翻譯七年制呼吸影像縱隔腫瘤

呼吸系統(tǒng)影像診斷學(xué)

Imagingdiagnosticsoftherespiratorysystem

1編輯ppt呼吸系統(tǒng)疾病DiseaseoftheRespiratorysystem2編輯ppt五.縱隔原發(fā)腫瘤〔mediastinaltumor〕指原發(fā)于縱隔的腫瘤primarymediastinaltumor原發(fā)性縱隔腫瘤繁多Thetumorprimaryinmediastinum,whicharevarious3編輯ppt常見的縱隔腫瘤：

Commonprimarymediastinumtumor

神經(jīng)源性腫瘤Neurogenictumor淋巴瘤Lymphoma畸胎瘤Teratoma胸腺瘤Thymoma胸內(nèi)甲狀腺等intrathoracicthyroid

4編輯ppt臨床病癥：clinlcalsymptom胸骨后不適及隱痛retrosternalmalaiseandvaguepain與腫瘤的大小、部位、良惡性有關(guān)relatedtothesize,positionandnature(benignormalignant)

5編輯ppt縱隔腫瘤所引起的病癥以壓迫病癥為主該類病癥的出現(xiàn)，對腫瘤的定位及定性亦有幫助cardinalsymptom:pressuresymptomisthecardinalsymptomofmediastinaltumorWhichhashelpstolocalizationandqualitativeanalysisofthetumor6編輯ppt壓迫鄰近組織器官：pressadjacenttissueandorgana上腔靜脈綜合征superiorvenacavasyndrome;SVCS聲嘶〔喉反神經(jīng)〕trachyphoniaHorner綜合征〔交感神經(jīng)〕Horner'ssyndrome(sympatheticnerve)心率慢〔迷走神經(jīng)〕slowheartrate(vagusnerve)吞咽困難〔食道〕hardtoswallow(esophagus)心臟受壓oppressionofheart食管受壓oppressionofesophagus氣管受壓等oppressionoftracheal7編輯ppt8編輯ppt〔一〕胸腺瘤〔Thymoma〕：較常見usual約30%患者有重癥肌無力myastheniagravis良性：benign有完整包膜integratedintegument，可有囊變cysticchange侵襲性〔惡性〕：invasion(malignancy)向鄰近組織局部侵犯localinvasionofadjacenttissue常發(fā)生胸膜種植轉(zhuǎn)移membranapleuralisimplantationmetastasisisusual很少有血行或淋巴轉(zhuǎn)移hematogenousmetastasisorlymphaticmetastasisissingularly9編輯ppt影像表現(xiàn)：imaging1.多位于前中縱隔偏上antemedialmediastina，多向一側(cè)突出extrudetooneside2.腫瘤為圓、橢圓或梭形致密影round,oval

orfusiformhighdensitylesion，偶呈片狀lamellarlesion邊界清楚theborderisclear(well-defined)3.惡性者呈分葉狀theriomaissublobe，局部邊界毛糙partborderOfthemiscoarse，鄰近胸膜受侵theadjacentpleurawasinvaded4.瘤內(nèi)可有斑片狀鈣化patchycalcificationinthetumor5.囊變者可有蛋殼狀鈣化eggshellcalcificationwithcysticchange10編輯ppt〔二〕畸胎類腫瘤〔Teratoma〕系原始胚胎組織殘留物形成的先天性腫瘤congenitaltumorwhichgrowupbyresidualprimordialgermtissue分為囊性cystic〔皮樣囊腫dermoidcyst〕和實(shí)性畸胎瘤Solidteratoma皮樣囊腫：dermoidcyst為良性benign，含外胚層animal-germlayer和少量中胚層衍生物mesodermramification〔毛發(fā)hair、皮脂sebum等〕實(shí)性畸胎瘤：Solidteratoma

含三個(gè)胚層衍生物includethreegermlayerramifacation〔毛發(fā)hair、牙teeth、骨bone、腺體gland、呼吸respiratory和胃腸道組織gastrointestinaltissue等〕可為良或惡性benignormalignant

