结节状阴影

腺泡结节状影：1cm以下（4-7mm），边清、梅花瓣状、无融合趋向，为肉芽肿、肿瘤、血管炎及其周围炎、渗出、出血、水肿。中上肺野-多见结核的增殖性病变、慢性炎症；弥散—细菌性真菌性肺炎、肺泡蛋白沉积症、支原体肺炎、肺出血、肺水肿。

粟粒状结节影：４ｍｍ以下，弥散分布，多由间质病变引起，见粟粒型肺结核、癌性淋巴管炎、结节病、特发性肺含铁血黄素沉着、急性细支气管炎、组织细胞病x。
较大-转移瘤、肺泡癌、支气管播散型肺结核；较小—肺泡微石症。
粟粒型肺结核—大小一致、分布均匀；癌性淋巴管炎—沿肺纹理分布。
短期增大为癌肿所致。肿块影直径2cm以上。

小结节影的分布（1）

淋巴管周围分布：淋巴管位于支气管血管束、小叶间隔、胸膜下。见于—癌性淋巴管炎、结节病、尘肺。

胸膜表面

小叶间隔

支气管血管束

支气管血管束小叶中心

小结节影的分布（2）

随机分布：广泛均匀分布，一般两侧对称；又称血行分布，胸膜下不突出，在小叶间隔、小叶中心、支气管血管束、胸膜下，见于—血源性肺转移瘤、急性粟粒型肺结核。

小结节影的分布（3）
小叶中心分布：不与小叶间隔、胸膜相连，经气道吸入发生的病变。见于—过敏性肺炎、嗜酸性肉芽肿、尘肺。可见“树丫征”

外围结节与胸膜距离5-10mm

多种结节分布

待续………………

43-year-old woman with an abnormal chest radiograph and cough

诊断
Sarcoidosis.
A perilympatic pattern of nodules, with predominance in relation to the fissures and peribronchovascular regions is typical of sarcoidosis.

Perilymphatic淋巴管周围分布

叶裂、胸膜表面结节

支气管血管束结节

小叶间隔

a 34-year-old man with an abnormal chest radiograph and dyspnea
34岁，男性，胸片异常，呼吸困难

Perilymphatic淋巴管周围分布

诊断Sarcoidosis
A perilymphatic pattern of nodules, with predominance in relation to the fissures and peribronchovascular regions is typical of sarcoidosis结节病以叶裂、支气管血管束分布为主 .

胸膜下结节

支气管血管束结节

小叶间隔结节

气管旁肿大淋巴结

肉芽肿块
Confluence of granulomas

a 48-year-old man with persistent cough
48岁，男性，持续咳嗽

perilymphatic淋巴管周围分布
This patient shows a perilymphatic pattern. Subpleural nodules （胸膜下结节）are visible in relation to the major fissures.The nodules are patchy in distribution, involving different parts of the lung to varying degrees. Peribronchovascular nodules （支气管血管束结节）are visible. Nodules in relation to the interlobular septa and centrilobular regions（小叶间隔、小叶中心） are also seen。

胸膜下结节

支气管血管束结节

小叶间隔结节

小叶中心结节

asymptomatic 34-year-old man with an abnormal chest radiograph suggesting lymph node enlargement
34岁，男性，无症状，胸片提示淋巴结肿大

纵隔窗：双侧肺门淋巴结增大

perilymphatic淋巴管旁分布
This patient shows a perilymphatic pattern. Subpleural nodules （胸膜下结节）are visible particularly in relation to the major fissures（叶裂）.The nodules are scattered and patchy in distribution, and predominate in the upper lobes. Some of the nodules are peribronchovascular（支气管血管束结节）

诊断
Sarcoidosis. A perilymphatic pattern of nodules, with predominance in relation to the fissures and peribronchovascular regions is typical of sarcoidosis（结节病以胸膜下、支气管血管束分布为主 ）
Diagnosis: Sarcoidosis, mild, with perilymphatic nodules （淋巴管周围结节）

胸膜下结节

支气管血管束结节

in follow-up of an asymptomatic 43-year-old man with with a history of heart transplantation several years before
男性，43岁，几年前心脏移植史

perilymphatic淋巴管周围分布
This patient shows a perilymphatic pattern. Subpleural nodules 胸膜下结节are visible in relation to the major fissure斜裂. The nodules are scattered and patchy in distribution, and predominate in the upper lobes. Some of the nodules are peribronchovascular支气管血管束分布.

