【请教】《肺部高分辨率CT》的错误中文翻译

不记得什么时候下载的了，好像也是在园子里下载的《肺部高分辨率CT》。全英文的资料，对着词典慢慢指，还是有些地方搞不清楚，干脆发上来，给行家们看看，兴许有空会指点指点。因为英语底子不好，基本上只是把词典的中文复制下来，这也是最希望能得到版友指点之处。
原文很长，是交互式的网页，我省去了一部分问答的内容。目前暂时翻译了10个病例。希望能全部做完吧。

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A basic understanding of HRCT technique, protocols, and artifacts is necessary before beginning.
开始之前必须的HRCT的技术、定则、伪影作基本的了解。

我的问题：protocol 金山词霸解作“礼仪；（条约）草案，草约；（外交）议定书”，这里应该是指特定的规则吧。
artifact 作“人造物品”，全医药大辞典还解作“伪影”。伪影在影像学极常见，但是本节中似乎没有太多提到这方面的问题。

TECHNIQUE
High-resolution CT (HRCT) technique attempts to optimize the demonstration of lung anatomy. Several technical modifications are essential for performing HRCT of the lung parenchyma (Figure 1). These include 1) the use of thin collimation, and 2) image reconstruction with a high-resolution (sharp or "high spatial frequency") algorithm. Other modifications in CT technique which also increase resolution, but not generally used, include increased kVp or mA technique and targeted image reconstruction
技术：
高分辨率CT（HRCT）是（一种）为了更好的显示肺组织解剖（而发展出来）的技术，（以下/有）几项优化是实现对肺组织高分辨率重建的必须的，包括：1、使用窄的准直器；2、高分辨率图象重建算法（锐利或高的空间分辨率）。还有一些不常用的提高空间分辨率的方法比如加大kV或者mA、目标图象重建等。

SCAN COLLIMATION
With 5-10 mm collimation, volume averaging within the plane of scan significantly reduces the ability of CT to resolve small structures. Scanning with the thinnest possible collimation (e.g. 1 mm) is essential if spatial resolution is to be optimized.
准直器
如果准直器用5-10mm的话，扫描层面的部分容积效应会大大减少CT对微小结构的重建能力。用尽可能小的准直（比如1mm）是提高空间分辨率的基本要求。

volume averaging：直译应该是平均体积，我想起一个专业上的常用词“部分容积效应”，意思应该没错，但是不知道是否确切。

RECONSTRUCTION ALGORITHM
With conventional body CT, scan data are usually reconstructed with a relatively low-resolution algorithm, which smoothes the image, reduces visible image noise, and improves the contrast resolution.
重建算法
常规CT扫描数据通常使用低分辨率算法重建，使图象更平滑、减少噪声并改善对比度。

Reconstruction of the image using a high-resolution algorithm increases spatial resolution, making structures appear sharper, but also increases image noise.
高分辨率重建算法提高了空间分辨率，使图象更锐利，但是同时也加大了噪声。

kVp, mA (mAs), AND SCAN TIME
In HRCT, image noise is more apparent than with standard CT. This noise usually appears as a graininess that can be distracting and may obscure anatomic detail. Increasing the kilovolt peak (kVp) or milliamperes (mA) used during scanning can reduce noise and improve scan quality, but this is not generally necessary to obtain diagnostic scans.
千伏、毫安（毫安秒）和扫描时间
在HRCT，图象噪声远较常规CT明显，表现为图象上的小颗粒，干扰解剖细节的显示并使之模糊不清。增加扫描时的管电压和电流能够减少噪声，改善图象质量，但是这不是获得诊断（所需）扫描图象的必要条件。

FIELD OF VIEW AND THE USE OF TARGETED RECONSTRUCTION
Scanning should be performed using a field of view large enough to encompass the patient (i.e. 35 cm). Retrospectively targeting image reconstruction to a single lung instead of the entire thorax, using a smaller field of view, significantly reduces the image pixel size and thus, increases spatial resolution. In clinical practice, image targeting is uncommonly used because it is time consuming and resulting in an increase number of images (and films).
视野和使用高分辨率目标图象重建
扫描时的视野范围必须包括整个病人比如35cm。目标图象重建可以针对单个肺（组织、病灶）重建（而不是整个胸部），使用更小的视野重建可以大大减少像素单元尺寸，提高空间分辨率。在临床实践中这项技术并不常用，因为这会增加扫描时间和图象数量（及胶片）。

pixel size，我们说到像素时常说的如512×512其实是单位视野内的像素总额，这里指的是单个像素的大小，所以应该是越小越好。

CHOOSING THE RIGHT WINDOW
Routine HRCT must be photographed using a "lung window" and a "soft-tissue" window. The "lung window" is most important in diagnosis.
选择正确的窗口
日常工作中HRCT照片必须使用肺窗和软组织窗，其中肺窗对诊断至关重要。

It should be emphasized that there are no "correct" or ideal window settings for the demonstration of lung anatomy. Often the precise window width and levels chosen are a matter of personal preference; the techniques recommended below should only serve as guidelines. However, it is important that one lung window setting be consistently used in all patients. Unless this is done, it is difficult to compare one case to another, develop an understanding of what appearances are normal and abnormal, and compare sequential examinations in the same patient.
必须强调实际工作中不存在所谓的最正确或最好的窗口设置，一般情况下窗宽和窗位的选择各有所好，技术指导只是提供大致方向。无论如何，对所有病例的窗口设置必须有一致性。否则的话，将难以在图象之间作比较。只有这样才能对正常与否作判断，并且能够在同一病例作前后对比。

I prefer level and width settings of approximately-700/1000 Hounsfield Units (HU)(Figure 2) for routine "lung windows", and these window settings are used for most of the cases shown on this disk. This window provides excellent contrast between lung parenchyma and lung structures or abnormalities. Lung parenchyma should appear slightly grayer than air in the trachea.
本人常规用的肺窗的窗位和窗宽大约是 -700/1000HU，本书中的大部分病例都使用这个设置。这个设置能有较好的对比度，包括肺实质、肺结构和病灶，肺实质能够比支气管中的气体稍白一些。

An extended window reduces contrast between the air containing lung and lung structures such as vessels and bronchi. On the other hand, extended windows can be of value in detecting abnormalities of overall lung attenuation, and are also useful in evaluating the relationship of peripheral parenchymal abnormalities to the pleural surfaces. An extended window (mean -700 HU; width 1500 HU) (Figure 3) is appropriate for a routine lung HRCT, but contrast is reduced, and the lung appears somewhat grayer than with a window of -700/1000 HU.
加大窗宽会减少肺内气体和肺组织比如血管和支气管的对比度，但加大窗宽有利于凸现病灶而弱化（其他）肺组织，也有利于突出肺外带病灶与胸膜的关系。在肺部HRCT常可以适当加大窗宽（窗位-700HU；窗宽1500HU），但对比度会降低，并且肺野会比 -700/1000HU时更白。

A wider window (mean -600; width 2000 HU) (Figure 4) could also be employed, and is particularly useful when pleuro-parenchymal abnormalities are being evaluated. The pleural surface and chest wall structures are seen with this window, but contrast between lung and parenchymal structures is reduced. Such a wide window is not generally recommended for HRCT.
在评估胸膜病变时会用到更大的窗宽（窗位-600；窗宽2000HU），这时胸膜表面和胸壁结构可见，但肺野和胸膜间的对比度降低。在HRCT这个窗口并不常用。

Window level/width settings of50/450(Figure 5) are best for evaluating of the mediastinum, hila, and pleura, information sometimes of value in interpreting HRCT of the lung.
窗位/窗宽 50/450是显示纵隔、肺门和侧胸壁的基本设定，HRCT常可提供有用的信息。

As stated above, choosing different window levels can be advantageous in individual cases, but the effects of different windows on the appearance of lung must be kept in mind. Low window settings with narrow window widths (-800 to -900 HU; width 500 HU) (Figure 6) can be valuable in contrasting emphysema or air-filled cystic lesions with normal lung parenchyma. With such a low window mean, normal lung parenchyma looks gray, while air containing structures areas (bronchi) or emphysema remain black. On the other hand, using this same window to image the lung interstitium or bronchi would be improper. Such a low window mean, particularly combined with a narrow window width, would make the lung interstitium appear much more prominent that it really is, and could make a normal case appear abnormal. This window would also result in an overestimation of the size of vessels, and an overestimation of bronchial wall thickness.
综上所述，不同的病例应选择不同的窗口设置，但要了解窗口设置对肺部表现的影响。低窗位窄窗宽有利于显示肺内的气肿或者含气的囊性病变，这时肺实质较白而气肿或肺内、气管内的气体仍为黑色。但是这样不利于肺间质或支气管的判别，（低窗位窄窗宽的设置）使正常的组织太突出而似异常，而且让人高估支气管壁的厚度和血管的管径。

Now let's begin.
闲话休提，言归正传。

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34-year-old woman with immunodeficiency, cough, and sinusitis. Four HRCT images at various levels are displayed using a lung window.
女性，34岁，免疫力下降，咳嗽，鼻窦炎。所示的图片为不同层面的肺窗。
Diagnosis: Normal Lung
DISCUSSION：Normal Arteries, Bronchi, and Veins
Within the lung, bronchi and pulmonary artery branches are closely associated and branch in parallel. When imaged at an angle to their longitudinal axis, central pulmonary arteries normally appear as rounded or elliptical opacities, accompanied by thin-walled bronchi of similar diameter. When imaged along their axis, bronchi and vessels should appear roughly cylindrical, or show slight tapering as they branch, depending on the length of the segment that is visible.
诊断：正常肺
讨论：正常的动静脉和支气管
肺部的支气管和肺动脉常相伴走行。当扫描层面和它们的长轴成角时，肺动脉分支表现为圆或椭圆形的点状不透光影，直径和伴行的薄壁支气管相当。当扫描层面和它们的长轴平行时，肺动脉分支和支气管呈圆柱状或远端变细分叉，这取决于它们在扫描层面内的长度和走行。
The diameter of an artery and its neighboring bronchus should be approximately equal, although a vessel may appear slightly larger than its adjacent bronchus, particularly in dependent lung regions. The presence of bronchi larger than their adjacent arteries is often assumed to indicate the presence of bronchiectasis, but bronchi may appear slightly larger than adjacent arteries in some normal subjects.
伴行的动脉和支气管直径大致相当。虽然经脉看起来应该稍粗些，特别是在肺内带。有时候支气管的管径稍大于伴行的动脉，看起来极似支气管扩张，其实可以是正常的。

（缩略图，点击图片链接看原图）

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57-year-old woman had HRCT for suspected small airways disease
This patient shows normal appearances of large vessels and bronchi and pulmonary fissures, and also illustrates the normal appearance of secondary pulmonary lobules.
女性，57岁，疑是小气道病变而行HRCT检查
本例为正常的大血管、支气管和肺裂，并可作为正常次级肺小叶的示例。

The Secondary Pulmonary Lobule
次级肺小叶
The lung is made up of numerous secondary pulmonary lobules. A secondary pulmonary lobule is irregularly polyhedral in shape and somewhat variable in size, measuring approximately 1-2.5 cm in diameter. Each secondary lobule is supplied by a small bronchiole and pulmonary artery, and is variably marginated, in different lung regions, by connective-tissue interlobular septa which contain pulmonary vein and lymphatic branches. A secondary lobule is made up of a limited number of pulmonary acini, usually a dozen or fewer.
此肺显示大量正常的次级肺小叶。单个次级肺小叶呈不规则的多面体形，大小不定，直径约1-2.5cm。肺小叶有小动脉和支气管支持，但是形态多变，不同区段小叶间隔可有不同程度的结缔组织，包括肺静脉和淋巴管。肺小叶由一定数量的腺泡组成，一般是十二个或更少。

An understanding of lobular anatomy and the appearances of lobular structures are key to the interpretation of HRCT. HRCT can show many features of the secondary pulmonary lobule in both normal and abnormal lungs, and, many lung diseases, particularly interstitial diseases, produce some characteristic changes in lobular structures.
已知的小叶解剖和小叶结构的表现是解读HRCT（图象）的关键。无论病变还是正常，HRCT能够显示许多次级小叶的形态。在肺部疾病，尤其是间质性病变，会产生许多特征性的小叶结构改变。

Interlobular Septa
小叶间隔
Secondary lobules are marginated by connective tissue interlobular septa, which extend inward from the pleural surface. A few normal septa are often visible in the lung periphery in normal subjects, but they tend to be inconspicuous; normal septa are most often seen anteriorly and along the mediastinal pleural surfaces. When visible, they are usually seen extending to the pleural surface. A dot-like artery is often visible in the center of a lobule.
次级小叶边缘系由结缔组织构成的小叶间隔，从（肺）内带一直延伸到胸膜下。正常的受检者肺边缘部只可见少数小叶间隔，而且不十分显眼。正常的小叶常趋向前和纵隔侧，延伸到胸膜表面，中心的小动脉呈逗点状。