11編輯ppt影像學(xué)表現(xiàn)：imaging1.多位于心大血管交界區(qū)的前中縱隔antemedialmediastina，向一側(cè)突出extrudetooneside2.腫瘤呈圓或橢圓形密度不均勻腫塊inhomogeneousdensitytumor〔可含透明間隙、牙teeth、骨bone等〕皮樣囊腫可見囊壁發(fā)生蛋殼狀鈣化eggshellcalcificationindermoidcyst3.良性者邊清楚theborderofthebenigntumorisclear4.惡性者分葉、邊界不規(guī)那么，發(fā)生粘連theriomaissublobe,irregularityboundaryandadhesion12編輯ppt〔三〕胸內(nèi)甲狀腺腫〔Intrathoracicgoitre〕包括先天性異位甲狀腺及胸骨后甲狀腺腫性質(zhì)為甲狀腺腫、囊腫或癌congenitalaberrantthyroidandretrosternalstruma甲狀腺腫struma、囊腫cyst或癌cancer13編輯ppt影像學(xué)表現(xiàn)：1.多位于前上縱隔antero-superior

mediastina，與頸部甲狀腺相連connectwiththyroid2.腫塊呈卵圓或梭形orbicular-ovateor

fusiform，邊界清楚well-defined3.隨吞咽移動movewithswallow4.腫塊內(nèi)可發(fā)生斑片狀鈣化patchycalcificationoccurredinthetumor5.壓迫氣管，甚至食管移位thetrachealispressedandtheesophagusshiftindeed14編輯ppt胸腺瘤

thymoma

15編輯pptthymomaAhighdensitylesionintheantero-superiormediastinaItiswell-definedandslightlyenhanced.16編輯ppt胸腺瘤CT表現(xiàn)

theCTfilmofthymoma17編輯ppt

畸胎瘤

Teratoma

18編輯ppt畸胎瘤CT表現(xiàn)19編輯ppt胸內(nèi)甲狀腺腫

Intrathoracicgoitre20編輯ppt〔四〕淋巴瘤〔Malignantlymphoma〕系發(fā)生于淋巴結(jié)的全身性腫瘤lymphnodesderivedgeneraltumor病理及臨床：pathologyandclinic分為霍奇金病Hodgkindisease及非霍奇金淋巴瘤non-Hodgkinlymphoma好發(fā)于青少年thecallan及老年人theelderly病程短，進(jìn)展快thecourseisshortandtheprogressisfast常有發(fā)熱fever、淺表淋巴結(jié)腫大enlargementofsuperficiallymphnodes淋巴瘤對放射線敏感sensitivitytoradiotherapy，小劑量照〔20~30Gy〕即可明顯縮小，但不能完全治愈Itmaybeshrinkobviouslyaftersmalldose(20-30Gy)irradiatebutcouldnotcure.21編輯ppt影像表現(xiàn)：1.常見兩側(cè)上、中縱隔淋巴結(jié)腫大lymphadenectasisofbilateralsuperiorandmiddlemediastinum，呈分葉狀向兩側(cè)肺野突出extrudetobothlungfieldlobatusly側(cè)位見縱隔、肺門淋巴結(jié)腫大enlargementofhilarormediastinallymphnodesatlateralposition，生長較大時(shí)可侵犯前縱隔invasionanteriormediastinalwhengrowlarge.2.氣管常受壓變窄thetrachealisoppressedandnarrowing3.有時(shí)向肺內(nèi)逆行浸潤和侵犯胸膜和心包Retrogradelyinfiltrateinthelungandinvadingpleuraandpericardiumsometimes.22編輯ppt淋巴瘤lymphoma23編輯ppt〔五〕囊腫cyst支氣管囊腫Bronchogeniccyst食管囊腫esophagalcyst心包囊腫pericardialcyst24編輯ppt1.支氣管囊腫〔Bronchogeniccyst〕系胚胎原始前腸的氣管芽突脫落的胚胎組織演變而成Growupbyfallofftissueoftrachealgemmuleofprimingforegut.屬良性病變，位于氣管旁paratracheal和氣管分叉bifurcatiotracheae附近病理：為薄壁含液囊狀物與支氣管不通itisbladdercontainsliquidwiththinwallandblindtothebronchi25編輯ppt影像學(xué)表現(xiàn)：1.囊腫位于上、中縱隔氣管和其分叉附近thecystisneartothebifurcatiotracheaeandsuperiorandmiddlemediastinumtracheae2.囊腫呈邊緣光滑銳利的橢圓形均勻密度增高影symmetricalellipsishighdensitylesionwithsmoothandsharpnessboarder一般無分葉、無鈣化withoutsublobeandcalcification3.囊腫隨呼吸活動及變形moveandtransmutatewithbreath26編輯ppt支氣管囊腫bronchocele27編輯ppt支氣管囊腫CT表現(xiàn)28編輯ppt2.食管囊腫〔esophagalcyst〕：食管囊腫的發(fā)病機(jī)制與支氣管囊腫類似thepathogenesisissimilartobronchogeniccyst常發(fā)生于縱隔內(nèi)食管中1／3處之左、右側(cè)lieinleftorrightsideof1/3epimerepartofesophagusinmediastinum29編輯ppt較多見于小兒child囊腫具有腺體功能，故逐漸增大，較早出現(xiàn)近結(jié)構(gòu)的壓迫病癥可出現(xiàn)氣急breathlessness、發(fā)紺cyanosis、吞咽困難hardtoswallow等亦可繼發(fā)肺炎pneumonia及胸膜炎pleurisy30編輯ppt食管囊腫位于食管旁paraesophageal密度均勻densityissymmetrical，CT值多在10-15HU邊緣光滑boarderissmooth，變換體位可見輕度變形slightlytransmutatewhenposturealternated增強(qiáng)檢查僅見囊壁輕度強(qiáng)化Intensiveexaminationonlyshowslightintensificationofthecystwall31編輯ppt食管囊腫esophagalcyst