胸膜下结节

支气管血管束结节

诊断
sarcoidosis
This appearance is typical of sarcoidosis.

Progressive sarcoidosis, with perilymphatic nodules 淋巴管周围分布结节

移植前胸部异常

移植前胸部异常

an asymptomatic 29-year-old man with chest pain and infiltrates on chest radiograph
29岁，女性，胸痛，胸片可见渗出性病变

双侧肺门淋巴结增大

胸膜下结节

诊断Diagnosis:
Sarcoidosis
A perilympatic pattern of nodules is present, although this appearance is somewhat atypical. A very patchy distribution of nodules is common in sarcoidosis, but the grouping of nodules seen in this case is unusual. When seen on chest radiograph, this appearance is sometimes called “alveolar sarcoid,”（肺泡癌） although the nodules are discrete and interstitial.

Sarcoidosis, with patchy lung involvement不均的肺内侵润.

an 45-year-old South African diamond miner with progressive dyspnea
男性，45岁，南非钻石矿工进行性呼吸困难

perilymphatic（淋巴管周围分布）
This patient shows a perilymphatic pattern. Subpleural nodules （胸膜下分布）are visible at the lung periphery.The nodules are scattered and patchy in distribution, and predominate posteriorly and in the upper lobes. The nodules show symmetrical involvement of both upper lobes.

诊断：
Silicosis.硅肺
The history suggests silicosis. A perilympatic pattern of nodules, with predominance in relation to the supleural interstitium, with a symmetrical, posterior, upper lobe predominance is consistent with this diagnosis.

胸膜下结节

a 63-year-old woman with breast cancer and progressive shortness of breath
63岁，女性，乳癌伴进行性呼吸困难

诊断
Lymphangitic spread of carcinomaCorrect. This appearance is typical of lymphangitic spread of carcinoma（癌性淋巴管炎）. In patients with lymphangitic spread of tumor, when nodules are visible, they are most often visible within the thickened peribronchovascular interstitium and interlobular septa. Septal thickening can result in the appearance of a “beaded串珠状" septum.

This patient shows a perilymphatic pattern. Large subpleural nodules（胸膜下结节）are visible in the lung periphery.In addition, the nodules are patchy in distribution and predominate in relation to thickened interlobular septa.

胸膜下结节

增厚的小叶间隔

a 53-year-old man with thyroid cancer and progressive shortness of breath
53岁，男性，甲状腺癌伴进行性喘憋

诊断
Lymphangitic spread of carcinoma. This appearance is nonspecific, but consistent with lymphangitic spread of carcinoma. Although this appearance could also be seen in patients with sarcoidosis, the history suggests the appropriate diagnosis. Interlobular septal thickening, common with lymphangitic spread of carcinoma is not seen in this case.

胸膜下结节

中心血管

增大淋巴结

a 43-year-old man with AIDS, cutaneous Kaposi sarcoma (KS), and progressive shortness of breath
43岁，男性，皮肤卡波西肉瘤伴进行性喘憋

This patient shows a perilymphatic pattern with a peribronchovascular predominance. In a patient with AIDS, this distribution suggests lung involvement by KS.

支气管血管束间质

小叶中心

小叶间隔增厚

a 44-year-old woman with AIDS, fever
44岁，女性，艾滋病，发热

诊断
Lymphangitic spread of carcinoma
This appearance is typical of lymphangitic spread of carcinoma（典型的癌性淋巴管炎）. An unusual cause of this pattern in patients with AIDS is lymphocytic interstitial pneumonia（淋巴间质性肺炎） (LIP).

胸膜下结节

增厚的小叶间隔呈结节状

a 33-year-old man with shortness of breath
33岁，男性，气短

Large, ill-defined lung nodules are visible, predominating in relation to the peribronchovascular interstitium（支气管血管束间质）. Nodules also involve the supleural region（胸膜下）, and lymph node enlargement （淋巴结增大）is present.

诊断Diagnosis:
Lymphoma淋巴瘤 arising from Mucosa Associated Lymphoid Tissue (MALToma粘膜相关组织的淋巴瘤 ), with peribronchovascular nodules.
The presence of peribronchovascular nodules is typical.
支气管血管束结节是典型表现。

胸膜下结节

淋巴结增大

支气管血管束间质

a 43-year-old man with fever and cough
男性，43岁，发热咳嗽

This patient shows a random pattern（随机分布）. Subpleural nodules are visible peripherally and in relation to the major fissures. Overall的, the nodules appear diffuse, and a predominance in relation to perilymphatic structures is not visible.