The Centrilobular Region
小叶中心区
The central portion of the lobule (the centrilobular region) contains the pulmonary artery and bronchiolar branches that supply the lobule. The centrilobular artery is visible as a linear, branching, or dot-like opacity 5-10 mm from the pleural surface, and can often be identified even if septa are not visible. Normal vessels are not seen to extend to the pleural surface. The centrilobular bronchiole is not normally visible. Pulmonary veins may be seen to marginate lobules.
小叶中心区由小叶动脉和支气管分支构成，（HRCT图象上）可以呈线状、分支状、逗点状不透光区，距边缘约5-10mm，即使（相应的）小叶间隔显示欠佳的时候也常可见。正常的小血管延伸向胸膜下，但是小支气管常无法显示。肺静脉分支有时在小叶边缘可以看到。

5-10mm frome the pleural surface 这个5-10mm应该是小叶半径吧，如果把pleural surface直接翻译成胸膜下的话似乎不好理解。

Lung Parenchyma
肺实质
With exception of large bronchi, vessels, and fissures, little is normally visible on HRCT. Lung parenchyma should appear slightly gray, as compared to air (in the trachea and bronchi), if proper window levels are selected. Lung attenuation seen on HRCT scans obtained at full inspiration appears relatively homogeneous, although dependent lung often is denser than nondependent lung. Measurements of lung attenuation in normal subjects can range from -700 to -900 HU, but this measurement is not usually of value in diagnosis.
除了较大的血管、支气管和肺裂，其他的结构在HRCT上难以显示。在适当的窗口下，肺实质常比气道内的气体稍白。深吸气时肺组织的表现大致相当的，虽然内带的肺组织的X线吸收率比外带稍高一些。观察正常受检者常用-700～-900HU，但这个设置实际上不常用。
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case3
HRCT in a 56-year-old man with asbestos exposure and decreasing exercise tolerance (Figure 1, Figure 2).
男性、56岁，有接触石棉及体力下降史。

Scans obtained in the supine position at two levels show an ill-defined increase in opacity in the posterior lung (Figure 1). On the supine images, it is not possible to determine if this finding is normal or abnormal, representing posterior lung disease. Vessels and bronchi appear normal and the right major fissure appears sharply marginated.
仰卧位扫描中的两个层面显示肺脏背侧边界模糊的不透光区，仅有仰卧位无法肯定这是病变或正常。（本例的）血管、支气管、肺裂未见异常。

The prone scan (Figure 3) shows the posterior lung to be normal in appearance. Arteries are visible about 5-10 mm from the pleural surface, and no interlobular septa are seen. There is no evidence of lung disease.
俯卧位扫描显示背侧肺脏正常表现。胸膜下5-10mm可见小动脉影，未见小叶间隔。没有证据证明存在肺部疾病。

Diagnosis: Normal dependent opacity
正常的相关不透光区。

根据rcrystal主任指点， 友情提醒：in dependent lung是指下垂部位的肺组织，这里dependent是hanging down的意思，可以和下文的gravitational distribution联合起来理解。 这个案例讲的是肺血容积坠积效应，发生在外带，近地侧胸膜下，这里的dependent可否解释成重力依赖性的意思。

DISCUSSION
Scans obtained with the patient supine are adequate in most instances, but, as in this case, prone scans are sometimes necessary for distinguishing subtle posterior lung disease from normal dependent atelectasis. Atelectasis is commonly seen in the dependent lung in both normal and abnormal subjects, resulting in a so-called "dependent opacity." If scans are obtained in both supine and prone positions, dependent opacity can be easily differentiated from true pathology; a true abnormality remains unchanged regardless of whether it is dependent or nondependent. As in this case, normal dependent opacity disappears in the prone position. Because of this potential problem, I routinely obtain prone scans.
讨论：多数情况下仰卧位扫描就足够了，但是此类病例需要俯卧位以鉴别背侧肺野的微小病变和重力性肺含气不全（这个应该就是我们说的肺血容积坠积效应吧）。肺含气不全常见于下垂部位的肺组织，正常人和病患者均可发生，即所谓的“肺血容积坠积效应”。如果在仰卧位和俯卧位都存在的话则易于把“肺血容积坠积效应”从真正的病变区分开来。真性病变两种体位下不透光区（用我们习惯说的“阴影”似乎省力点）都存在且部位不变，与重力无关。如此例所见，阴影于俯卧位时消失。出于这种潜在的可能性，我会例行的作俯卧位扫描。

这里例行俯卧扫描可商榷，是仅作俯卧位还是仰卧俯卧都作？肺血容积坠积效应似乎不只见于仰卧位，在《体部成像的伪影与误判》一书中有俯卧位的图片。如果要鉴别的话单纯俯卧位是不够的，所以我理解成两个体位都做。

HRCT in the prone position may be obtained only when dependent lung opacity is problematic; however, this approach requires that the scans be closely monitored, or that the patient be called back for additional scans. In most patients having HRCT, I obtain scans at 2-cm intervals in both supine and prone positions.
在怀疑“肺血容积坠积效应”时可行俯卧位扫描，但这需要（诊断医师）实时监控扫描过程，或者能找回病人做（这项）附加检查。对大部分行HRCT检查的病人，我在仰卧和俯卧扫描中都采用2cm的层距。

It should be pointed out that dependent opacity results in a diagnostic problem only in patients who are normal or have subtle abnormalities. In patients with obvious abnormalities, such as honeycombing, or who have diffuse lung disease, dependent density is not a diagnostic problem. Thus, if the patient being studied has evidence of moderate to severe lung disease on plain radiographs, prone scans are not likely to be needed. On the other hand, if the patient has normal or near normal plain radiographs, either the supine scan sequence must be closely monitored or prone scans should be obtained.
必须指出，只有微小的病变有需要鉴别“肺血容积坠积效应”。在较大范围的病变比如蜂窝肺、弥漫性肺部病变，不必考虑“肺血容积坠积效应”。因此，如果患者平片现实中-大片的肺部病变，就无需加做俯卧位扫描。反之，如果患者平片正常或接近正常，则必须密切监控仰卧位扫描过程，或者加做俯卧位扫描。

In another patient, a supine scan (Figure 4) shows ill defined posterior lung opacity, and a prone scan (Figure 5) was obtained.
另一病例中，仰卧位扫描现实病灶位于背侧肺野，并有做俯卧位扫描。

The prone scan (Figure 5) shows persistence of the abnormal opacity in the posterior lung. This finding represents early interstitial fibrosis associated with lupus.
俯卧位现实病灶依旧位于背侧肺野。此例为早期的狼疮性纤维化。

（缩略图，点击图片链接看原图）

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case4
A 45-year-old woman presented with shortness of breath.
女性，45岁，气促

Scans show normal findings (Figure 1). Pulmonary arteries are sharply defined and of normal size. Bronchi are thin-walled and smaller than the adjacent pulmonary arteries. Fissures are thin, sharply defined, and smooth in contour. A few interlobular septa are visible, but they are inconspicuous. The most peripheral vessels visible are 5-10 mm from the pleural surface. Intralobular bronchioles are invisible. Lung parenchyma is homogenous in attenuation. "Star" artifacts and "doubling" artifacts are visible anteriorly.
扫描显示正常的肺部表现。肺动脉边界清晰并大小正常。支气管壁薄而稍小于伴行的肺动脉（分支）。肺裂薄而清晰，平滑。少数小叶间隔可见，但并不显著。多数的周围血管于胸膜下5-10mm。小叶支气管未显示。肺实质密度相似。肺前部可见星芒状和双裂征动脉伪影

Diagnosis: Normal artifacts
RETICULAR OPACITIES
Generally, HRCT findings of lung disease can be classified into four large categories, based on their appearances. These are: reticular opacities; nodules and nodular opacities; increased lung opacity; and abnormalities associated with decreased lung opacity, including cystic lesions, emphysema, and airways abnormalities. These four categories will be reviewed in discussing the cases included on this disk.
诊断：正常伪影
网状阴影
一般情况下，肺部病变在HRCT的变现一般分为4大类：网状影，小结节状影，浸润性影以及异常的密度减低影，包括囊状改变、肺气肿和小气道异常。这四类病变在本书的案例中会不断出现。

The first type of abnormality on HRCT is reticular opacities.
HRCT上的第一类异常改变是网状影。

（缩略图，点击图片链接看原图）

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前面的4个案例其实都是正常/伪影，从第5例开始真正的病例。有几个病例曾经在我以前的帖子里发过，不过不是按原来的顺序，图片贴得也有些乱。

case5
HRCT was obtained at four levels in a 60-year-old woman with a known history of breast cancer and progressive dyspnea. (Figure 1, Figure 2, Figure 3, Figure 4)
女性，60岁，进行性呼吸困难，有乳腺癌病史。以下为HRCT的四个层面。

Scans show marked thickening of interlobular septa in both lungs, but predominantly on the right. The abnormal reticular opacities can be identified as septa by the characteristic appearance of the pulmonary lobules they outline. Note that a pulmonary artery branch is visible in the center of a number of pulmonary lobules. The septa appear smooth in contour. A small right anterior pneumothorax is incidentally seen, due to recent thoracentesis.
扫描显示双肺显著增厚的小叶间隔，右侧为主。特征性的小叶形态说明网状阴影是（增厚的）小叶间隔。在许多小叶中心可见肺动脉分支。（本例中增厚的）小叶间隔边缘仍平滑。右肺前方可见局限性气胸，提示最近曾作胸穿（应该是取活检吧，这种弥漫性的改变是否会取活检？我自己在基层医院，活检都很少见，请指点）。
个人问题：Note that a …… 中的Note不知道该怎么译，如果理解作标注、注释的话，给出的图片并没有标注肺动脉分支的箭头，如果理解为笔记的话就应该指代前文中提到肺动脉分支的内容。这里不知道怎么理解更合适一些。

In addition to interlobular septal thickening, there is thickening of the peribronchovascular interstitium, recognized as "peribronchial cuffing" or thickening of bronchial walls. As with the interlobular septal thickening, this finding is most evident on the right.
除了增厚的小叶间隔之外，还可见支气管血管周围间质增厚，成为“支气管袖套征”或支气管壁增厚。本例中与小叶间隔增厚一样，都以右侧为主
peribronchovascular, 字典里没有。peri-是周围，bronch应该是支气管的字根吧，vascular是血管的，interstitium 是间质，peribronchovascular interstitium应该是支气管血管周围间质的意思吧，按文意该包括管壁，不知道有没有简化的中文名词。

At a lower level, thickening of the major fissure is visible on the left. Large nodules are also visible.
在较低层面，可见增厚的左侧肺裂，并可见较大的结节样改变。

In a patient with a history of carcinoma who is short of breath, HRCT findings of smooth interlobular septal thickening, as seen in this case, are typical of lymphangitic carcinomatosis and are usually considered diagnostic. Common associated findings include thickening of the peribronchovascular interstitium, thickening of fissures, nodules, and pleural effusion. Asymmetry of abnormalities is common. In clinical practice, lung biopsy is uncommonly performed in this setting. In patients without a known neoplasm, HRCT can be helpful in directing lung biopsy to the most productive sites. Transbronchial biopsy is usually positive in patients with lymphangitic carcinomatosis.
在乳腺癌并有呼吸困难病人，HRCT发现平滑的小叶间隔增厚，如本例所见，诊断考虑是典型的癌性淋巴管炎。一般并有支气管血管周围间质增厚、肺裂增厚、结节病灶（直译的话应该是小瘤）以及胸腔积液，一般双侧不对称。临床工作中，这样的病例一般不会活检。在没有确切肿瘤病史的患者，HRCT有助于指导肺组织活检（取最有价值的部位，好啰唆啊）。经支气管取活检一般为癌性淋巴管炎。

Diagnosis:
Lymphangitic spread of breast carcinoma with interlobular septal thickening.
DISCUSSION
Thickening of the lung interstitium by fluid, fibrous tissue, or because of interstitial infiltration by cells usually results in a pattern of reticular opacities as seen on HRCT. The easiest reticular pattern to recognize is interlobular septal thickening.
诊断：乳腺癌淋巴道播散并小叶间隔增厚
讨论：增厚的肺间质可以是液体、间质组织或者是间质的细胞浸润，表现为HRCT上网状影，最容易辨认的就是小叶间隔增厚。

Although thickening of interlobular septa is relatively common in patients with interstitial lung disease, it is uncommon as a predominant finding and has a limited differential diagnosis. On HRCT, numerous clearly visible interlobular septa almost always indicate the presence of an interstitial abnormality; only a few septa should be visible in normal patients. Septal thickening can be seen in the presence of interstitial fluid, infiltration, or fibrosis.
虽然增厚的小叶间隔常见于间质并肺部病变患者，但无特异性而无法（进一步）定性。在HRCT，大量的小叶间隔增厚提示间质异常。若仅见少量的小叶间隔可以是正常。小叶间隔增厚可以是间质中的液体、浸润、或纤维化。

（缩略图，点击图片链接看原图）

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HRCT scans at 5 levels in a 73-year-old man with cough and shortness of breath.
男性，73岁，咳嗽，气促，5个HRCT层面

All scans show marked thickening of interlobular septa involving the right lung; the left lung appears normal. Note that the centrilobular pulmonary artery branch is visible within a number of pulmonary lobules outlined by thickened septa. This is helpful in identifying the lines as thickened septa.
所有的扫描层面显示右肺显著增厚的小叶间隔，左肺正常。许多小叶间隔增厚的小叶中心可见肺动脉分支。这有助于区别线状的增厚的小叶间隔。
这个Note that……和前面如出一辙，我还是没能搞明白。