32編輯ppt

3.心包囊腫

pericardialcyst33編輯ppt

影像學(xué)表現(xiàn)：病變多呈圓形或橢圓形shapeofthecystismostlyrotundityorellipse輪廓光整、清楚thecontourissmoothandclear多位于右側(cè)心膈角處mostlylieinrightcardiodiaphragmaticangle，心包pericardial其它部位亦可發(fā)生側(cè)位胸片lateralchestfilm呈滴水狀dripshape，上尖下圓theupissharpandtheunderisrotundity，變換體位后囊腫形態(tài)亦會發(fā)生變化34編輯pptCT：平掃：pre-contrastimages病變與心包不能分割thecystcouldnotseparatefrompericardial壁光整，多無鈣化thewallissmothand

integratedandwithoutcalcification腔內(nèi)為液體密度intracavityisliquiddensity增強(qiáng)：囊內(nèi)無強(qiáng)化，囊壁強(qiáng)化亦不明顯withoutintensificationinthecystandintensificationofthewallisnotobvious35編輯pptMRI：

T1WI低信號lowsignalintensityonT1weghtedimaging，但略高于游離水slightlyhigherthanfreewater，囊壁呈線狀略高信號影thewallisslightlylinearhighsignalintensitylesion粘液性囊腫myxoidcystT1WI呈均勻的高信號，說明囊液中蛋白含量較高T2WI多為信號均勻的高信號symmetricalhighsignalintensity36編輯ppt心包囊腫pericardialcyst〔MRI〕37編輯ppt38編輯ppt鑒別診斷differentialdiagnosis：Differentwith主要應(yīng)與心包憩室pericardialdiverticulum鑒別:主要鑒別點(diǎn)是應(yīng)該觀察其是否與心包相通communicatewithpericardiaornotisthemaindifferentialpoint有時(shí)鑒別困難，如果改變體位病變縮小那么可以提示心包憩室之可能Alteringpositionwhenhardtodifferentiate.Itmaybepericardialdiverticulumifthepathylogicalchangeslessen39編輯ppt心包憩室pericardialdiverticula