诊断
Miliary tuberculosis
Based on history, infection is likely.

胸膜下结节

an 57-year-old man being treated for bladder cancer
57岁，男性， 膀胱癌

This patient shows a random pattern（随机分布）. Subpleural nodules are visible peripherally and in relation to the major fissures. Overall, the nodules appear diffuse.

Small nodules appearing randomly distributed in relation to structures of the lung： and secondary lobule are often seen in patients with miliary tuberculosis, miliary fungal infections, and hematogenous metastases（血行多发转移瘤）.

诊断首先考虑
Hematogenous metastases.
Based on history， hematogenous metastases is most likely。However, this patient is being treated for bladder cancer by having BCG, a (usually) non-pathogenic mycobacterium, instilled into his bladder. This rarely results in hematogenous dissemination, identical in appearance and histology to miliary TB, but easier to treat.

胸膜下结节

Following appropriate antibiotic treatment, the nodules have resolved.

最终诊断Diagnosis:
Miliary nontuberculous mycobacterium (BCG), with random nodules。

a 53-year-old man with fever and cough

This patient shows a random pattern. Subpleural nodules are visible peripherally and in relation to the major fissures. Overall, the nodules appear diffuse.

Miliary nodules related to fungal infection（许多粟粒状结节与真菌感染有关系） cannot be distinguished from miliary TB。（不能与粟粒型肺结核区别. ）

结节呈随机分布
胸膜下结节

an 51-year-old asymptomatic woman with breast cancer who is post liver transplantation
51岁，女性，无症状，乳癌肝转移

This patient shows a random pattern（随机分布）. Subpleural nodules are visible peripherally and in relation to the major fissure. Overall, the nodules appear diffuse, with a peripheral predominance. Considering the history of breast cancer, metastases are likely. An ill-defined opacity in the right upper lobe reflects fluid from recent bronchoscopy with bronchoalveolar lavage.

诊断Diagnosis: Hematogenous metastases from breast cancer血行多发转移瘤, with random nodules 随机分布。

胸膜下结节

an 57-year-old woman with a history of breast cancer
57岁，女性，乳癌史

This patient shows a random pattern（随机分布）. Subpleural nodules are visible peripherally and in relation to the major fissure. Overall, the nodules appear diffuse.

诊断 Diagnosis:
Hematogenous metastases from breast cancer血行多发转移瘤, with random nodules随机分布.

胸膜下结节

an 63-year-old man with a history of thyroid cancer
63岁，男性，甲状腺癌

This patient shows a random pattern（随机分布）. Subpleural nodules are visible peripherally and in relation to the major fissure胸膜下（外围、叶裂）. Overall, the nodules appear diffuse, with a peripheral predominance。

诊断Diagnosis:
Metastatic thyroid carcinoma甲状腺癌, with random and perilymphatic nodules随机、淋巴管周围分布.

胸膜下结节

In this patient, interlobular septal thickening both smooth and nodular（小叶间隔光滑、结节状增厚,） is also visible, suggesting a perilymphatic pattern（淋巴管周围分布.）

an 43-year-old Italian priest with an abnormal chest radiograph and cough
43岁，意大利牧师，胸片异常伴咳嗽

This patient shows a random pattern随机分布. Subpleural nodules are visible peripherally and in relation to the major fissures胸膜下结节（外围、叶裂）. Overall, the nodules appear diffuse.

Although the differential diagnosis would include miliary TB, miliary fungal infection, or hematogenous metastases as most likely尽管鉴别诊断包括（结核、真菌感染粟粒状,血行转移瘤） lung biopsy revealed sarcoidosis病理为结节病.
诊断Diagnosis: Sarcoidosisiejie结节病, with random nodules随机分布。

胸膜下结节

a 53-year-old man with productive cough
53岁，男性，排痰性咳嗽

This patient shows a centrilobular pattern小叶中心性分布. Subpleural nodules are not seen, and the most peripheral nodules visible range from 5 to 10 mm from the pleural surface and fissure. Overall, the nodules appear diffuse and uniform in distribution.

诊断Diagnosis:
Infectious 感染性的bronchiolitis细支气管炎 with centrilobular nodules小叶中心性结节.

外围结节（胸膜下5-10MM）

a 48-year-old man with common variable immunodeficiencyand productive cough
48岁，女性，免疫缺陷，排痰性咳嗽

This patient shows a centrilobular pattern小叶中心性分布. Subpleural nodules are not seen, and the most peripheral nodules visible range from 5 to 10 mm from the pleural surface and fissure.

