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支气管肺炎病情比较轻,但仍有灰黄*色的实变区域。右下有肺动脉和支气管的部位是肺门。许多支气管肺炎发生于病毒性肺炎患者,尤其冬季流行性感冒较多时,老年人最容易发病。

This bronchopneumonia is more subtle, but there are areas of lighter tan consolidation. The hilum is seen at the lower right with radiating pulmonary arteries and bronchi.Many bronchopneumonias follow an earlier viral pneumonia, particularly in older persons in the winter months when influenza is more common.

左上叶全部实变的大叶性肺炎。这种类型的肺炎比支气管肺炎少多了。部分原因是,绝大多数大叶性肺炎由链球菌(肺炎球菌)引起,并且数十年来,青霉素治疗对其比较有效,因此复杂、严重的病例不常见。然而,象大多数其它细菌一样,肺炎球菌逐渐对抗菌素产生耐药。严重肺炎球菌性肺炎仍然发生,甚至在青年到中年人中(并非小儿和老年人)发生,死亡率为20%。

This is a lobar pneumonia in which consolidation of the entire left upper lobe has occurred. This pattern is much less common than the bronchopneumonia pattern. In part, this is due to the fact that most lobar pneumonias are due to Streptococcus pneumoniae (pneumococcus) and for decades, these have responded well to penicillin therapy so that advanced, severe cases are not seen as frequently. However, pneumoccoci, like most other bacteria, are developing more resistance to antibiotics. Severe pneumococcal pneumonia still occurs, even in young to middle aged persons (not just the very young and the very old) and has a mortality rate of 20%!

大叶性肺炎近距离观显示了肺上叶和发生实变的肺下叶之间的差别。放射照片上实变区域类似浸润。

A closer view of the lobar pneumonia demonstrates the distinct difference between the upper lobe and the consolidated lower lobe. Radiographically, areas of consolidation appear as infiltrates.

左下胸膜表面可看见黄褐色脓性渗出物。肺炎也可能并发胸膜炎。最初,可能有胸膜腔渗出,也可能出现纤维素性胸膜炎。然而,细菌感染传播到胸膜,并形成脓性胸膜炎,胸膜腔内脓液聚集形成脓胸。

The pleural surface at the lower left demonstrates areas of yellow-tan purulent exudate. Pneumonia may be complicated by a pleuritis. Initially, there may just be an effusion into the pleural space. There may also be a fibrinous pleuritis. However, bacterial infections of lung can spread to the pleura to produce a purulent pleuritis. A collection of pus in the pleural space is known as empyema.

两个肺脓肿,一个在左肺上叶,一个左肺下叶。脓肿是比较严重的肺炎并发症,引起该病最典型的病原微生物是例如S.金葡菌。脓肿是吸入性肺炎的并发症,常见于右肺背侧。

Seen here are two lung abscesses, one in the upper lobe and one in the lower lobe of this left lung. An abscess is a complication of severe pneumonia, most typically from virulent organisms such as S. aureus. Abscesses are complications of aspiration, where they appear more frequently in the right posterior lung.

肺脓肿,脓性渗出物排出显示空洞。脓肿是引起败血症的原因之一,很难治疗。

Seen here are lung abscesses grossly in which the purulent exudate has drained following sectioning to reveal the abscess cavities. Abscesses can be a source for septicemia and are difficult to treat.

脓性支气管肺炎,在灰黄*色实变区内几个脓肿,脓肿壁形状不规则,表面不平。如果肺脓肿足够大,将包含液化坏死物质和脓性渗出物,因此胸片上显示脓肿的气-液平面。

This is an abscessing bronchopneumonia in which several abscesses with irregular, rough-surfaced walls are seen within areas of tan consolidation. Lung abscesses, if large enough, will contain liquefied necrotic material and purulent exudate that often results in an air-fluid level by chest radiograph in the abscess.

左边肺泡内充满嗜中性粒细胞,与支气管肺炎病变区相一致。右边是充满气体的肺组织。

At the left the alveoli are filled with a neutrophilic exudate that corresponds to the areas of consolidation seen grossly with the bronchopneumonia. This contrasts with the aerated lung on the right of this photomicrograph.

可见一不规则病灶区,充满炎细胞。肺泡结构仍然保存,这就是为什么肺炎对肺结构破坏最小的原因。

At higher magnification can be seen a patchy area of alveoli that are filled with inflammatory cells. The alveolar structure is still maintained, which is why a pneumonia often resolves with minimal residual destruction or damage to the lung.

高倍镜下,可见以嗜中性粒细胞渗出为主的肺泡。周围肺泡壁毛细血管扩张充血,血管内充满红细胞。这种渗出是细菌性感染的典型表现。渗出引起咳脓性黄痰,如细菌性肺炎。

At high magnification, the alveolar exudate of mainly neutrophils is seen. The surrounding alveolar walls have capillaries that are dilated and filled with RBC's. Such an exudative process is typical for bacterial infection. This exudate gives rise to the productive cough of purulent yellow sputum seen with bacterial pneumonias.


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