喉癌的影像学诊断

,早 会 诊 张印（10.12）,患者 男 71Y患者于1年前无明显诱因出现声音嘶哑，无咽喉部疼痛，病来无咽喉部异物感。患者于辽渔医院取病理回报（2012.9.26）：左声带高-中分化鳞状细胞癌,既往史：1.高血压病史5-6年，心率失常病史，规律用药，血压正常；2.2型糖尿病病史；3.1964年肝炎病史，分型不详，治愈,患者 男 55Y患者4个月前因声门型喉癌，于大连医科大学附属第一医院（2012.6.18）行喉裂开及气管切开术，术后因颈部切口感染，于我科门诊持续换药，20天前出现气短，复查喉镜示：右侧声带肉芽样新生物，10天前，动态喉镜下取病理回报：高分化鳞状细胞癌,喉：在颈前正中，舌骨下第3颈椎至第5颈椎平面上通喉咽下接气管（气道门户）,喉的位置,声门上区层面（舌骨层面）,正常的喉部CT解剖,声门上区层面（喉前庭层面）,声门区层面（真声带层面）,声门下区层面,患者，男性，52岁，声嘶20日左右,病例一,声门上型喉癌，鳞状细胞癌,病理诊断,患者，男性，50岁，渐进性声嘶8月,病例二,左侧声门癌，鳞状细胞癌,病理诊断,喉癌是喉部最常见的恶性肿瘤，发生率男性多于女性，男:女约8：1，认为与吸烟、饮酒及病毒感染有关。其病理类型97%为鳞状上皮细胞癌，腺瘤。,喉癌的CT诊断,指发生于声门上区的癌，主要好发生于会厌喉面、杓状软骨皱襞、梨状窝、喉室及室带。通常分化程度较低，由于血供及淋巴组织丰富，癌细胞生长迅速，肿瘤的体积常明显大于其他部位的肿瘤。,一、声门上型喉癌,该处因距离声带较远，早期常不容易发现，一旦发现大多数已是晚期，该处的癌易侵犯会厌前间隙及喉旁间隙，易发生颈淋巴转移 。CT上常表现为喉前庭肿块或结节，部分病例可侵及会厌致会厌增厚或呈结节状，杓会厌皱襞肿胀。,声门区癌最为常见，它好发于声带的前中1/3，可向各个方向发展，癌细胞分化较好，故癌灶常较小，CT 表现为声带增厚，外形不规则，可见结节状或菜花状肿块，声带固定在内收位。容易侵犯前联合，前联合受累意味着对侧声带受侵犯。,二、声门型喉癌,声门下癌未累及声带前不出现临床症状， 所以早期就诊者少，CT 的横断面连续扫描能清晰显示声门下区各壁和肿瘤的上下边界、大小范围，使得侵及声门下区的肿瘤可准确显示。CT 表现为声门下区偏心性结节或肿块,三、声门下型喉癌,喉癌在CT影像上都有一定的共性：1、喉内占位肿块；2、受累处喉襞组织增厚，两侧不对称；3、喉腔气道变形或狭窄；4、喉旁或会厌前脂肪间隙消失；,总结,5、声带固定，声门裂矢状线偏转；6、喉软骨破坏，颈部淋巴结肿大。,Most laryngeal cancers are squamous cell carcinomas, reflecting their origin from the squamous cells which form the majority of the laryngeal epithelium.,Laryngeal cancer,Smoking is the most important risk factor for laryngeal cancer. Death from laryngeal cancer is 20 times more likely for heaviest smokers than for nonsmokers.,On plain CT scan , An irregular mass was found in the laryngeal which appears as a heterogenous soft tissue density.After contrast injection ,the mass showed heterogeneous obvious enhancementThere are some enlarged lymph nodes in the neck.,CT Manifestations,physical exam includes a systematic examination of the whole patient to assess general health and to look for signs of associated conditions and metastatic disease.,Diagnosis,That is all,thank you,CT manifestation,The lesion is located in the lower lobe of the right lung without a clear margin. There are cystic low density areas in the lesion. In the peripheral part of the lesion, there are irregular low density areas, and air-fluid level in it.,Possible diagnosis:pulmonary bulla infection,Differential diagnosis,Pulmonary hypoplasia:There are some cystic like lesions at the end of the bronchi.Lung abscessThe wall of the abscess is always thick, and the inner wall is irregular.,Differential diagnosis,Pulmonary sequestration:It is commonly seen in young adults. There is no clear boundary between the normal lung tissue and sequestr