The septa appear smooth in contour (Figure 3); no distinct nodules are visible within them. Slight variation in thickness of the septa may reflect the presence of pulmonary veins.
（增厚的小叶）间隔边缘平滑，未见明显的结节状改变。增厚的小叶间隔局部轻微厚度改变提示为肺静脉所在。

In addition to interlobular septal thickening, there is distinct thickening of the peribronchovascular interstitium, in the right lung recognized as "peribronchial cuffing" or thickening of bronchial walls. It is easily diagnosed when compared to the normal left side.
除了小叶间隔增厚，可见右肺明显的支气管血管周围间质增厚，为支气管周围袖套征或支气管壁增厚。与正常的左肺比较这些征象易于分辨。

This is recognized as thickening of the major fissure, which is visible on the right.
右肺可见增厚的斜裂。
This appearance and the unilateral distribution are typical of lymphangitic spread of carcinoma. A soft tissue window scan shows a right hilar mass, subcarinal lymph node enlargement, and right pleural effusion typical of bronchogenic carcinoma.
这些征象单侧出现时是典型的癌性淋巴管炎表现。软组织窗可见支气管肺癌典型表现：右肺门肿块，隆突下淋巴结增大，和右侧胸腔积液。

Diagnosis: Lymphangitic spread of carcinoma, right hilar bronchogenic carcinoma, with interlobular septal thickening.
诊断：右肺癌、癌性淋巴管炎，并小叶间隔增厚。

DISCUSSION
Pulmonary lymphangitic carcinomatosis (PLC) is a term that refers to tumor growth in the lymphatic system of the lungs. It occurs most commonly in patients with carcinomas of the lung, breast, stomach, pancreas, prostate, cervix, or thyroid, and in patients with metastatic adenocarcinoma from an unknown primary site. PLC results from hematogenous spread to lung, with subsequent interstitial and lymphatic invasion, or, as in this case, direct lymphatic spread of tumor from hilar or mediastinal lymph nodes. Symptoms of shortness of breath are common and can predate radiographic abnormalities.
讨论：肺部的癌性淋巴管炎（PLC）是关于肺部淋巴系统肿瘤浸润的属于。它常见于肺、乳腺、胃、胰腺、前列腺、宫颈、甲状腺、或未知原发灶的腺癌患者。PLC可由血道转移、间质浸润、淋巴道转移，或如此例由肺门或纵隔淋巴结、肿瘤直接蔓延而来。气促症状出现常早于X线表现。
subsequent interstitial 直译应该是继发间质，所以我考虑为直接蔓延。肿瘤的转移无非血道、淋巴道、直接蔓延和种植转移，肺内转移不存在种植的问题。但是下文中提到的此例本来就是直接转移，我实在不知道如何解释。

On HRCT, PLC is often characterized by interlobular septal thickening, thickening of fissures, and thickening of the peribronchovascular interstitium. The thickened septa are most often smooth, but septal nodules may sometimes be seen. Because lung architecture is preserved, lobules outlined by thick septa have a normal appearance. Four factors account for interstitial thickening seen on HRCT in patients with PLC. These are (1) tumor filling pulmonary vessels or lymphatics, (2) the presence of tumor within the interstitium, (3) distention of vessels or lymphatic channels distal to central vascular or lymphatic tumor emboli, and (4) interstitial edema or fibrosis secondary to the presence of interstitial tumor.
在HRCT，PLC通常表现为特征性的小叶间隔增厚、肺裂增厚、支气管血管周围间质增厚。增厚的小叶间隔常平滑，但有时可呈结节状。由于肺架构保存，间隔增厚的小叶轮廓仍保持正常。HRCT上PLC的间质增厚由（以下）四个因素来说明：1、肿瘤填充肺的血管和淋巴管；2、间质肿瘤细胞浸润；3、近端血管和淋巴管瘤栓栓塞，远端扩张；4、肿瘤浸润间质继发水肿或纤维化。

In approximately 50% of patients, the abnormalities of PLC appear focal or unilateral rather than diffuse. This finding is helpful in distinguishing PLC from other causes of interlobular septal thickening. Hilar lymphadenopathy is visible on CT in 50% of patients with PLC.
约半数病例，PLC表现为局限性或单侧性，这有助于区别其它原因所致的小叶间隔增厚。PLC病人中约半数可见肺门淋巴结肿大。

In addition to interlobular septal thickening and thickening of fissures, thickening of the interstitium surrounding vessels and bronchi in the parahilar lung ("peribronchial cuffing") is a common finding in lymphangitic carcinomatosis.
除了小叶间隔增厚和肺裂增厚，肺门旁区肺血管支气管间质增厚（支气管袖套征）亦常见于癌性淋巴管炎。

Since the thickened peribronchovascular interstitium cannot be distinguished from the underlying opacity of the bronchial wall or pulmonary artery, this finding is usually perceived on HRCT as:1) an increase in bronchial wall thickness; and 2) an increase in diameter of pulmonary artery branches. Bronchial wall thickening or "peribronchial cuffing" is the easiest of these two findings to recognize.
由于支气管血管周围间质增厚通常无法和支气管壁、血管壁分开辨别，这征象在HRCT上通常这样看：1、支气管壁增厚；2、血管直径增大。支气管壁增厚或支气管袖套征常较血管增粗易于辨别。

As with interlobular septal thickening, thickening of the peribronchovascular interstitium can appear smooth, nodular, or irregular in different diseases. Smooth peribronchovascular interstitial thickening is most common in patients with lymphangitic spread of carcinoma and interstitial pulmonary edema. Nodular thickening of the peribronchovascular interstitium is particularly common in sarcoidosis and lymphangitic spread of carcinoma.
如同小叶间隔增厚，支气管血管周围间质增厚在不同的病例中可平滑、结节状或不规则。平滑的支气管血管周围间质增厚最常见于癌性淋巴管炎和间质性肺水肿。结节状的增厚常见于韦格氏肉芽肿和癌性淋巴管炎。

（缩略图，点击图片链接看原图）

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HRCT lung window scans in a 79-year-old man with known lymphoma and an abnormal chest radiograph (Figure 1, Figure 2, Figure 3, Figure 4, Figure 5, Figure 6).
男性，79岁，有淋巴瘤病史及胸片发现胸部异常。

All scans show marked smooth thickening of interlobular septa involving both lungs in a symmetrical fashion.
所有的扫描层面均显示双侧对称性的小叶间隔均匀增厚。

In addition to interlobular septal thickening, there is distinct thickening of the peribronchovascular interstitium. In this case, it is bilateral and symmetrical.
除了小叶间隔增厚，明显可见支气管血管间质增厚，此例中为双侧均匀对称性（出现）。

Subpleural interstitial thickening is present and is recognized as thickening of the major fissures.
可见胸膜下间质增厚，可形似斜裂改变。

This appearance is typical of lymphangitic spread of lymphoma.
此为典型的淋巴瘤癌性淋巴道播散。

Diagnosis: Lymphangitic spread of lymphoma, with interlobular septal thickening
Findings identical to those seen in pulmonary lymphangitic carcinomatosis can also be seen in patients with interstitial infiltration of the lung by lymphoma, including interlobular septal thickening, thickening of fissures, and periobronchovascular interstitial thickening. As with lymphangitic carcinomatosis, abnormalities can be patchy or diffuse, as in this case. Some benign infiltrative lymphocytic diseases, such as lymphocytic interstitial pneumonitis (LIP) can also show these findings.
诊断:淋巴瘤淋巴道播散，并小叶间隔增厚。
肺部的癌性淋巴管炎亦可见于淋巴瘤肺部播散，包括小叶间隔增厚、肺裂增厚、支气管血管周围间质增厚。如同PLC，病灶可斑片样不均匀分布，亦可像本例一样弥漫存在。某些良性的淋巴细胞浸润性病变，如淋巴细胞性间质性肺炎（LIP），亦可出现这些表现。
最后的两个病名不是很肯定。

（缩略图，点击图片链接看原图）

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case8
Prone scans in a 58-year-old man with heart disease and a persistently abnormal chest radiograph (Figure 1, Figure 2).
男性，58岁，有心脏病史，胸部照片持续性异常。

Both scans show smooth thickening of interlobular septa involving both lungs symmetrically. Note that the septal thickening is most obvious in dependent lung, adjacent to the diaphragm.
两层面均显示双肺小叶间隔平滑的增厚。靠近横膈的下垂部位肺野的小叶间隔增厚最明显。

In addition to interlobular septal thickening, there is distinct thickening of the peribronchovascular interstitium. In this case, this abnormality is also bilateral and symmetrical.
除了小叶间隔增厚，还可见明显的支气管血管周围间质增厚。此例所示的异常是双侧对称的。

The fissures are not visible on these scans, and thickening of the subpleural interstitium cannot be assessed.
在这些扫描层面肺裂未见显示，并且胸膜下的间质增厚较难评估。

Because of the history of heart disease, characteristic abnormalities, symmetry, and the predominance of septal thickening in dependent lung, this diagnosis must be considered most likely.
由于有心脏病史，特征性的异常（表现），对称性出现且下垂部位的小叶间隔增厚更明显，这个诊断是最值得考虑的。

Diagnosis: Pulmonary edema, with interlobular septal thickening
诊断：肺水肿并小叶间隔增厚
DISCUSSION
Hydrostatic pulmonary edema generally results in a combination of septal thickening and ground-glass opacity, but septal thickening or ground glass opacity can predominate in individual cases. There is a tendency for hydrostatic edema to have a perahilar and gravitational distribution, but this is not always visible. Thickening of the parahilar peribronchovascular interstitium (peribronchial cuffing), and fissural thickening are also common.
讨论：流体静力性肺水肿可致小叶间隔增厚和毛玻璃状阴影同时出现，但在具体的病例中可以其中一种占优势。流体静力性肺水肿常趋向于以肺门旁区为主和重力性分布，但肺门旁区支气管血管周围间质增厚（支气管袖套征）和肺裂增厚也很常见。

Patients with pulmonary edema are not generally imaged using HRCT, as their diagnosis is usually based on a combination of clinical and chest radiographic findings. However, a knowledge of the HRCT appearance of pulmonary edema can be helpful in avoiding misdiagnosis.
肺水肿患者行HRCT检查并不常见，诊断需结合临床及胸片表现。无论如何，多了解一些肺水肿的HRCT表现有助于避免误诊。
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case9
HRCT in both supine and prone positions in a 53-year-old woman with and abnormal chest radiograph and mild shortness of breath (Figure 1, Figure 2, Figure 3, Figure 4, Figure 5, Figure 6).
女性，53岁，胸片显示异常，有轻微气促，包括仰卧位和俯卧位扫描。

Marked thickening of interlobular septa predominantly involving the lung bases is visible on both supine and prone scans.
小叶间隔显著增厚，主要见于肺底部，仰卧和俯卧均可见。

Some of the thick septa appear nodular in contour. Also note that distinct nodules are visible in relation to the fissures and peripheral subpleural interstitium. Thickening of the peribronchovascular interstitium is also visible.
部分增厚的小叶间隔呈结节状。显著的结节小叶间隔增厚可见于肺裂旁和胸膜下。亦可见支气管血管周围间质增厚。

sarcoidosis. Nodular thickening of interlobular septa and fissures can be seen in this disease and lymphangitic spread of carcinoma.
结节病。结节状增厚的小叶间隔和肺裂可见于本病和癌性淋巴管炎。

Diagnosis: Sarcoidosis with interlobular septal thickening.
DISCUSSION
Nodular thickening of interlobular septa can be seen in lymphangitic carcinomatosis, sarcoidosis, and silicosis. In sarcoidosis, nodular interlobular septal thickening reflects the presence of interstitial granulomas. It is visible on HRCT in a majority of patients, but it is not usually as extensive as seen in this patient.
诊断：结节病并小叶间隔增厚。
讨论：结节状小叶间隔增厚可见于癌性淋巴管炎、结节病和硅肺。结节病的结节样小叶间隔增厚是间质肉芽肿的表现。大部分的结节病患者可见此表现，但一般没本例所见的范围那么大。

Sarcoid granulomas frequently cause nodular thickening of the peribronchovascular interstitium on HRCT, and extensive peribronchovascular nodularity is characteristic and highly suggestive of this disease. Subpleural nodules are also typical of sarcoidosis.
结节病常在HRCT上见到支气管血管周围间质的结节状增厚，见到此征像高度提示结节病。胸膜下结节亦可见于典型的结节病。

这个病例的图像感觉像用了低X线剂量扫描，所以出现很多波纹状伪影。不过我所在的医院设备连高分辨率CT也没法儿做，更别说低剂量扫描了，所以其实没有实际经验，有经验的战友请指点一二。

（缩略图，点击图片链接看原图）

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Protocol: （扫描）程序，就是你做某一件事情的方法，步骤，程序，方案之类的。
Artifact：伪影
note that... 是提醒你注意。。。 或 重点看。。。的意思

不足之处还望大家指点。

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提几点意见供参考:

1.A basic understanding of HRCT technique, protocols, and artifacts is necessary before beginning.
开始之前必须的HRCT的技术、定则、伪影作基本的了解。