40編輯ppt附：生殖細(xì)胞腫瘤

germinoma：良性畸胎瘤benigndermoidtumor占縱隔生殖細(xì)胞腫瘤mediastinumgerminoma的75%以上縱隔惡性生殖細(xì)胞腫瘤malignantmediastinumgerminoma較少，以精源細(xì)胞瘤seminoma最常見，其他有內(nèi)胚竇瘤endodermalsinustumor、胚胎癌embryonalcarcinoma、絨毛膜上皮癌chorionepithelioma等大多位于前縱隔majorityinanterior

mediastinum，少數(shù)在后縱隔minorityinposteriormediastinum41編輯ppt精源細(xì)胞瘤42編輯ppt〔六〕神經(jīng)原性腫瘤〔Neurogenictumors〕后縱隔最常見腫瘤包括：神經(jīng)纖維瘤neurofibroma神經(jīng)鞘瘤neurilemmoma節(jié)細(xì)胞神經(jīng)瘤ganglioneuroma神經(jīng)纖維肉瘤neurofibrosarcoma神經(jīng)母細(xì)胞瘤neuroblastoma腫塊一般位于脊柱旁溝paravertebralchimb或椎間孔anteriorforaminavertebral偶爾也位于前、中縱隔

43編輯ppt影像表現(xiàn)：1.腫塊常位于后上縱隔posteriorsuperiormediastinum，向一側(cè)突出側(cè)位lateralposition與脊柱spine重疊overlap2.腫塊一般呈圓形或橢圓形，邊界清楚的密度增高影44編輯ppt3.腫塊位于椎間孔anteriorforaminavertebra，那么呈啞鈴形dumbbell，并破壞骨質(zhì)destructionofbone而出現(xiàn)邊界光滑的壓跡4.節(jié)細(xì)胞神經(jīng)瘤常呈三角形shapeofganglioneuromaistrianglemostly神經(jīng)母細(xì)胞瘤可發(fā)生鈣化neuroblastomaiscalcificationable5.惡性腫塊呈分葉狀，破壞鄰近骨骼themalignancyissublobeanddestroythenearbone45編輯ppt神經(jīng)原性腫瘤〔節(jié)細(xì)胞神經(jīng)瘤ganglioneuroma〕46編輯ppt神經(jīng)源性腫瘤47編輯ppt神經(jīng)鞘瘤CT表現(xiàn)椎間孔擴(kuò)大、破壞enlargementanddestructionofanteriorforaminavertebra48編輯ppt〔七〕縱隔腫塊與肺內(nèi)腫塊的鑒別診斷：Differentialdiagnosisofintramediastinalmassandintrapulmonarymass1、鑒別方法：〔1〕透視轉(zhuǎn)動患者觀察rotatethepatientandobservation〔2〕體層攝影tomography〔3〕CT及MRI

49編輯ppt2.鑒別：〔1〕肺內(nèi)腫塊隨呼吸動，縱隔腫塊那么無theintrapulmonarymasswouldbemovingwithbreathbuttheintramediastinalmassnot〔2〕肺內(nèi)腫塊與縱膈之間有一密度減低帶，縱隔腫塊那么無Thereislesionoflowdensitybetweentheintrapulmonarymassandmediastinal50編輯ppt〔3〕肺內(nèi)腫塊與縱隔交界為銳角，縱隔腫塊為鈍角theincludedangleofmediastinalandintrapulmonarymassissharpbuttheintramediastinalisobtuse.〔4〕腫塊的最大縱徑在肺內(nèi)為肺內(nèi)腫塊，在縱隔內(nèi)為縱隔腫塊maximaldiameteroftheintrapulmonarymassisinpulmonaryandtheintramediastinalmassinmediastinal〔5〕肺內(nèi)腫塊使氣、食管輕度移位，縱膈塊那么顯著theintrapulmonarymasscausethetrachealandesophagusshiftslightly51編輯ppt〔八〕縱隔腫瘤與縱隔淋巴結(jié)結(jié)核的鑒別診斷Differentialdiagnosisofmediastinalmassandintramediaseinallymphnodituberculosis1.淋巴結(jié)核多見于青少年adolescent2.淋巴結(jié)核多發(fā)生在右上縱隔旁rightsuperiormediastinum，80%為單側(cè)unilateral3.淋巴結(jié)核腫塊邊界清楚well-defined，有時(shí)呈分葉狀sometimeslobulated4.結(jié)核菌素試驗(yàn)tubercalintest52編輯ppt53編輯ppt鄭州大學(xué)第一附屬醫(yī)院54編輯ppt呼吸系統(tǒng)影像診斷學(xué)