Overall, the nodules appear patchy in distribution, and some are clearly related to thick-walled bronchi. Lucencies within several nodules represent centrilobular bronchioles, which are somewhat dilated.
诊断Diagnosis: Infectious bronchiolitis感染性细支气管炎 and bronchopneumonia支气管肺炎 with centrilobular nodules小叶中心结节.

胸膜下结节（胸膜下5-10MM）

增厚的细支气管壁

小叶中心细支气管

a 46-year-old man with a fever and productive cough
46岁，男性，发热咳嗽

This patient shows a centrilobular pattern小叶中心分布. Subpleural nodules are not visible, and some nodules are clearly related to small airways or contain a central lucency, representing a centrilobular bronchiole.

Larger areas of opacity, having a patchy distribution are visible in the lung bases. These represent lobular areas of consolidation, some containing a central air bronchogram (i.e. the centrilobular bronchiole).
诊断Diagnosis:
Bacterial细菌的 bronchopneumonia支气管肺炎 with peribronchial支气管周围 and lobular areas of consolidation肺小叶.

小叶中心透亮区

肺小叶！

a 57-year-old woman with progressive shortness of breath over several weeks, a nonproductivecough, and low-grade fever
57岁，女性，进行性气短数周，干咳，低热

This patient shows a centrilobular pattern小叶中心分布. Subpleural nodules are not seen, and the most peripheral nodules visible range from 5 to 10 mm from the pleural surface and major fissure. Overall, the nodules appear diffuse in distribution and evenly spaced. Abnormal bronchi and frank consolidation are not seen.

外围结节

Additional history revealed that the patient lived with several birds. In patients with a history of exposure, this appearance is highly suggestive of hypersensitivity pneumonitis高度暗示过敏性肺炎.

诊断
Diagnosis:
过敏性肺炎
Hypersensitivity pneumonitis, subacute stage, with centrilobular nodules.

过敏性肺炎
1.斑片状边缘模糊影：肺泡腔内空气被浆液渗出物取代—肺泡炎。
2.弥漫分布粟粒影：鸽子肺。
3.线、网状、粟粒状影：为间质性渗出性改变。

a 78-year-old man with progressive shortness of breath
78岁，男性，进行性喘憋

This patient shows a centrilobular pattern小叶中心分布. The most peripheral nodules are centered 5-10 mm from the pleural surface. Although the largest nodules in the posterior lung touch the pleural surface, no nodules appear to arise at the pleural surface. Overall, the nodules appear diffuse in distribution and evenly spaced. No abnormal bronchi are visible.

This appearance is nonspecific（无特殊性）. Bronchoscopy yielded bronchioloalveolar carcinoma支气管镜检为肺泡癌.
诊断Diagnosis: Bronchioloalveolar carcinoma, diffuse nodular form, with centrilobular nodules

Bronchioloalveolar carcinoma细支气管肺泡癌 (BAC) can result in:
1) a solitary nodule or mass (40% of patients);
2) focal or diffuse consolidation (30%);
3) diffuse ill-defined nodules 弥漫(30%). When multiple nodules are present, they may be centrilobular, as in this case, due to endobronchial spread, or may mimic the appearance of hematogenous metastasis.

a 35-year-old man with a fever and productive cough
35岁，男性，发热伴排痰性咳嗽

This patient shows a centrilobular pattern 小叶中心分布. Subpleural nodules are not visible. Some of the subpleural opacities have an irregular branching appearance（胸膜下可见树芽征）. This appearance, mimicking a branching tree, is termed "tree-in-bud."

诊断Diagnosis:
Bacterial bronchopneumonia支气管肺炎 with a centrilobular pattern 小叶中心分布and “tree-in-bud.” 树芽征（为细支气管内粘液栓）

Bronchoscopy revealed infection with Hemophilus influenza（流感嗜血杆菌）.

a 53-year-old woman with a right lung transplantation for emphysema and productive cough
53岁，女性，肺气肿，右肺肺移植术后，排痰性咳嗽

The left lung shows typical findings of panlobular emphysema（左肺为典型的全小叶型肺气肿）. Multiple small, well-defined centrilobular nodules 小叶中心结节 are visible in the transplanted right lung. Subpleural nodules are not visible. Tree-in-bud is visible in the right lower lobe（树芽征右下叶可见）.