我的问题：protocol 金山词霸解作“礼仪；（条约）草案，草约；（外交）议定书”，这里应该是指特定的规则吧。
artifact 作“人造物品”，全医药大辞典还解作“伪影”。伪影在影像学极常见，但是本节中似乎没有太多提到这方面的问题。——protocol可译为“参数”

2.SCAN COLLIMATION
With 5-10 mm collimation, volume averaging within the plane of scan significantly reduces the ability of CT to resolve small structures. Scanning with the thinnest possible collimation (e.g. 1 mm) is essential if spatial resolution is to be optimized.
准直器
如果准直器用5-10mm的话，扫描层面的部分容积效应会大大减少CT对微小结构的重建（分辨）能力。用尽可能小的准直（比如1mm）是提高空间分辨率的基本要求。

3.volume averaging：直译应该是平均体积，我想起一个专业上的常用词“部分容积效应”，意思应该没错，但是不知道是否确切。———同意。

4.An extended window reduces contrast between the air containing lung and lung structures such as vessels and bronchi. On the other hand, extended windows can be of value in detecting abnormalities of overall lung attenuation, and are also useful in evaluating the relationship of peripheral parenchymal abnormalities to the pleural surfaces. An extended window (mean -700 HU; width 1500 HU) (Figure 3) is appropriate for a routine lung HRCT, but contrast is reduced, and the lung appears somewhat grayer than with a window of -700/1000 HU.
加大窗宽会减少肺内气体和肺组织比如血管和支气管的对比度，但加大窗宽有利于凸现病灶而弱化（其他）肺组织，也有利于突出肺外带病灶与胸膜的关系。在肺部HRCT常可以适当加大窗宽（窗位-700HU；窗宽1500HU），但对比度会降低，并且肺野会比 -700/1000HU时更白。

Window level/width settings of50/450(Figure 5) are best for evaluating of the mediastinum, hila, and pleura, information sometimes of value in interpreting HRCT of the lung.
窗位/窗宽 50/450是显示纵隔、肺门和侧胸壁的基本设定，HRCT常可提供有用的信息。————窗位/窗宽 50/450评估纵隔、肺门和胸膜最佳，HRCT常可提供有用的信息。

5.Scans show marked thickening of interlobular septa in both lungs, but predominantly on the right. The abnormal reticular opacities can be identified as septa by the characteristic appearance of the pulmonary lobules they outline. Note that a pulmonary artery branch is visible in the center of a number of pulmonary lobules. The septa appear smooth in contour. A small right anterior pneumothorax is incidentally seen, due to recent thoracentesis.
扫描显示双肺显著增厚的小叶间隔，右侧为主。特征性的小叶形态说明网状阴影是（增厚的）小叶间隔。在许多小叶中心可见肺动脉分支。（本例中增厚的）小叶间隔边缘仍平滑。右肺前方可见局限性气胸，提示最近曾作胸穿（应该是取活检吧，这种弥漫性的改变是否会取活检？我自己在基层医院，活检都很少见，请指点）。
个人问题：Note that a …… 中的Note不知道该怎么译，如果理解作标注、注释的话，给出的图片并没有标注肺动脉分支的箭头，如果理解为笔记的话就应该指代前文中提到肺动脉分支的内容。这里不知道怎么理解更合适一些。——Note可译为“请注意.....”

6.Pulmonary lymphangitic carcinomatosis (PLC) is a term that refers to tumor growth in the lymphatic system of the lungs. It occurs most commonly in patients with carcinomas of the lung, breast, stomach, pancreas, prostate, cervix, or thyroid, and in patients with metastatic adenocarcinoma from an unknown primary site. PLC results from hematogenous spread to lung, with subsequent interstitial and lymphatic invasion, or, as in this case, direct lymphatic spread of tumor from hilar or mediastinal lymph nodes. Symptoms of shortness of breath are common and can predate radiographic abnormalities.
讨论：肺部的癌性淋巴管炎（PLC）是关于肺部淋巴系统肿瘤浸润的属于。它常见于肺、乳腺、胃、胰腺、前列腺、宫颈、甲状腺、或未知原发灶的腺癌患者。PLC可由血道转移、间质浸润、淋巴道转移，或如此例由肺门或纵隔淋巴结、肿瘤直接蔓延而来。气促症状出现常早于X线表现。
subsequent interstitial 直译应该是继发间质，所以我考虑为直接蔓延。肿瘤的转移无非血道、淋巴道、直接蔓延和种植转移，肺内转移不存在种植的问题。但是下文中提到的此例本来就是直接转移，我实在不知道如何解释。——PLC可由血道转移，随后是间质浸润、淋巴道转移，

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多谢yishengyishi，多谢马哥！
居然把best看成是base，自己都觉得过分。
note that……句式应该是公共英语里常用的吧，不过我的公共英语也不是一般的弱，否则也不会干这事儿，呵呵！
再次谢谢yiyi和马哥！

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再跌再来！
case10
HRCT at two levels in a 42-year-old man with mild shortness of breath for a number of years (Figure 1, Figure 2).
男性，42岁，轻微气促数年，HRCT扫描的两个层面。

Thickened interlobular septa are visible bilaterally and are associated with distortion of lung architecture. Architectural distortion is indicated by the presence of irregularity and distortion of the fissures. In this patient, the interlobular septal thickening represents fibrosis.
增厚的小叶间隔可见于双侧，并肺结构变形。肺裂的扭曲提示肺结构改变。此例的小叶间隔增厚为纤维化。

Diagnosis: End-stage sarcoidosis with fibrosis and interlobular septal thickening.
DISCUSSION
Although interlobular septal thickening is often seen in patients with fibrosis, other findings predominate except in some patients with sarcoidosis. In patients with sarcoidosis, septal fibrosis can predominate if septal granulomas were present in the active phase of disease. Septal thickening associated with fibrosis is characteristically irregular in contour and associated with distortion of lung architecture.
诊断：终末期结节病并纤维化、小叶间隔增厚。
讨论：虽然小叶间隔增厚常为纤维化所致，但大部分结节病患者以其它表现为主。在结节病，如果小叶间隔的肉芽肿处于活动期则可以小叶间隔纤维化为主要表现。小叶间隔纤维化的特征性改变为轮廓不规则增厚及显著的肺结构改变。

Other findings of fibrosis are common with sarcoidosis, including traction bronchiectasis, conglomerate masses of fibrous tissue, cysts, and honeycombing. These are often seen in combination with septal thickening.
结节病（肺组织）纤维化的其他表现包括牵拉性支气管扩张、纤维结节、小囊状及蜂窝状改变。这些表现常可和小叶间隔增厚同时出现。
见到traction bronchiectasis我首先想到的是双轨征，因为tract和bronch-，但其实双轨征是double tract sign. 虽然双轨征是支扩的表现，但是这里强调的是纤维化的收缩所致的支扩，还好对着辞典。
screen.width-333)this.width=screen.width-333" width=420 height=612 title="Click to view full case10.jpg (420 X 612)" border=0 align=absmiddle>

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case11
HRCT in the supine position in a 68-year-old woman with rheumatoid arthritis and progressive shortness of breath over a 2-year period (Figure 1, Figure 2, Figure 3, Figure 4, Figure 5, Figure 6).
女性，68岁，有类风关病史及进行性气促两年。HRCT仰卧位扫描

Although some interlobular septal thickening is visible in less abnormal regions, the predominant finding is honeycombing in the lung periphery, visible at all levels.
虽然病变区可见少量的小叶间隔增厚，但主要的发现是肺外带的蜂窝样改变，所有层面均可见。

The HRCT finding of honeycombing indicates the presence of marked interstitial fibrosis.
HRCT上的蜂窝样改变是显著肺纤维化的表现。

Diagnosis: Rheumatoid lung disease, with fibrosis and honeycombing.
DISCUSSION：Extensive interstitial and alveolar fibrosis results in the characteristic HRCT finding of honeycombing or honeycomb lung. Honeycombing represents the second reticular pattern recognizable on HRCT (the first is interlobular septal thickeing). Pathologically, honeycombing is defined by the presence of small cystic spaces, generally lined by bronchiolar epithelium, and having thickened walls composed of dense fibrous tissue. It indicates the presence of "end-stage" lung and can be seen in almost any process leading to severe pulmonary fibrosis.
诊断：类风关肺部病变，并蜂窝样纤维化。
讨论：广泛的肺间质及肺泡纤维化在HRCT上的特征性表现为蜂窝样改变，或称为蜂窝肺。蜂窝样改变是第二种网状改变（第一种是小叶间隔增厚）。在病理学上，（肺部）蜂窝是披覆支气管上皮的小空泡，其厚壁由纤维组织构成。这是终末期肺部改变，几乎可见于所有严重的肺部纤维化病变。

Honeycombing produces a cystic appearance on HRCT which is easy to recognize and allows a confident diagnosis of lung fibrosis (Figure 2). On HRCT, the cystic spaces of honeycombing usually average about 1 cm in diameter, although they can range from several millimeters to several centimeters in size; they are characterized by clearly definable walls 1-3 mm in thickness. Adjacent honeycomb cysts typically share walls. Honeycombing has been described as producing an "intermediate reticular pattern", to distinguish it from the larger pattern seen with interlobular septal thickening, and the smaller pattern visible with intralobular interstitial thickening.
HRCT上的蜂窝呈囊泡状，易于辨认而且可确诊为肺纤维化。在HRCT上，蜂窝的小囊泡大小可从数mm至数cm，平均直径约1cm，相邻的囊泡共用一壁。蜂窝可描述成中度网状影，以区分较大的小叶间隔增厚和微仅可见的小叶间质增厚。

Honeycomb cysts often predominate in the peripheral and subpleural lung regions regardless of their cause, and parahilar lung can appear normal despite the presence of extensive peripheral abnormalities. Subpleural honeycomb cysts typically occur in several contiguous layers; this finding can allow honeycombing to be distinguished from subpleural emphysema (paraseptal emphysema) in which subpleural cysts usually occur in a single layer.
无论何种病因，（肺）蜂窝状囊泡均以外带及胸膜下区为主，即使病变广泛，肺门旁区也可显示正常。蜂窝状改变常见于数个相邻层面，这易于与胸膜下肺气肿（隔旁气肿）鉴别，因胸膜下气肿通常仅见于单个层面。

When honeycombing is visible, lung biopsy will usually show usual interstitial pneumonia (UIP) or "end-stage lung". Because the appearance of honeycombing is so characteristic, lung biopsy is not usually performed when this finding is visible. If lung biopsy is considered to be warranted, CT may be useful in allowing the most severe areas of honeycombing to be avoided. Less abnormal regions, or regions showing other findings are more likely to yield a diagnosis.
若见肺部蜂窝状改变，肺组织活检常为间质性炎症或终末期肺。由于特征性蜂窝状改变，常不需再行肺组织活检。如确实需要活检，则应避开CT所见的蜂窝状改变区，取相对正常的或显示其它异常的肺组织更有助于诊断。

The differential diagnosis of honeycombing includes idiopathic pulmonary fibrosis (IPF), accounting for about 60% of such cases, autoimmune diseases such as scleroderma and rheumatoid arthritis (as in this case), asbestosis, end-stage hypersensitivity pneumonitis, drug-reactions resulting in fibrosis, and sometimes, sarcodiosis.
蜂窝肺可见于：特发性肺纤维化、……、自身免疫性疾病如硬皮病、类风关（比如本例）等、石棉肺、终末期过敏性肺炎、药物反应性纤维化，有时亦见于结节病。
differential diagnosis 应该是鉴别诊断的意思，日常所见的教科书在某病之后一般都会把鉴别诊断罗列出来，但这里蜂窝肺只是一个征象，所以应该指的是可见这个征象的所有病变吧。
account for 是解释说明的意思，不过account是从count来的，本身有计数、账目的意思，能否解释做“据统计……”？这里是否指IPF出现蜂窝肺的机率达60％？

（缩略图，点击图片链接看原图）

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case12
HRCT in a 74-year-old woman with progressive shortness of breath over 6 months and an abnormal chest radiograph (Figure 1, Figure 2, Figure 3),
女性，74岁，进行性气促超过6个月，胸片发现异常。

Honeycombing is the predominant abnormality. As in the last case, honeycomb cysts often predominate in the peripheral and subpleural lung regions (Figure 2). Subpleural honeycomb cysts typically occur in several contiguous layers. When honeycombing such as this is visible, lung biopsy will usually show usual interstitial pneumonia (UIP) or "end-stage lung". Because the appearance of honeycombing is so characteristic, lung biopsy is not usually performed when this finding is visible.
（本例）蜂窝状改变是主要的异常表现。如上一例，蜂窝囊泡以肺外带和胸膜下为主。胸膜下蜂窝囊泡可见于数个相邻层面。出现蜂窝样改变时，肺组织活检常为间质性炎症或终末期肺。若见此典型的蜂窝样改变一般不需再行肺组织活检。