Imagingdiagnosticsoftherespiratorysystem

鄭州大學(xué)第一附屬醫(yī)院放射科

thefirstaffiliatedhospitalradiologydepartmentofZhengzhouUniversity

張焱

ZhangYan55編輯ppt(六)肺腫瘤

pulmonarytumours56編輯ppt分類：Ⅰ.原發(fā)性Primary：〔1〕良性benign〔少見singularly〕〔2〕惡性malignant①支氣管肺癌bronchiogeniccancer〔98%〕②肺肉瘤sarcomaⅡ.繼發(fā)性secondary〔肺轉(zhuǎn)移瘤metastasis〕57編輯ppt1.原發(fā)性支氣管肺癌〔Primarybronchogeniccarcinomaoflung〕:近年來肺癌的發(fā)病率與死亡率急劇上升incidenceandmortalityoflungcancersharprised吸煙smoking、大氣污染atmosphericpollution及工業(yè)致癌物質(zhì)industrialcarcinogen為主要的致病因素causativeagent58編輯ppt〔1〕病理pathology：①癌起源于支氣管上皮bronchialepithelium，腺體glandularorgan或細(xì)支氣管及肺泡上皮epitheliumofthebronchioleoralveolus59編輯ppt肺癌組織學(xué)分型histologicaltype：小細(xì)胞肺癌smallcelllungcancer;SCLC及非小細(xì)胞肺癌nonsmall-celllungcancer;NSCLC非小細(xì)胞肺癌nonsmall-celllungcancer;NSCLC分為：鱗癌squamocellularcancer腺癌adenocarcinoma腺鱗癌adenosquamouscarcinoma

大細(xì)胞癌

largecellcarcinoma60編輯ppt大體病理分型macropathology：①中央型centraltype

：②周圍型peripheral：③彌漫型diffuse：61編輯ppt按照肺癌的發(fā)生部位可以分為三型position

：①中心型centraltype

：系指發(fā)生于肺段以上支氣管的肺癌abovethesegmentalbronchi

②外圍型peripheral

：系指發(fā)生于肺段支氣管以下的肺癌belowthesegmentalbronchi③細(xì)支氣管肺泡癌bronchioalveolarcarcinoma

：

系指發(fā)生于細(xì)支氣管或肺泡上皮的肺癌epitheliumofthebronchioleoralveolus

62編輯ppt③生長方式growthpattern：管內(nèi)型intracanaliculartype〔息肉polypus、菜花狀cauliflowwer〕管壁型walltype〔管腔狹窄或閉塞straitnessorocclusion〕管外型extratubaltype〔肺內(nèi)腫塊intrapulmonarymass〕63編輯ppt64編輯ppt〔2〕臨床clinic：咳嗽cough、咳血emptysis、胸痛chestpain、氣促polypnea壓迫病癥pressuresymptom：上腔靜脈綜合征superiorvenacavasyndrome，膈神經(jīng)nerviphrenicus和喉返神經(jīng)recurrentlaryngealnerve麻痹paralysis等肺外病癥extrapulmonarysymptom：杵狀指achropachy、肺性肥大性骨關(guān)節(jié)病hypertrophicpulmonaryarthropathy等65編輯ppt不同部位的肺癌可有以下幾種生長方式growthpattern：①管內(nèi)型intracanaliculartype：癌瘤向管腔內(nèi)生長，形成息肉樣或菜把戲腫塊，逐漸引起支氣管阻塞intracanalicularpolypoidorcauliflower-likemassblockbronchus②管壁型walltype：癌瘤沿支氣管壁浸潤生長alongbronchus，可使管壁增厚thewallthickening，造成支氣管狹窄或阻塞straitnessorocclusion③管外型extratubaltype：癌瘤穿透支氣管壁向外生長，在肺內(nèi)形成腫塊penetratethewallexcentricgrowth，intrapulmonarymass①～③型多為中心型肺癌的生長方式growthpatternofthecentrallungcancer66編輯ppt④肺段以下較小支氣管的肺癌，很易侵入肺內(nèi)形成腫塊intrapulmonarymassisusualinthelungcancerbelowthesegmentalbronchi⑤細(xì)支氣管或肺泡上皮的肺癌thecancerfromepitheliumofthebronchioleoralveolus