诊断Diagnosis:
Bacterial bronchopneumonia支气管肺炎 with tree-in-bud.
DISCUSSION：Identifying the presence of “tree-in-bud” is very important in the differential diagnosis of centrilobular opacities（识别小叶中心树芽征鉴别诊断很重要）, as it strongly suggests the presence of infection. Tree-in-bud is most common with bacterial and mycobacterial infections, but can also be seen with fungal or viral infections.

左侧全小叶型肺气肿

树芽征

a 58-year-old man with fever and productive cough

A centrilobular pattern of nodules is visible, associated with bronchial wall thickening, and mild bronchiectasis.

Tree-in-bud is present！

诊断Diagnosis:
Bronchiectasis, bacterial bronchitis and bronchiolitis细菌性支气管炎、细支气管炎, with "tree-in-bud."

DISCUSSION：Tree-in-bud is often visible in patients with chronic airways disease（树芽征在慢性气道阻塞常见）, particularly bronchiectasis, when infection is present. In this patient, tree in bud is associated with bronchiectasis.

in a 28-year-old woman with cough and night sweats
28岁，女性，咳嗽盗汗

树芽征！

空洞！！！

Several nodular opacities are visible in the right upper lobe, with focal 焦点cavitation and several areas of “tree-in-bud.” The appearance of tree-in-bud strongly suggests endobronchial infection. This appearance in association with a focal apical opacity suggests TB.

诊断Diagnosis: Active tuberculosis活动性肺结核 with endobronchial spread and "tree-in-bud"
DISCUSSION：In a patient with tuberculosis, the presence of tree in bud indicates active树芽征存在指示活动 disease and endobronchial spread of infection末细支气管播散、感染.

a 35-year-old man with cough and night sweats
35岁，男性，咳嗽盗汗

Multiple large nodular opacities are visible in the upper lobes, with areas of cavitation, multiple clusters and rosettes of centrilobular nodulespresenting endobronchial spread of infection, and several areas of "tree-in-bud."

诊断Diagnosis: Active tuberculosis with endobronchial spread and "tree-in-bud"

空洞！！！

梅花瓣状！

树芽征！

a 78-year-old woman with cough and hemoptysis
78岁，女性，咳嗽咳血

树芽征！

大的边界不清的结节

Infection with atypical mycobacteriaCorrect. In an elderly woman年老的女人, this combination of findings could be seen with any of these diseases, but is most suggestive of atypical mycobacterial infection更支持非典型分支杆菌感染.

诊断Diagnosis
Mycobacterium（分支杆菌） avium-intracellulare complex (MAC) infection with tree-in-bud 。

a 73-year-old woman with cough

诊断：
Infection with atypical mycobacteria. 非典型分枝杆菌感染
In an elderly woman, the combination of bronchiectasis, nodules, and tree-in-bud is highly suggestive of MAC infection 。

支气管扩张

大的边界不清的结节

树芽征！

a 35-year-old man with leukemia
男性，35岁， 白血病

On the lung window scan, a lung nodule is surrounded by a halo of ground-glass opacity磨玻璃晕征. This is termed the “halo sign晕征”. On the soft tissue window scan, low-attenuation necrosis is visible in the central portion of the nodule.

诊断Diagnosis:
Invasive aspergillosis曲霉病 with the “halo sign晕征"

晕征！！！

坏死！！！

a 28-year-old man with leukemia and treated aspergillosis
28岁，男性，白血病，经过曲霉病治疗

诊断Diagnosis:
Invasive aspergillosis 曲霉病with infarction and air-crescent sign 新月征

不规则的空洞

结节影像

a 31-year-old woman with an abnormal chest radiograph
31岁，女性，异常胸片

诊断Diagnosis:
Wegener‘s granulomatosis with multiple nodules韦格纳肉芽肿

DISCUSSION：Large lung nodules can be associated with a variety of lung diseases, and in most instances, their appearance is nonspecific . The differential diagnosis includes metatstatic tumor转移瘤, infectious 感染or inflammatory lesions炎性损害, infarctions肉芽肿病, nodules of Wegener‘s granulomatosis, sarcoidosis结节病, and fibrotic masses 纤维块as are common in sarcoidosis or silicosis在结节病、硅肺病

不错，很好，希望有更多好图上传，谢谢！

好的东西，收藏！楼主辛苦了！

楼主,有没有关于这些病的整个的一组图片,一个人的.方便能联系一下我吗:372067892

不好意思，这是一个放射科的朋友总结的
我已经把他总结的资料全部发了出来