The most likely diagnosis is Idiopathic pulmonary fibrosis (IPF). The differential diagnosis of honeycombing includes idiopathic pulmonary fibrosis (IPF), accounting for about 60% of such cases, autoimmune diseases such as scleroderma and rheumatoid arthritis, asbestosis, end-stage hypersensitivity pneumonitis, drug-reactions resulting in fibrosis, and sometimes, sarcodiosis. In most cases, HRCT does not allow a distinction between these causes. Based on numbers alone, the most likely diagnosis is IPF.
最可能的诊断是特发性肺纤维化（IPF）。可能的诊断包括：特发性肺纤维化、自身免疫性疾病如硬皮病、类风关（比如本例）等、石棉肺、终末期过敏性肺炎、药物反应性纤维化，有时亦见于结节病。在多数情况下HRCT上难以鉴别纤维化的病因。仅仅考虑（病灶）数量的话，最可能的诊断是IPF。
这一段鉴别诊断和上例如出一辙，account的问题依旧。base on ……句心里也没什么底。

Diagnosis: Idiopathic pulmonary fibrosis with honeycombing.
DISCUSSION
Idiopathic pulmonary fibrosis (IPF) occurs most commonly in patients between 40 and 60 years of age. Patients with IPF typically present with progressive shortness of breath and a dry cough. On physical examination finger clubbing is seen in 25 to 50% of cases, and on auscultation, late inspiratory crackles (so-called Velcro rales) are characteristic. Idiopathic pulmonary fibrosis has a poor prognosis, with a mean survival of 4 years from the onset of symptoms. Pathologically, patients with IPF show typical histologic findings of usual interstitial pneumonia (UIP).
诊断：特发性间质纤维化并蜂窝（肺）。
讨论：IPF好发于40～60岁，典型症状为进行性气促和干咳。体格检查杵壮指发生率为25～50％，听诊吸气末湿啰音，自发病起半数生存率约为4年。病理学上典型的IPF表现为间质性肺炎。
a mean survival 应该有统计学术语，似乎我们的书本常用生存率、存活率代之，照统计学的说法应该是半数生存率或者中位生存率吧，确切的专有名词我不太清楚，请指教。

In 90% of IPF cases, findings of honeycombing predominate. Honeycomb cysts usually range from 2 to 20 mm in diameter, but can be larger. They typically appear to share walls on HRCT and usually occur in several layers in the subpleural lung.
90％的IPF病例以蜂窝肺为主要表现。蜂窝肺的囊泡直径从2mm～20mm，也可以更大，典型的表现是囊泡间共用囊壁并常见于胸膜下数个相邻层面。

（缩略图，点击图片链接看原图）

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case13
86-year-old man with chronic myelogenous leukemia, treated using methotrexate, now complains of shortness of breath (Figure 1, Figure 2, Figure 3, Figure 4, Figure 5).
男性，86岁，慢性粒细胞性白血病氨甲喋呤治疗后，主诉为气促。
chronic myelogenous leukemia 全医药大词典即指即译为慢性髓细胞性白血病，不知道白血病的分类中是否有这个说法，或者是慢粒的另一个名字。如果在词典中直接输入中文慢性粒细胞性白血病也可以得到这个英文，故此这里直接译作慢粒。

Findings indicative of usual interstitial pneumonitis (UIP) visible in this patient include:（1）honeycombing;（2）irregular fissures;（3）irregular interlobular septal thickening;（4）traction bronchiectasis.
间质性肺炎常可见以下表现：1、蜂窝肺；2、叶间裂变形；3、不规则小叶间隔增厚；4、牵拉性支气管扩张

The most likely diagnosis is drug-related lung injury. The pattern of fibrosis seen in this patient is nonspecific, and could be caused by IPF. The recent history of treatment with methotrexate makes drug-related fibrosis most likely. Lung involvement by leukemia would likely result in an appearance similar to that of lymphangitic spread of carcinoma with septal thickening being the predominant finding.
最可能的诊断是药物反应性肺损伤。肺部纤维化的表现没有特异性，亦可见于IPF。由于近期的氨甲喋呤治疗史，最可能的诊断是药物反应性（肺）纤维化。白血病肺部浸润的表现和癌性淋巴管炎相似，以小叶间隔增厚为主。

Diagnosis: Drug-related lung injury, with fibrosis and honeycombing
DISCUSSION
Many drugs can be associated with lung disease. Drugs can result in a variety of pathologic reactions in the lung parenchyma, including diffuse alveolar damage, interstitial pneumonitis with fibrosis, pulmonary edema, the adult respiratory distress syndrome, eosinophilic pneumonia, bronchiolitis obliterans organizing pneumonia (BOOP), pulmonary hemorrhage, and granulomatous lesions. Prompt recognition of pulmonary drug complications is important because early abnormalities may resolve completely when treatment with the drug is discontinued.
诊断：药物反应性肺损伤，并肺纤维化及蜂窝肺。
讨论：许多药物和肺部病变相关。药物反应可导致多种肺部改变，包括弥漫性肺泡损伤、间质性肺炎并纤维化、肺水肿，急性呼吸窘迫综合征、嗜酸性细胞性肺炎、细支气管阻塞性肺炎、肺出血及肉芽肿性炎。药物反应性肺损伤的早期诊断十分重要，因为及时停药可使病变可完全消失。
ARDS，曾经有很多名字，包括成人呼吸窘迫综合征（症？）等，全医药大词典所给出的也是成人...，按照现在的说法，似乎用急性呼吸窘迫综合征更合适些。BOOP没找到现成的中文，bronchiolitis obliterans可以解作阻塞性细支气管炎，阻塞性肺炎是obstructive pneumonia，两者连在一起，是否指因梗阻而累及细支气管和肺泡的炎症？
UIP with lung fibrosis is a common pattern of drug-related lung injury. A long list of drugs have been implicated, but this pattern is most commonly the result of cytotoxic chemotherapeutic agents such as bleomycin, busulfan, vincristine, methotrexate, adriamycin, and carmustine (BCNU).
UIP并肺纤维化是药物反应性肺损伤的常见表现。可致肺损伤的药物很多，但最常见于化疗的细胞毒药物比如博来霉素、白消安、长春新碱、氨甲喋呤、阿霉素和卡氮芥。

The most common pattern seen on HRCT in patients with drug induced lung injury is that of fibrosis, indistinguishable from the appearance of idiopathic pulmonary fibrosis. This pattern is characterized by the presence of irregular reticular opacities, honeycombing, architectural distortion, traction bronchiectasis, and/or areas of consolidation. HRCT abnormalities are usually bilateral and symmetric, with predominant lower lung zone involvement. A peripheral and subpleural distribution of abnormalities is also common.
最常见的药物性肺损伤表现是肺纤维化，这不足以与特发性肺纤维化鉴别。不规则网状阴影、蜂窝肺、肺结构变形、牵拉性支气管扩张、和/或肺塌陷。（药物性肺损伤）在HRCT上常双侧对称出现，并以下肺、肺外带胸膜下为主。

（缩略图，点击图片链接看原图）

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case14
HRCT is shown at two levels in a 63-year-old man with a history of scleroderma and progressive shortness of breath (Figure 1, Figure 2).
男性，63岁，有硬皮病史并进行性气促。

Findings include:（1）interlobular septal thickening;（2）traction bronchiectasis;（3）subpleural honeycombing; （4）irregular fissures.
发现包括：1、小叶间隔增厚；2、牵拉性支气管扩张；3、胸膜下蜂窝肺；4、不规则肺裂变形。

The presence of honeycombing is diagnostic of fibrosis. Traction bronchiectasis is also strongly suggestive of fibrosis. Interlobular septal thickening and irregular fissures are nonspecific, and cannot be relied upon to diagnose fibrosis.
蜂窝肺的存在足以诊断肺纤维化。牵拉性支气管扩张也强烈提示肺纤维化。小叶间隔增厚和不规则肺裂变形没有特异性，不足以证明是否有纤维化。

Diagnosis: Scleroderma, with lung fibrosis, honeycombing, and traction bronchiectasis
DISCUSSION
Scleroderma leads to some degree of fibrosis in nearly all cases. As many as 75% patients with scleroderma have evidence of lung disease at autopsy, although only 1% present with pulmonary symptoms. As with rheumatoid arthritis, chest radiographs may appear normal despite abnormal pulmonary function tests. The incidence of radiographically recognizable interstitial disease is probably around 25%. In addition to fibrosis, scleroderma is commonly associated with pulmonary vasculitis and pulmonary hypertension.
诊断：硬皮病，伴肺纤维化、蜂窝肺及牵拉性支气管扩张
讨论：几乎所有的硬皮病均有不同程度的肺纤维化。约75％的硬皮病病例尸检时发现存在肺组织病变，但只有1％出现呼吸症状。和类风关相似，肺功能检查显示异常可早于胸片，出现X线表现异常的几率大约是25％。出了肺纤维化，硬皮病还常常合并有肺部血管炎和肺动脉高压。

The HRCT findings of interstitial fibrosis are quite similar to those of IPF, including honeycombing (60%) and septal thickening (45%). Honeycombing most commonly has a basal, posterior, and peripheral predominance, and is usually characterized by the presence of small irregular cysts. Ground-glass opacity may also present.
（硬皮病的）肺纤维化在HRCT上和IPF（特发性肺纤维化）相似，包括蜂窝肺（60％）、小叶间隔增厚（45％）。蜂窝肺常出现在肺底部的背侧，以肺外带为主，并有特征性的不规则多发小囊泡。亦可见毛玻璃样阴影。

Other findings on CT in patients with scleroderma include diffuse pleural thickening seen in 30% of cases and asymptomatic esophageal dilatation present in 40-80% of cases. The presence of esophageal dilatation may be helpful in the differential diagnosis of scleroderma from other diffuse interstitial lung diseases.
硬皮病的其它CT表现包括弥漫性胸膜增厚，可见于30％的病例；无症状的食管扩张，可见于约40～80％的病例。食管扩张有助于鉴别其他的弥漫性肺部病变。

In patients with scleroderma, a predominant HRCT finding of ground-glass is opacity often correlates with the presence of inflammation; the presence of a predominantly reticular pattern on HRCT correlates closely with the presence of fibrosis.
硬皮病在HRCT上的主要表现：毛玻璃样影和炎症有关，而网格状影与纤维化有关。

UIP associated with progressive systemic sclerosis follows a less progressive course and has a better long term prognosis than UIP associated with idiopathic pulmonary fibrosis. Improvement following treatment, similar to that seen in patients with IPF, is more frequent in patients with a prominent ground-glass component than in those with predominant reticular abnormalities.
全身性硬皮病常合并间质性肺炎，进展缓慢，预后好于特发性纤维化伴间质性肺炎。治疗后改变与IPF相似，以毛玻璃影为主的病例改善显著于网格状影为主的病例。
screen.width-333)this.width=screen.width-333" width=420 height=711 title="Click to view full case14.jpg (420 X 711)" border=0 align=absmiddle>

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case15
HRCT was performed in a 61-year-old woman with progressive shortness of breath (Figure 1).
女性，61岁，进行性气促。

Which of the following findings are shown on this scan?
a. Honeycombing 蜂窝肺
b. A subpleural line 胸膜下线
c. A peripheral and subpleural distribution （病灶分布于）肺外带及胸膜下
d. All of the above
Correct. Small subpleural cysts are present typical of mild honeycombing. An irregular line parallels the pleural surface, termed a subpleural line. A peripheral and subpleural distribution of abnormalities is clearly seen.
轻度的蜂窝肺可见胸膜下小囊泡。外带胸膜下可见不规则线状影，于胸膜大致并行，即胸膜下线。显而易见病变以肺外带及胸膜下分布为主。

Idiopathic pulmonary fibrosis (IPF). In the absence a history to suggest one of the specific diagnoses on this list, IPF is most likely. It accounts for 60% of cases having this appearance.
特发性肺纤维化。在没有确定的病史是最可能的诊断就是IPF，近60％的病例有这样的表现。

Diagnosis: Idiopathic pulmonary fibrosis, with honeycombing and a subpleural line.
DISCUSSION
A subpleural line is typically a few millimeters thick, less than 1 cm from the pleural surface, and parallels the pleura. It is usually seen in patients with pulmonary fibrosis, but is uncommonly the sole abnormal finding. Increased reticulation, traction bronchiectasis, or honeycombing are often visible. In some patients, a confluence of honeycomb cysts can result in a somewhat irregular subpleural line.
诊断：特发性肺纤维化，并蜂窝肺及胸膜下线。
讨论：典型的胸膜下线厚约数mm，距离胸膜小于1cm，与胸壁平行。它通常可见于肺纤维化，但是很少单独出现，常合并粗网格状影、牵拉性支气管扩张和蜂窝肺。部分病例的蜂窝囊泡壁融合形成胸膜下线。
increased reticulatio的increase 该解作增多还是增粗？没什么把握。

A subpleural line can also be seen in normal patients as a result of atelectasis in the dependent lung (e.g. the posterior lung when the patient is positioned supine). Such normal lines are transient, and disappear in the prone position.
胸膜下线亦可见于某些肺含气不全病人的下垂部肺野（例如仰卧位扫描的背侧肺野），这时的胸膜下线并不恒定，俯卧位时可消失。
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case16
HRCT in the supine and prone positions in a 34-year-old man with progressive shortness of breath and an abnormal chest radiograph (Figure 1, Figure 2, Figure 3, Figure 4, Figure 5, Figure 6).
男性，34岁，进行性气促，胸片发现异常。仰卧位及俯卧位HRCT扫描。