初期可沿肺泡壁生長，形成孤立結(jié)節(jié)狀腫塊initialstage

，growalongthewallofalveolus

，formaisolatednode晚期可經(jīng)支氣管及淋巴管播散，形成彌散性斑片狀或粟粒狀癌灶

advancedstagedisseminatedalongbronchusandlymphvesselformdiffusecarcinomatosis

67編輯ppt〔3〕影像表現(xiàn)：

①中心型centraltype：68編輯pptA.支氣管改變bronchus：支氣管管壁增厚和管腔狹窄〔正常支氣管壁厚度均勻，約為1-3mm〕thewallthickeningandstraitnessB.肺門腫塊massinhiluspulmonis，常伴有g(shù)owith阻塞性肺氣腫obstructiveemphysema、阻塞性肺炎o(hù)bstructivepneumonia、阻塞性肺不張obstructiveatelectasisC.侵犯縱隔mediastinumencroachmentD.縱隔及肺門淋巴結(jié)腫大lymphadenectasisinmediastinumandhiluspulmonis69編輯ppt70編輯ppt右肺上葉不張atelectasisinsuperiorlobeofrightlung

71編輯ppt72編輯ppt中央型肺癌〔癌塊、肺不張、橫S征〕

centrallungcancer73編輯ppt

②外圍型肺癌peripheral

lungcancer

：腫瘤位于肺段以下到細(xì)支氣管之間的支氣管betweenthesegmentalbronchiandthebronchiole

74編輯ppt主要征象maincharacter：A.腫塊征

mass：早期earlystage直徑diameter<2cm，輪廓模糊weakenedcontours

，密度稍高之結(jié)節(jié)slightlyhighdensitylesion、球狀或小片狀影globosityorlamellar

密度有時(shí)不均、出現(xiàn)空泡征vacuolesign等thedensityisinhomogeneous

中晚期呈分葉狀腫塊，邊緣有短毛刺，亦可有癌洞等middlelatestagethemassislobulated,shallowneedlingandcavity癌塊倍增時(shí)間平均約3月averagedoublingtimeisabout3months75編輯pptB.轉(zhuǎn)移征同中央型metastaticisthesameascentrallungcancerC.阻塞征在病灶周圍，較中央型范圍小obstructionisless-thancentrallungcancerD.胸膜受侵征〔局限性增厚localizedthickening，胸膜凹陷征pleuralindentationsign等〕pleuraisencroached76編輯ppt發(fā)生于肺尖部的癌稱肺上溝癌〔pancoasttumor〕apical可侵蝕鄰近肋骨及椎體并可壓迫臂叢引起臂痛encroachribandvertebrae,pressbrachialplexus也可壓迫頸部交感神經(jīng)而引起Horner綜合征presscervicalsympatheticnerve表現(xiàn)為同側(cè)眼瞼下垂、瞳孔縮小homolateralptosisandmyosis77編輯ppt③細(xì)支氣管肺泡癌bronchioalveolarcarcinoma：腫瘤位于細(xì)支氣管或肺泡上皮epitheliumofthebronchioleoralveolusA.早期earlystage：為孤立的結(jié)節(jié)狀或肺炎樣浸潤影isolatedinvasionlesion，內(nèi)有含氣的小透明區(qū)aeratedtransparentzone〔空泡征vacuolesign〕B.晚期laterperiod：

一側(cè)肺或兩肺出現(xiàn)多數(shù)大小不等unilateralorbilateralmultiplyinequalityofsize、境界不清ill-defined的結(jié)節(jié)或斑片狀影nodularorpatchylesion，開展那么融合成大片絮狀