外型隔离症与其他异常相关，如左后膈疝（80％），先天性心脏病和先天性囊性腺瘤样畸形，或者它们可能与胃肠道（食道或胃）连接。 ● Other Imaging Findings ● 其他影像表现 ● No Other Imaging Findings ● 没有其他影像表现 ● Pearls and Pitfalls ● 经验与教训 ● Intralobar sequestrations have venous drainage through the pulmonary venous system, whereas extralobar sequestrations have systemic venous drainage through the azygos vein, hemiazygos system, or inferior vena cava. ● 叶内型隔离症通过肺静脉系统进行静脉引流，而叶外型隔离症通过奇静脉、半奇静脉或下腔静脉引流至系统静脉。 ● On conventional radiographs, PS can have a wide spectrum of imaging findings, including a solid mass, a cystic lesion, and an air-fluid level, which can be confused with pneumonia, abscess, cyst, and tumor. ● 在常规X线片上，PS可以有多种影像学表现，包括实性肿块、囊性病变和气液平面，可类似于肺炎、脓肿、囊肿和肿瘤。 ● Further Readings ● Berrocal T, Madrid C, Novo S, Gutiérrez J, Arjonilla A, Gómez-León N. Congenital anomalies of the tracheobronchial tree, lung, and mediastinum: embryology, radiology, and pathology. Radiographics. 2004;24(1):e17. ● Bolca N, Topal U, Bayram S. Bronchopulmonary sequestration: radiologic findings. Eur J Radiol. 2004;52(2):185-191. ● Evrard V, Ceulemans J, Coosemans W, et al. Congenital parenchymatous malformations of the lung. World J Surg. 1999;23(11):1123-1132. ● Zylak CJ, Eyler WR, Spizarny DL, Stone CH. Developmental lung anomalies in the adult: radiologic-pathologic correlation. Radiographics. 2002;22:S25-S43. |
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