Honeycombing is not visible in this patient. A fine irregular reticular pattern is present in the lung periphery, representing intralobular interstitial thickening. In some patients with pulmonary fibrosis, this finding will predominate. Other findings of fibrosis in this patient include traction bronchiectasis. The differential diagnosis of this appearance is identical as that for honeycombing.
此例未见蜂窝肺改变。肺外带可见明显的不规则网状影，提示小叶间质增厚。部分肺纤维化的病例可以此征象为主要表现。此例的其它肺纤维化表现还有牵拉性支气管扩张。这种征象的意义和蜂窝肺相同。
differential diagnosis 是“鉴别诊断”，如前文所述，应该是出现这种征象的所有可能的诊断，似乎用“意义”更符合我们的习惯。
intralobular interstitial 直译就是小叶间质，不知道和intralobular septum(小叶间隔)如何区分。

Diagnosis: Idiopathic pulmonary fibrosis, with intralobular interstitial thickening.
DISCUSSION
In some patients with early or mild fibrosis, honeycombing is not a predominant HRCT finding. A fine reticular pattern may be recognized on HRCT in some of these, termed intralobular interstitial thickening. The presence of these lines produces a fine "spider-web" or "lace-like" appearance. These may be associated with traction bronchiectasis, as in this case.
诊断：特发性肺纤维化并小叶间隔增厚。
讨论：部分早期肺纤维化的病例，并不以蜂窝肺为主要表现。这时可见明显的小叶间质增厚，呈明显的网格状阴影，呈蜘蛛网状或花边状。这些征象可合并牵拉性支气管扩张，如此例所见。

（缩略图，点击图片链接看原图）

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case17
Supine and prone HRCT in a 71-year-old man with progressive shortness of breath and an abnormal chest radiograph (Figure 1, Figure 2, Figure 3, Figure 4, Figure 5, Figure 6).
男性，71岁，进行性气促并胸片发现异常，仰卧位及俯卧位HRCT扫描

Honeycombing is not clearly seen in this patient. A fine but irregular reticular pattern is present in the lung periphery, representing intralobular interstitial thickening. In some patients with pulmonary fibrosis, this finding will predominate. Other findings of fibrosis in this patient include traction bronchiectasis, and irregular interlobular septal thickening. The differential diagnosis of this appearance is identical to that for honeycombing.
此例未见蜂窝肺改变。肺外带可见明显的不规则网状影，提示小叶间质增厚。部分肺纤维化的病例可以此征象为主要表现。此例的其它肺纤维化表现还有牵拉性支气管扩张。这种征象的意义和蜂窝肺相同。（这段怎么和上个病例一摸一样？）

Diagnosis: Idiopathic pulmonary fibrosis, with intralobular interstitial thickening.
诊断：特发性肺纤维化并小叶间质增厚。

（缩略图，点击图片链接看原图）

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case18
HRCT in a 55-year-old salami manufacturer with progressive shortness of breath
55岁，从事制造意大利香肠工作，进行性气促（没有提供性别，看下文应该是男性）

The most likely diagnosis in this case is:
Idiopathic pulmonary fibrosis (IPF)
Autoimmune disease (e.g., rheumatoid lung disease)
End-stage hypersensitivity pneumonitis
Asbestosis
Drug-related lung injury
Sarcoidosis
Any diagnosis is possible. The HRCT scans show peripheral honeycombing. Idiopathic pulmonary fibrosis would be most likely on the basis of odds. However, his history of occupational exposure to meat products and materials used in their manufacture raises the possibility of end-stage hypersensitivity pneumonitis.
本例最可能的诊断是？
a. IPF；
b.自身免疫性疾病（例如类风湿肺病）；
c.终末期过敏性肺炎；
d.石棉肺；
e.药物反应性肺损伤；
f.结节病。
上述诊断均有可能。HRCT显示肺外带蜂窝状改变。极可能并有IPF的基础病。无论如何，该患者从事肉制品行业（的职业史）提高了终末期过敏性肺炎的可能性。

Diagnosis: End-stage hypersensitivity pneumonitis, with honeycombing.
DISCUSSION
Hypersensitivity pneumonitis (HP) is an allergic lung disease caused by the inhalation of antigens contained in a variety of organic dusts, e.g. farmer's lung. The radiographic and pathologic abnormalities that are seen in patients with HP are quite similar, regardless of the organic antigen responsible; these abnormalities can be classified into acute, subacute, and chronic stages. The acute and subacute stages of HP are usually associated with patchy or nodular ground-glass opacity. The chronic stage of HP is characterized by the presence of fibrosis, which may develop months or years after the initial exposure
诊断：终末期过敏性肺炎并蜂窝肺
讨论：过敏性肺炎（HP）是由于吸入过敏性抗原而致的变态反应性疾病，例如农民肺，过敏原可为各种有机粉尘。各种过敏原所致的HP在病理学及放射学的表现相似。病灶可分为急性期、亚急性期和慢性期。急性期和亚急性期HP表现为片状或结节状毛玻璃样阴影。慢性HP病灶特征性的表现为纤维化，可于接触过敏原数月或数年后出现。

In patients with chronic HP, HRCT can show irregular reticular opacities representing fibrosis, traction bronchiectasis, or frank honeycombing. The fibrosis appears patchy in distribution in some cases, and predominantly subpleural or peribronchovascular in others. Honeycombing present in about 25% of cases is usually subpleural in distribution, mimicking IPF. When findings of fibrosis are patchy and involve parahilar rather than subpleural lung, it can sometimes be distinguished from IPF based on this distribution.
慢性期HP的肺纤维化在HRCT上表现为不规则网状影、牵拉性支气管扩张及蜂窝肺。部分病例的肺纤维化呈斑片状，可于胸膜下或大支气管血管周围。约25％的病例蜂窝肺位于胸膜下，和IPF相似。若纤维化（的表现）呈斑片状以肺门旁为主，则可藉此和IPF相鉴别。

Findings of fibrosis in patients with chronic HP most often show a mid-lung zone predominance or are evenly distributed throughout the upper, mid, and lower lung zones. Relative sparing of the lung bases, seen in a majority of cases of chronic HP, can sometimes allow distinction of this entity from idiopathic pulmonary fibrosis, in which the fibrosis usually predominates in the lung bases. However, in some patients with chronic HP, HRCT findings are identical to those of IPF. In clinical practice, the differential diagnosis of HP and IPF is facilitated by the clinical history and laboratory findings.
慢性HP的肺纤维化常以中肺野为主，或弥散分布于上、中、下肺野。大部分HP的肺纤维化病例肺底部相对正常，这有助于鉴别IPF，其纤维化常以肺底部为主。在临床实践中，HP和IPF通过病史和实验室检查即可鉴别。
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case19
Supine and prone HRCT in 34-year-old woman with lupus erytematosus, interstitial lung disease, and progression of pulmonary function test abnormalities (Figure 1, Figure 2, Figure 3, Figure 4, Figure 5, Figure 6).
女性，34岁，有系统性红斑狼疮及间质性肺疾病病史，进行性肺功能异常。仰卧位及俯卧位HRCT扫描。

HRCT obtained in the supine and prone positions shows a number of findings indicating fibrosis, including:
honeycombing which is mild in degree;
traction bronchiectasis;
intralobular interstitial thickening;
interlobular septal thickening; and
a subpleural distribution.
HRCT仰卧及俯卧扫描，显示肺纤维化的多种表现，包括：
轻度蜂窝肺；
牵拉性支气管扩张；
小叶间质增厚；
小叶间隔增厚
（上述病变）于胸膜下
这个小叶间隔增厚和间质增厚又出现了，看来不是同一个征象的异名。

Diagnosis: Systemic lupus erythematosus, with fibrosis and honeycombing.
DISCUSSION
Systemic lupus erythematosus (SLE) is commonly associated with pleural and pulmonary abnormalities. Pleuritis or pleural fibrosis is present in up to 85% of cases at autopsy, and pleural effusion is often visible on chest radiographs in patients with SLE. More than 50% of patients with SLE have lung disease at some time, but interstitial pneumonia and fibrosis similar to that seen in other connective tissue diseases is relatively rare in SLE, with a prevalence of only a few percent. Its appearance is indistinquishable from that of idiopathic pulmonary fibrosis.
诊断：SLE并肺纤维化、蜂窝肺
讨论：SLE常合并肺及胸膜异常。尸检可见近85％的SLE有胸膜炎及胸膜纤维化，胸片检查可见胸腔积液。超过50％的SLE有不同程度的肺部病变，但因发病率低而较其它结缔组织病少见。它的表现和IPF难以鉴别。
indistinquishable在全医药大词典找不到，但是在金山词霸2003医学版找到个distinquishable，是“可区别的”，in-作为否定前缀应该没有问题。

（缩略图，点击图片链接看原图）

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case20
Prone HRCT in a 65-year-old woman with rheumatoid arthritis and mild dyspnea (Figure 1, Figure 2).
女性，65岁，有类风湿病史及轻度的呼吸困难。俯卧位扫描。

HRCT obtained in the supine and prone positions shows a number of findings indicating mild fibrosis, including:
traction bronchiectasis;
intralobular interstitial thickening; and
a subpleural line.
HRCT包括仰卧位及俯卧位扫描，显示肺纤维化的多种表现，包括：
牵拉性支气管扩张、小叶间质增厚及胸膜下线。
这里并没有提供仰卧位的图象，可能为作者的笔误。

Diagnosis: Rheumatoid lung disease, with mild pulmonary fibrosis and intralobular interstitial thickening.
DISCUSSION
Most collagen-vascular diseases can cause chronic interstitial pneumonia with clinical, radiologic, HRCT, and pathologic features indistinguishable from those of IPF. Pleural thickening and pleural effusion are also common. The two most common conditions associated with interstitial fibrosis are rheumatoid arthritis and progressive systemic sclerosis (scleroderma).
诊断：类风湿肺部改变，并轻度肺纤维化及小叶间质增厚。
讨论：大部分胶原血管病在临床上会出现慢性间质性肺炎，无论平片、HRCT还是病理均无法于IPF鉴别。胸膜增厚和胸腔积液十分常见。（这类疾病中）合并间质纤维化的最常见的是类风湿和硬皮病。
多说一句，因为是英文资料，国外的疾病谱和国内可能有所不同。

Rheumatoid arthritis (RA) is commonly associated with thoracic abnormalities, including interstitial pneumonitis and fibrosis, pleural effusion or pleural thickening, and necrobiotic (rheumatoid) nodules.
RA常常合并胸部病变，包括间质性肺炎和纤维化，胸腔积液或胸膜增厚，以及风湿小结。

Pulmonary fibrosis is common, and although pulmonary function abnormalities have been reported in as many as 40% of patients with RA, the chest radiograph is normal in more than half of these patients. The prevalence of radiologically detectable interstitial disease in patients with rheumatoid arthritis is probably around 10%.
RA常发生肺纤维化。据报道RA出现肺功能障碍机率约40％，但即使如此胸片仍可过半数无发现。放射学检出RA患者肺纤维化的机率大约只有10％。
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case21
Supine and prone HRCT in a 26-year-old woman with mixed connective tissue disease, basilar crackles on physical examination, and restrictive disease on pulmonary function tests (Figure 1, Figure 2, Figure 3, Figure 4, Figure 5, Figure 6).
女性，26岁，混合性结缔组织病，体格检查肺底部湿啰音，肺功能检查提示限制性病变。仰卧位及俯卧位HRCT扫描

HRCT obtained in the supine and prone positions shows a number of findings indicating mild fibrosis, including:
traction bronchiectasis;
intralobular interstitial thickening; and
a subpleural distribution (Figure 1).
仰卧位及俯卧位HRCT扫描显示轻度肺纤维化的多种表现，包括：牵拉性支气管扩张、支气管间质增厚，以胸膜下为主。

Diagnosis: Mixed connective tissue disease, with pulmonary fibrosis, and intralobular interstitial thickening
DISCUSSION
Mixed connective tissue disease (MCTD) is associated with clinical and laboratory findings overlapping those of scleroderma, systemic lupus erythematosus, and polymyositis-dermatomyositis. It is characterized by the presence of high titers of a circulating antinuclear, antiribonucleoprotein antibody which is uncommon in other connective tissue diseases. MCTD is commonly associated with radiologic and functional evidence of interstitial lung disease and/or pleural effusion; several studies indicate an prevalence of up to 80%.
诊断：混合性结缔组织病，肺纤维化及小叶间质增厚。
讨论：MCTD的临床表现和实验室检查和硬皮病、SLE及多发性皮肌炎常有重叠。它的特征性表现是血中抗核抗体极高，这在其它结缔组织病较少见。

More than two-thirds of patients with MCTD have abnormal pulmonary function tests, but chest radiographic abnormalities are less frequent, visible in about 20%. The interstitial lung disease of MCTD appears identical to that of UIP or IPF on histologic examination, radiographs, and on HRCT.
超过2/3的MCTD有肺功能障碍，但胸片检查较少发现，常少于20％。MCTD的肺部间质性病变在组织学、平片及HRCT上的表现和UIP或IPF相同。

