肺泡微石症、转移性肺钙化丨影像表现

2022-08-08 熊猫放射 胸部影像诊断

肺泡微石症、转移性肺钙化的影像表现。

肺泡微石症 

Alveolar Microlithiasis

概述

  • 以肺泡内微石弥漫性沉积为特征的罕见特发性疾病

影像表现:致密的肺部,与症状不成比例

X线:

  • 双肺致密,心脏及膈肌边界模糊;

  • 弥漫性粟粒性钙化:肺泡微石;

  • “黑色”胸膜:小的胸膜下囊肿(5-10mm) 

CT/HRCT:

  • 微结节样散在钙化,叠加在磨玻璃影上

  • 沿胸膜、小叶间隔、支气管血管束大量钙化

  •  “黑色”胸膜表现与胸膜下囊肿相关

  • 偶尔出现小的肺尖部肺大疱

  • 无淋巴结肿大

(左) 肺泡微结石患者的PA胸片显示弥漫性双肺钙化和周围肺泡钙化引起的 “透明” 纵隔。

(右) 同一患者的PA胸片 (左肺上叶) 显示特征性沙尘暴钙化,可见单个钙球,黑色胸膜征被认为是胸膜下小肺囊肿所致的表现。

(左)同一患者的轴位 NECT(骨窗)显示弥漫性肺部磨玻璃影,右肺下叶和左肺上叶致密钙化,胸膜下肺小囊肿。典型的钙化分布导致小叶间隔增厚和小叶内网状影。 

(右)示意图显示了肺泡中层状叠加的钙球。单个钙球限定在肺泡内,不会聚集。

转移性肺钙化

Metastatic Pulmonary Calcification

影像

  • 最佳诊断线索:慢性肾功能衰竭患者,肺上野分布为主的高密度或钙化影

X线:

  • 敏感性较低,除非严重受累;

  • 弥漫性或局灶性、界限不清的结节性/线状高密度影,类似感染或肺水肿

  • 上叶最常受累

  • 肾衰的表现: 心脏肿大,肾性骨营养不良 

CT/HRCT:

  • 小叶中心桑葚样无定形钙化 (3-10mm) 

  • 非特异性磨玻璃影/实变

  • 小血管钙化:胸壁、心、肺

核医学

  • 骨扫描: 肺高密度影被证实有摄取

(左) 一例转移性肺钙化患者的轴位CT显示小叶中心桑椹样高密度影,与肺实质钙化有关另见散在小叶中心型肺气肿。

(右) 同一患者的轴位CT(骨窗) 显示高密度结节,与钙化一致。转移性肺钙化的典型位置是小叶中心。上肺占优势多见,可能由于肺尖的碱性环境。

(左) 一例转移性钙化患者的轴位CT显示肺前部有密集的钙化样实变。

(右) 转移性钙化患者的骨扫描显示肺弥漫性摄取。HRCT表现不能确定时,骨扫描有助于明确转移性钙化的诊断。

↓ 内容摘译自:

本书摘译内容请查看话题:#胸部影像诊断

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    2022-08-08 医鸣惊人

    认真学习了

    0

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