第221课继发性secondarytuberculosisoflung（九）
这是说说矽肺的相关临床影像表现：
proliferation矽肺是尘肺中最常见的类型，矽肺患者是的易患人。据资料统计显示，I期矽肺合并的发生率约33.9%，II期矽肺合并的发生率为47.9%，III期矽肺合并的发生率可高达60-70%。
Silicosis is the most common type of pneumoconiosis, and patients with silicosis are susceptible to tuberculosis. Statistics show that the incidence rate of stage I silicosis complicated with tuberculosis is about 33.9%, that of stage II silicosis complicated with tuberculosis is 47.9%, and that of stage III silicosis complicated with tuberculosis can be as high as 60-70%.
矽肺与之间具有密切的关系，在矽肺发展的病理过程中，许多因素均有利于的发生。如粉尘对呼吸道黏膜的慢性刺激和损坏，肺间质纤维化形成，病变区淋巴管和毛细血管结构破坏，淋巴系统免疫功能下降、病变区的巨噬细胞数量减少等，均有利于结核分枝杆
菌繁殖和扩散。矽肺的基本病理改变以形成矽肺结节和伴有弥漫性肺间质纤维化以及淋巴结病变为特点，而并发的病变具有进展快、破坏性强等特点，病灶可在短期内增大、融合，出现空洞，并发生支气管播散；但由于病灶常被纤维组织包围，结核分枝杆菌的排出较困难，因此，痰结核分枝杆菌的阳性率低于单纯。
There is a close relationship between silicosis and tuberculosis. In the pathological process of silicosis development, many factors are conducive to the occurrence of tuberculosis. Such as dust to respiratory tract mucosa chronic stimulation and damage, lung interstitial fibrosis formation, lesion area lymphatic and capillary structure destruction, lymphatic system immune function decline, the number of macrophages in lesion area decreased, are conducive to mycobacterium tuberculosis reproduction and proliferation. The basic pathological changes of silicosis are characterized by formation of silicosis nodules, accompanied by diffuse pulmonary interstitial fibrosis and lymphadenopathy, while the pulmonary tuberculosis lesions are characterized by rapid progress and strong destruction. The lesions can be enlarged, fused, cavitary and spread in bronchus in a short time. But because tuberculosis disease spot is surrounded by fibro
us tissue often, of mycobacterium tuberculosis eduction is more difficult, accordingly, the positive rate of phlegm tuberculosis mycobacterium is lower than pure tuberculosis.
矽肺合并时主要反映两个方面的X线表现：一是矽肺的X线表现，即两肺弥漫分布的小结节影，密度较高，边缘清晰；I期以两肺中下野分布为主，两侧分布较为对称；II、III期时两上肺亦见多发结节影，并可见较大结节与肿块影出现。二是的X线表现，一般也以两肺上叶尖段和下叶背段好发，主要以结节、斑片、条索、钙化和大小不等的空洞等多形性改变为特点，晚期常导致明显纤维化、瘢痕、钙化以及肺门与纵隔结构移位等改变。
The X-ray manifestations of silicosis complicated with pulmonary tuberculosis mainly reflect two aspects: one is the X-ray manifestations of silicosis, that is, the diffuse distribution of small nodules in the two lungs with high density and clear edges; Stage I was dominated by the distribution of the lower and middle fields in both lungs, and the distribution was relatively symmetrical on both sides. At stage II and III, multiple nodules were seen in both upper lungs, and larger nodules and masses were seen. Second, the X-ray manifestations of pulmonary tuberculosis are also common in the upper lobe tip an
d lower lobe dorsal segment of the two lungs, mainly characterized by nodules, plaques, cords, calcification and varying sizes of holes and other polymorphous changes, late often lead to obvious fibrosis, scar, calcification and lung hilum and mediastinal structure displacement and other changes.
↑  矽肺III期
X线胸片显示两肺弥漫分布小结节影，密度较高，边缘清楚，右上肺可见大结节阴影
↑  矽肺合并
X线胸片显示两中上肺病变呈多形性改变，病灶区域可见多发斑点与结节钙化影，伴肺门上移、纵隔移位，两中下肺呈网织结节样改变及肺气肿。
在CT上，矽肺早期合并主要位于普通结核的好发部位，即两肺上叶的尖后段或下叶背段，多为不规则斑片状影、结节影与条索状影，密度不均，可呈现出多形性的特点；此外，矽肺病变具有对称性特点，如在单侧肺出现多发结节、斑片阴影，其形态、大小和分布明显与对侧不同则提示合并可能。当II、III期矽肺患者合并时，病程进展加快，主要表现为原来矽肺小结节影不断增大，线条影不断增粗，边缘模糊，大的阴影周围出现播散病灶等；同时，矽肺III期的大团块影合并结核易出现干酪样坏死和溶解性空洞，壁较厚，内部不光整，周围伴大量纤维化病灶及胸膜炎改变。矽肺的肺门与纵隔淋巴结大多伴有蛋壳样钙化，特点是累计多组淋巴结，以肺门。隆突下和气管旁淋巴结更多见。
On CT, silicosis complicated with pulmonary tuberculosis in the early stage is mainly located in the common tuberculosis prone site, that is, the tip of the upper lobe of the two
lungs or the back of the lower lobe segment, mostly irregular patchy shadow, nodular shadow and cable-like shadow, the density is uneven, can show the characteristics of pleomorphism; In addition, silicosis has symmetrical characteristics, such as the appearance of multiple nodules and patchy shadows in one side of the lung, and its morphology, size and distribution are obviously different from that of the opposite side, indicating the possibility of pulmonary tuberculosis. When patients with stage II and III silicosis complicated with tuberculosis, the course of the disease was accelerated, mainly manifested as the original silicosis nodular shadow was constantly increased, line shadow was constantly thickened, the edge was blurred, tuberculosis spread around the large shadow and so on. At the same time, large masses of silicosis stage III with tuberculosis are prone to caseous necrosis and lytic cavitation, with thick walls, not only the internal integrity, accompanied by a large number of fibrotic lesions and pleurisy changes around. The hilum and mediastinal lymph nodes of silicosis are mostly accompanied by eggshell-like calcification. Subcarinal and paratracheal lymph nodes are more common.

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