（缩略图，点击图片链接看原图）

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本以为渐入佳境，谁知问题多多！似乎再没斑友肯指点，有些郁闷。
case22
Supine and prone HRCT in a 81-year-old man with significant occupational exposure to asbestos, dyspnea, and abnormal chest radiograph (Figure 1, Figure 2, Figure 3, Figure 4, Figure 5, Figure 6).
男性，81岁，有较重的石棉接触史，呼吸困难及胸片发现异常。

Findings of fibrosis include:
traction bronchiectasis;
intralobular interstitial thickening; and
a subpleural distribution.
irregular interlobular septal thickening
肺纤维化表现包括：
牵拉性支气管扩张、小叶间质增厚且以胸膜下为主，不规则的小叶间隔增厚。

Diagnosis: Asbestosis with traction bronchiectasis and intralobular interstitial thickening.
DISCUSSION
The lung disease associated with asbestos fiber inhalation is known as "asbestosis". Pathologically, asbestosis is defined as interstitial fibrosis associated with the presence of intrapulmonary asbestos bodies or asbestos fibers. However, it is uncommon in clinical practice to obtain histologic proof of asbestosis; this diagnosis is usually presumptive and based on indirect evidence, including a combination of chest radiographic abnormalities, restrictive abnormalities on pulmonary function tests, appropriate physical findings, and known exposure to asbestos. Although none of these clinical or radiographic criteria is specific, the presence of multiple abnormal findings in an individual with significant asbestos exposure is taken as presumptive evidence of asbestosis. A diagnosis of asbestosis is difficult to make and is probably inappropriate when only a few physical or functional abnormalities are present. Also in 5% of cases, interstitial fibrosis in asbestos exposed patients represents another disease.
诊断：石棉肺，牵拉性支气管扩张病小叶间质增厚。
讨论：吸入石棉纤维导致的肺部病变称为“石棉肺”。病理学上石棉肺的定义是肺间质纤维化并发现肺内石棉小体或石棉纤维。然而在临床工作中，常难以获得组织学上的证据。这个诊断常通过以下几个间接表现推论而来，包括：胸片发现异常、肺功能试验及体格检查所见的限制性肺功能障碍、确切的石棉接触史。虽然这些临床和平片表现的本身没有特异性，但这些征象同时出现并有石棉接触史则基本上可以确定石棉肺的诊断。若单凭体格检查或肺功能检查则很容易误诊。约5％的肺纤维化并有石棉接触史的病例其实不是石棉肺。
最后一句能否意译为“上述简易诊断标准约有5％的误诊率。”

（缩略图，点击图片链接看原图）

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case23
HRCT shown at soft-tissue windows in a patient with asbestos exposure (Figure 1, Figure 2, Figure 3, Figure 4).
患者有石棉接触史，以下为HRCT的软组织窗（纵隔窗）

Scans at four levels show typical findings of asbestos-related pleural thickening. These include pleural thickening and calcification:
internal to ribs;
internal to the intercostal muscles;
in the paravertebral regions; and
involving the diaphragmatic pleura
四个扫描层面的软组织窗显示了石棉所致肺纤维化表现。包括胸膜增厚、钙化：于肋骨旁、肋间肌旁、脊柱旁区及膈胸膜。

Diagnosis: Asbestos-related pleural disease
DISCUSSION
Parietal pleural thickening occurs commonly in patients with occupational asbestos exposure. Parietal pleural plaques are the most common manifestation, and the most characteristic radiographic feature, of asbestos exposure. They represent focal and discrete regions of pleural thickening, and predominate along the posterolateral costal pleural surfaces, and along the surface of the diaphragm, but typically spare the apices and costophrenic sulci.
诊断：石棉肺累及胸膜。
讨论：胸膜增厚常见于职业性的石棉肺患者。肺尖部胸膜斑是石棉肺在放射学检查最常见和最具特异性的表现。它们（胸膜斑）可与胸膜增厚区分别出现，以后外侧肋骨下胸膜最常见，亦可见于膈胸膜顶部，典型者肋膈角区常正常。
discrete 既可以解释为“分离”亦可以解作“间断”，这里是该理解为与胸膜增厚分别出现还是多发的钙化斑在胸膜增厚区呈离散分布？
parietal 可以是“壁”或“顶”，在这里指的是单纯的胸壁还是肺尖部胸膜？

Asbestos-related pleural thickening has a typical appearance on HRCT. The pleural thickening appears smooth and sharply defined, and can be recognized when measuring only 1 or 2 mm in thickness. Early pleural thickening is discontinuous and abnormal areas can be easily contrasted with adjacent normal regions. Areas of pleural thickening or plaques of thickened pleura are commonly visible adjacent to the inner surfaces of ribs or vertebral bodies. The presence of bilateral pleural plaques or focal pleural thickening is strongly suggestive of asbestos exposure, particularly when calcification is also visible. Pleural calcification is visible on HRCT in about 15% of patients. Often, even when not grossly calcified, asbestos-related areas of pleural thickening appear slightly denser that adjacent intercostal muscles.
石棉肺的胸膜增厚在HRCT上具有典型表现，增厚的胸膜平滑而边界清晰，厚约1～2mm。早期的胸膜增厚可间断出现，易于与正常胸膜区别。胸膜增厚及胸膜斑常位于肋骨下及椎体旁。双侧出现的胸膜增厚及胸膜斑强烈提示石棉肺。在HRCT上约15％（的石棉肺）可见胸膜钙化。即使在钙化不十分显著时也可出现胸膜增厚区轻度密度增高，尤其是肋间肌下的胸膜。

On HRCT, parietal pleural thickening is easiest to see internal to visible rib segments; only the pleura, extrapleural fat, and endothoracic fascia pass internal to ribs, and in most normal patients these are too thin to recognize on HRCT. Although the normal innermost intercostal muscle is visible on HRCT as a 1-2 mm thick opaque stripe between adjacent rib segments, it does not pass internal to them, and should not be confused with pleural thickening.
在HRCT所见的胸膜斑常于肋骨下，其间只有胸膜、胸膜外脂肪层、胸内筋膜，但多数情况下这些组织太薄而难以再细分。虽然最内层的肋间肌可以在肋骨内侧（的两端）形成1～2mm不透光区，但它不会通过肋骨最内缘，故不会和胸膜增厚混淆。

The HRCT diagnosis of pleural thickening is made easier in many locations by the presence of a distinct layer of extrapleural fat, usually measuring from 1 to 4 mm in thickness, which separates the thickened pleura from adjacent structures of the chest wall, such as rib or innermost intercostal muscle. Extrapleural fat allows the thickened pleura to be seen on HRCT as a discrete linear opacity, even when the pleural thickening is minimal.
由于在HRCT上胸膜外脂肪为厚约1～4mm的低密度影，位于增厚胸膜和胸壁（例如肋骨、肋间肌）间，故此易于辨认增厚的胸膜。胸膜外脂肪使胸膜增厚呈（与胸壁）分开的条状不透光区，即使轻微的胸膜增厚也是如此。

（缩略图，点击图片链接看原图）

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case24
Lung and soft-tissue window scans in a 58-year-old man with a history of asbestos exposure and and an abnormal chest radiograph (Figure 1, Figure 2, Figure 3).
男性，58岁，有石棉接触史，胸片发现异常，以下为肺窗及软组织窗

HRCT at soft-tissue windows shows posterior pleural thickening typical of asbestos exposure. Lung window scans at the lung bases show irregular linear opacities, without evidence of honeycombing, intralobular interstitial thickening, or traction bronchiectasis.
HRCT软组织窗显示石棉肺的背侧胸膜增厚，肺窗可见肺底部不规则线状影，未见蜂窝肺、小叶间质增厚及牵拉性支气管扩张。

Linear opacities as seen in this case (termed parenchymal bands) are common in patients with pleural thickening, but are not necessarily associated with lung fibrosis.
本例所见的线状影常可见于胸膜增厚患者，但不一定合并肺纤维化。

Diagnosis: Asbestos exposure with pleural disease and parenchymal bands
DISCUSSION
The term "parenchymal band" is used to describe a non-tapering, linear opacity, several centimeters in length, seen in patients with pleural disease or pulmonary fibrosis. Parenchymal bands are often several millimeters thick, irregular in contour, and associated with significant distortion of adjacent lung parenchyma and bronchovascular structures. They are often peripheral in location and generally contact the pleural surface. Their appearance has been likened to "crow's feet."
诊断：????并胸膜病变、PB
讨论：所谓的PB指粗细均匀的线状影，长约数cm，常见于胸膜病变及肺纤维化。PB一般宽数mm，边缘不规则，伴明显是肺实质及支气管血管结构变形，常位于肺外带，可达胸膜面，呈鸦足样。
parenchymal 是（肺）实质，band 是条、带状物（这里肯定不是银行吧，呵呵），是否可以译成肺实质带征？反正应该是这个意思。不知道和胸膜下线有什么区别，或者同征异名？因为我不知道这个征象确切的中文译名，故此全部用PB代替。
Asbestos exposure 直译就是暴露于石棉下的意思，我一直理解为接触石棉病史，但是把这作为影像诊断似乎说不过去。而且case25、case26也都有这个诊断，而且文意中和石棉肺明显不同，该怎么理解？

Parenchymal bands have been reported as most common in patients with asbestos related lung and pleural disease, sarcoidosis with interstitial fibrosis, silicosis associated with progressive massive fibrosis, and tuberculosis with scarring. In patients with asbestos-related disease, parenchymal bands can reflect pulmonary fibrosis or areas of atelectasis occurring in association with pleural plaques or pleural thickening.
据报道PB最常见于石棉相关性肺及胸膜病变、结节病肺间质纤维化、硅肺巨块纤维化、结核瘢痕。在石棉相关性疾病，PB是肺纤维化或肺含气不全合并胸膜增厚、胸膜斑时的表现。

When seen in association with pleural thickening in patients with asbestos exposure, these bands, in and of themselves, should not be considered to represent asbestosis. Because the pleural disease has a basal predominance, bands tend to as well. In some patients, bands can be seen to progress to rounded atelectasis. A subpleural line, can also be seen adjacent to pleural thickening in patients with asbestos exposure. It usually represents atelectasis rather than asbestosis.
单凭石棉接触史和胸膜增厚、PB并不足以诊断石棉肺。因为以胸膜改变为主的疾病同样可能出现PB。比如在某些球形肺不张的形成过程中，亦可见PB。胸膜下线也可见于有石棉接触史的患者，并且同样和增厚的胸膜毗邻，但常提示肺不张而不是石棉肺。
这一段实在没什么把握，请斧正。

（缩略图，点击图片链接看原图）

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case25
HRCT in a 67-year-old man with a history of asbestos exposure and and abnormal chest radiograph (Figure 1, Figure 2).
男性，67岁，有石棉接触史，胸片发现异常。

HRCT at lung windows shows irregular linear opacities ( "crow's feet"), without evidence of honeycombing, intralobular interstitial thickening, or traction bronchiectasis. This appearance does not indicate asbestosis. Linear opacities, as seen in this case (parenchymal bands) are common in patients with pleural thickening related to asbestos exposure, but are not necessarily associated with lung fibrosis. They represent focal areas of atelectasis, associated with the pleural thickening, or focal areas of scarring.
肺窗显示不规则线样阴影（鸦爪征），未见蜂窝肺、小叶间质增厚或牵拉性支气管扩张。这个表现不足以诊断石棉肺。线状阴影，如本例所见（PB），常见于胸膜增厚并有石棉接触史患者，但不一定有肺纤维化。这些阴影提示肺含气不全，合并胸膜增厚或瘢痕形成。

Diagnosis: Asbestos exposure with pleural disease and parenchymal bands
DISCUSSION
In another patient with asbestos exposure a thin subpleural line is seen adjacent to pleural thickening on targeted prone images. This finding usually indicates focal atelectasis rather than asbestosis.
诊断：接触石棉并胸膜病变，PB
讨论：另一例接触石棉患者的俯卧位扫描图象，有胸膜下细线状阴影并相邻的胸膜增厚。这种表现通常提示灶性肺不张而不是石棉肺。

（缩略图，点击图片链接看原图）

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case26
Supine soft-tissue window scan and prone lung window scans in a 56-year-old man with significant occupational exposure to asbestos, dyspnea, and a normal chest radiograph (Figure 1, Figure 2, Figure 3).
男性、56岁，长期的职业性接触石棉史，呼吸困难，胸片未见异常。

A focal, calcified pleural plaque is visible anteriorly, typical of asbestos exposure. Although plaques are more likely posterior in location, this appearance is highly suggestive.
在前方可见局部胸膜钙化，典型的asbestos exposur（表现）。这种（钙化）灶更常见于背侧，高度提示asbestos exposur.

There is mild septal thickening and reticulation in the posterior subpleural region on the right. This is unassociated with adjacent pleural thickening. This is a very subtle abnormality which could represent the earliest stage of asbestosis. However, in the absence of a more definite abnormality or similar findings on the left, it would be difficult to make a definite diagnosis of fibrosis or asbestosis.
右侧胸膜下可见轻度间隔增厚及网状改变，和胸膜增厚部位相隔较远。这种轻微的异常提示早期石棉肺。但是在缺乏足够多的异常表现并且左肺未见异常的情况下，无法确定石棉肺及肺纤维化的诊断。

Diagnosis: Asbestosis exposure. Possible fibrosis.
DISCUSSION
On HRCT, asbestosis can result in a variety of findings, depending on the severity of the disease. In general, HRCT findings reflect the presence of interstitial fibrosis, and are similar to those seen in patients with IPF. Although none of these findings are specific for asbestosis, the presence of typical parietal pleural thickening in association with lung fibrosis is highly suggestive. Findings of fibrosis have a distint basal, posterior, and supleural predominance.
诊断：Asbestosis exposure 可能合并肺纤维化。
讨论：石棉肺在HRCT上有多种表现，与病变程度相关。一般情况下，HRCT上的表现反映的是肺纤维化，同理IPF也是如此。虽然这不是石棉肺的特异性改变，但肺纤维化并胸膜增厚高度提示石棉肺。肺纤维化以肺底部、背侧及胸膜下为主。

Asbestosis exposure 这个诊断有些怪，疑为Asbestos exposure 之误。同样，下一段倒数第二个单词supleural疑为subpleural, distint 疑为distinct。
Asbestos exposure这个诊断已经多次出现了，实在不知道该如何译。实际上，前面的众多病例多有描述性的诊断诸如蜂窝肺，像支气管扩张也是作为单独病变的时候才下的诊断，似乎著者并不执着于用一个病名来囊括全部表现，而是加上许多辅助性的哪怕描述性的诊断。这个Asbestos exposure可能是一个疑诊，并且程度远比Asbestosis轻。但是无论直译作“暴露于石棉粉尘下”或“石棉接触史”都不能作为一个独立的诊断，头痛啊！

In the early stages of disease, the presence of peribronchiolar fibrosis can also result in an abnormal prominence of the centrilobular arteries, giving rise to an increased reticulation in the peripheral lung.
病变早期，支气管血管周围纤维化可表现为小叶动脉异常突起，加重网格状改变。

It should be kept in mind that patients with asbestosis usually show a number of HRCT findings indicative of lung fibrosis, and the abnormalities are usually bilateral and often somewhat symmetrical. The presence of focal or unilateral HRCT abnormalities should not be considered sufficient for making this diagnosis.
必须谨记石棉肺的HRCT表现为大量肺纤维化，且双侧大致对称。局限性单侧出现的病灶不足以作出这个诊断。

（缩略图，点击图片链接看原图）

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case27
Supine and prone HRCT in a 57-year-old woman with years of progressive dyspnea and an abnormal chest radiograph (Figure 1, Figure 2, Figure 3, Figure 4, Figure 5).
57岁，女性，进行性呼吸困难并胸片发现异常。HRCT仰卧位及俯卧位扫描。

This patient shows a number of findings indicative of pulmonary fibrosis. These include:
Extensive traction bronchiectasis involving both upper lobes;
Irregular reticular opacities and distortion of lung architecture associated with traction bronchiectasis; and
Honeycombing at the lung bases
本例显示大量的肺纤维化表现，包括：
广泛的牵拉性支气管扩张，上肺亦可见；不规则网状影，并肺结构变形及牵拉性支气管扩张；及肺底部蜂窝状改变。

With exception of the posterior honeycombing, the findings of fibrosis in this patient lack the peripheral, lower lobe, and subpleural predominance of IPF. These findings are typical of end-stage sarcoidosis.
（原文有个提问“本例是否足以诊断IPF”，答案是“否”）除了背侧的蜂窝肺，肺纤维化的改变并不像IPF那样以外带，肺底部及胸膜下为主。（本例中的）表现是典型的终末期结节病。

Diagnosis: End-stage sarcoidosis, with traction bronchiectasis and honeycombing.
DISCUSSION
In patients with sarcoidosis, progressive fibrosis often leads to peribronchovascular conglomerate masses of fibrous tissue, typically most marked in the upper lobes. Bronchi and vessels are clustered together because of retraction, and bronchi appear dilated (i.e. traction bronchiectasis); the only other diseases that commonly result in this appearance are silicosis, tuberculosis, and talcosis. Posterior displacement of the upper lobe bronchi indicating volume loss in the posterior segments of the upper lobes is a common early finding.
诊断：终末期结节病，牵拉性支气管扩张及蜂窝肺。
讨论：在结节病患者，进行性纤维化常导致纤维组织在支气管血管周围聚拢呈团块状，以上肺为主。支气管和血管被（纤维组织）牵拉呈簇状，并支气管扩张（即牵拉性支气管扩张）。会有这种表现的其它疾病只有硅肺、结核及滑石病。上叶支气管后移提示上叶后段容积减少，常是早期（结节病）的表现。
talcosis用全医药大词典查出来就是滑石病，估计滑石粉尘所导致的尘肺？

Honeycombing or lung cysts can be present in patients with sarcoidosis, but this finding is less common than in other fibrotic lung diseases such as idiopathic pulmonary fibrosis. Honeycombing is usually limited to patients with severe fibrosis and central conglomeration of bronchi. The honeycombing seen in patients with sarcoidosis involves mainly the middle and upper lung zones, with relative sparing of the lung bases. However, in an occasional case, findings can mimic IPF.
蜂窝肺或肺囊泡可见于结节病患者，但不像其它致肺纤维化性疾病那么常见。（结节病的）蜂窝肺常局限于严重的肺纤维灶及支气管聚拢的部位。（结节病的）蜂窝肺主要分布于中、上肺野而下肺野较少。然而（结节病的）表现有时候可以酷似IPF。
lung cysts 直译应该是肺囊肿，但是这里应该是指肺部的囊泡样改变，不一定像蜂窝肺那样多而密集的意思。

（缩略图，点击图片链接看原图）

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case28
HRCT in a 46-year-old man history of shortness of breath and hemoptysis (Figure 1, Figure 2, Figure 3, Figure 4, Figure 5, Figure 6).
男性，46岁，气促、咯血

This patient shows a number of findings indicative of pulmonary fibrosis.
Typical subpleural honeycombing or reticulation, with a basal, subpleural, and posterior predominance is absent. Findings of fibrosis in this patient include:
traction bronchiectasis in association with central, peribronchovascular masses of fibrous tissue shown on lung windows and soft tissue windows;
irregular interlobular septal thickening;
distortion of fissures;
lung cysts or bullae sometimes termed "paracicatricial emphysema;" and
an upper lobe predominance, with sparing of the lung bases (Figure 5).
These findings are typical of end-stage sarcoidosis.
本例可见大量的肺纤维化表现。
（文中这里有一个提问“本例是否可以诊断IPF”，答案是“否”。实际上这套东西里有很多这类提问，作出选择后会有答案及分析，我一般删调问答，只保留分析。当然所有答案的分析都是一样的）
典型的胸膜下蜂窝肺或网格状影，不以肺底部、胸膜下及背侧为主，本例的肺纤维化表现包括：
肺窗及软组织窗显示牵拉性支气管扩张并中心性分布的支气管血管周围纤维组织团块；不规则小叶间隔增厚；肺裂变形；肺大泡（瘢痕旁型肺气肿）；上述改变以上肺为主。
这是典型的终末期结节病表现。

An important additional finding is present. This is typical of an aspergilloma arising in a preexisting cyst or cavity.
本例还有一个并发的改变，一个典型的囊泡内曲菌球。

Diagnosis: End-stage sarcoidosis, with traction bronchiectasis and cysts, complicated by an aspergilloma.
DISCUSSION
In 20-25% of patients with sarcoidosis, fibrosis results from healing of granulomas. As fibrosis develops, irregular reticular opacities, including irregular septal thickening, often become a prominent feature.
诊断：终末期结节病，牵拉性支气管扩张及肺大泡，并发曲菌球。

Progressive fibrosis leads to abnormal central conglomeration of parahilar bronchi and vessels, associated with masses of fibrous tissue, typically most marked in the upper lobes. This finding is frequently associated with bronchial dilation (i.e. traction bronchiectasis); the only other diseases that commonly result in this appearance are silicosis, tuberculosis, and talcosis. Posterior displacement of the main and upper lobe bronchi indicating volume loss in the posterior segments of the upper lobes is commonly present. Findings of fibrosis in patients with end-stage sarcoidosis lack the typical subpleural, posterior, lower lobe predominance seen in patients with idiopathic pulmonary fibrosis. A central and upper lobe predominance of fibrosis suggests sarcoidosis.
进行性纤维化可导致肺门旁支气管血管聚拢，并周围纤维组织团块。这种表现通常合并支气管扩张（即牵拉性支气管扩张）。其它会有这种表现的疾病有硅肺、结核及滑石病。上叶支气管后移提示上叶后段含气减少，很常见。终末期结节病的改变与IPF不同，不以胸膜下、背侧及肺底部为主。（病变）以上肺及肺内带为主常提示结节病可能。

Even though true cavitary sarcoidosis is rare, pseudocavities representing bullae or bronchiectasis are common in patients with extensive fibrosis. Superimposed bacterial infection and saprophytic fungal infection with mycetoma formation can be readily detected with CT. Hemoptysis, present in this patient, is a common manifestation of mycetoma.
虽然结节病很少见真性空洞，但是可有肺大泡的假空洞及广泛纤维化形成的支气管扩张。并发的细菌和霉菌感染易于为CT显示。本例的咯血为足分支菌感染的表现。
mycetoma是“足菌病、足分支菌病”，似乎是一种确定的菌种，但我没听说过。上文的aspergilloma却是曲霉肿（应该就是我们说的曲菌球吧）。查词典曲霉菌应该是Aspergillus，真菌是eumycete;mycetes;true fungus，真菌的字根虽然和mycetoma相同，后缀却不同，是mycosis;nosomycosis。是否这个足分支菌是曲菌的分支，或者“曲霉肿”也可是别的霉菌感染的表现。

（缩略图，点击图片链接看原图）

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case29
HRCT in a 74-year old-man with progressive shortness of breath for one year. (Figure 1, Figure 2, Figure 3, Figure 4).
男性，74岁，进行性气促一年。

Findings of fibrosis in this patient include:
intralobular interstitial thickening resulting in irregular reticular opacities;
traction bronchiectasis resulting in irregular reticular opacities; and
interlobular septal thickening.
本例的肺纤维化表现有：小叶间质增厚的不规则网格状阴影；牵拉性支气管扩张的不规则网格状影；小叶间隔增厚。

Typical subpleural honeycombing or reticulation, with a basal, subpleural, and posterior predominance is absent. An upper lobe predominance (Figure 1) is present, with relative sparing of the lung bases (Figure 4). This distribution suggests a diagnosis other than IPF. Also, a supleural predominance, typical of IPF, is also lacking in this patient (Figure 1). Sarcoidosis would be a possibility. Additional history revealed a long exposure to pet birds.
本例未见典型的胸膜下、肺底部、背侧为主的蜂窝肺或网格状影。（病灶）以上肺为主而下肺较少，这提示别的诊断而不是IPF，并且也没有IPF典型的胸膜下分布。（本例）有可能是结节病。该患者长期饲养宠物鸟。

Diagnosis: End-stage hypersensitivity pneumonitis with fibrosis.
DISCUSSION
In patients with chronic HP, HRCT can show irregular reticular opacities representing fibrosis, traction bronchiectasis, or frank honeycombing. The fibrosis appears patchy in distribution in some cases, and predominantly subpleural or peribronchovascular in others.
诊断：终末期过敏性肺炎并纤维化。
讨论：慢性HP的HRCT的不规则网状影提示肺纤维化，牵拉性支气管扩张或蜂窝肺。肺纤维化有时呈斑片状分布，以胸膜下为主或支气管血管周围为主。

When findings of fibrosis are patchy and involve parahilar rather than subpleural lung, it can sometimes be distinguished from IPF. Findings of fibrosis in patients with chronic HP most often show a mid-lung zone predominance or are evenly distributed throughout the upper, mid, and lower lung zones. Relative sparing of the lung bases is seen in a majority of cases of chronic HP.
当纤维化的片状分布以肺门旁区为主而不是胸膜下时，可和IPF鉴别。慢性HP常为中肺野为主或均匀分布于上、中、下肺野，一般少见肺底部病灶。

（缩略图，点击图片链接看原图）

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Prone HRCT in a 59-year-old man with marked dyspnea (Figure 1).
男性，59岁，显著的呼吸困难。俯卧位HRCT扫描。

The most likely diagnosis in this patient is idiopathic pulmonary fibrosis. Idiopathic pulmonary fibrosis is most likely because of typical posterior, lower lobe, and subpleural honeycombing.
最可能的诊断是IPF。IPF病灶呈典型的背侧、下肺叶及胸膜下为主。

This patient also shows two potential complications of IPF. An air-filled lung cyst is visible posteriorly. This may result from enlargement of a honeycomb cyst. A posterior lung nodule is also visible and represents lung cancer. There is a significant increased incidence of lung cancer in patients with pulmonary fibrosis.
此例可见IPF的两个并发症：一个是背侧的充气肺大泡，可由蜂窝肺扩大形成。另一个是背侧的肺内结节，提示肺癌。肺纤维化患者并发肺癌的风险十分高。

Diagnosis: Idiopathic pulmonary fibrosis with honeycombing, complicated by lung cancer.
诊断：IPF并蜂窝肺，肺癌。
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