翻译七年制呼吸影像纵隔肿瘤

呼吸系统影像诊断学

Imagingdiagnosticsoftherespiratorysystem

1编辑ppt呼吸系统疾病DiseaseoftheRespiratorysystem2编辑ppt五.纵隔原发肿瘤〔mediastinaltumor〕指原发于纵隔的肿瘤primarymediastinaltumor原发性纵隔肿瘤繁多Thetumorprimaryinmediastinum,whicharevarious3编辑ppt常见的纵隔肿瘤：

Commonprimarymediastinumtumor

神经源性肿瘤Neurogenictumor淋巴瘤Lymphoma畸胎瘤Teratoma胸腺瘤Thymoma胸内甲状腺等intrathoracicthyroid

4编辑ppt临床病症：clinlcalsymptom胸骨后不适及隐痛retrosternalmalaiseandvaguepain与肿瘤的大小、部位、良恶性有关relatedtothesize,positionandnature(benignormalignant)

5编辑ppt纵隔肿瘤所引起的病症以压迫病症为主该类病症的出现，对肿瘤的定位及定性亦有帮助cardinalsymptom:pressuresymptomisthecardinalsymptomofmediastinaltumorWhichhashelpstolocalizationandqualitativeanalysisofthetumor6编辑ppt压迫邻近组织器官：pressadjacenttissueandorgana上腔静脉综合征superiorvenacavasyndrome;SVCS声嘶〔喉反神经〕trachyphoniaHorner综合征〔交感神经〕Horner'ssyndrome(sympatheticnerve)心率慢〔迷走神经〕slowheartrate(vagusnerve)吞咽困难〔食道〕hardtoswallow(esophagus)心脏受压oppressionofheart食管受压oppressionofesophagus气管受压等oppressionoftracheal7编辑ppt8编辑ppt〔一〕胸腺瘤〔Thymoma〕：较常见usual约30%患者有重症肌无力myastheniagravis良性：benign有完整包膜integratedintegument，可有囊变cysticchange侵袭性〔恶性〕：invasion(malignancy)向邻近组织局部侵犯localinvasionofadjacenttissue常发生胸膜种植转移membranapleuralisimplantationmetastasisisusual很少有血行或淋巴转移hematogenousmetastasisorlymphaticmetastasisissingularly9编辑ppt影像表现：imaging1.多位于前中纵隔偏上antemedialmediastina，多向一侧突出extrudetooneside2.肿瘤为圆、椭圆或梭形致密影round,oval

orfusiformhighdensitylesion，偶呈片状lamellarlesion边界清楚theborderisclear(well-defined)3.恶性者呈分叶状theriomaissublobe，局部边界毛糙partborderOfthemiscoarse，邻近胸膜受侵theadjacentpleurawasinvaded4.瘤内可有斑片状钙化patchycalcificationinthetumor5.囊变者可有蛋壳状钙化eggshellcalcificationwithcysticchange10编辑ppt〔二〕畸胎类肿瘤〔Teratoma〕系原始胚胎组织残留物形成的先天性肿瘤congenitaltumorwhichgrowupbyresidualprimordialgermtissue分为囊性cystic〔皮样囊肿dermoidcyst〕和实性畸胎瘤Solidteratoma皮样囊肿：dermoidcyst为良性benign，含外胚层animal-germlayer和少量中胚层衍生物mesodermramification〔毛发hair、皮脂sebum等〕实性畸胎瘤：Solidteratoma

含三个胚层衍生物includethreegermlayerramifacation〔毛发hair、牙teeth、骨bone、腺体gland、呼吸respiratory和胃肠道组织gastrointestinaltissue等〕可为良或恶性benignormalignant

11编辑ppt影像学表现：imaging1.多位于心大血管交界区的前中纵隔antemedialmediastina，向一侧突出extrudetooneside2.肿瘤呈圆或椭圆形密度不均匀肿块inhomogeneousdensitytumor〔可含透明间隙、牙teeth、骨bone等〕皮样囊肿可见囊壁发生蛋壳状钙化eggshellcalcificationindermoidcyst3.良性者边清楚theborderofthebenigntumorisclear4.恶性者分叶、边界不规那么，发生粘连theriomaissublobe,irregularityboundaryandadhesion12编辑ppt〔三〕胸内甲状腺肿〔Intrathoracicgoitre〕包括先天性异位甲状腺及胸骨后甲状腺肿性质为甲状腺肿、囊肿或癌congenitalaberrantthyroidandretrosternalstruma甲状腺肿struma、囊肿cyst或癌cancer13编辑ppt影像学表现：1.多位于前上纵隔antero-superior

mediastina，与颈部甲状腺相连connectwiththyroid2.肿块呈卵圆或梭形orbicular-ovateor

fusiform，边界清楚well-defined3.随吞咽移动movewithswallow4.肿块内可发生斑片状钙化patchycalcificationoccurredinthetumor5.压迫气管，甚至食管移位thetrachealispressedandtheesophagusshiftindeed14编辑ppt胸腺瘤

thymoma

15编辑pptthymomaAhighdensitylesionintheantero-superiormediastinaItiswell-definedandslightlyenhanced.16编辑ppt胸腺瘤CT表现

theCTfilmofthymoma17编辑ppt

畸胎瘤

Teratoma

18编辑ppt畸胎瘤CT表现19编辑ppt胸内甲状腺肿

Intrathoracicgoitre20编辑ppt〔四〕淋巴瘤〔Malignantlymphoma〕系发生于淋巴结的全身性肿瘤lymphnodesderivedgeneraltumor病理及临床：pathologyandclinic分为霍奇金病Hodgkindisease及非霍奇金淋巴瘤non-Hodgkinlymphoma好发于青少年thecallan及老年人theelderly病程短，进展快thecourseisshortandtheprogressisfast常有发热fever、浅表淋巴结肿大enlargementofsuperficiallymphnodes淋巴瘤对放射线敏感sensitivitytoradiotherapy，小剂量照〔20~30Gy〕即可明显缩小，但不能完全治愈Itmaybeshrinkobviouslyaftersmalldose(20-30Gy)irradiatebutcouldnotcure.21编辑ppt影像表现：1.常见两侧上、中纵隔淋巴结肿大lymphadenectasisofbilateralsuperiorandmiddlemediastinum，呈分叶状向两侧肺野突出extrudetobothlungfieldlobatusly侧位见纵隔、肺门淋巴结肿大enlargementofhilarormediastinallymphnodesatlateralposition，生长较大时可侵犯前纵隔invasionanteriormediastinalwhengrowlarge.2.气管常受压变窄thetrachealisoppressedandnarrowing3.有时向肺内逆行浸润和侵犯胸膜和心包Retrogradelyinfiltrateinthelungandinvadingpleuraandpericardiumsometimes.22编辑ppt淋巴瘤lymphoma23编辑ppt〔五〕囊肿cyst支气管囊肿Bronchogeniccyst食管囊肿esophagalcyst心包囊肿pericardialcyst24编辑ppt1.支气管囊肿〔Bronchogeniccyst〕系胚胎原始前肠的气管芽突脱落的胚胎组织演变而成Growupbyfallofftissueoftrachealgemmuleofprimingforegut.属良性病变，位于气管旁paratracheal和气管分叉bifurcatiotracheae附近病理：为薄壁含液囊状物与支气管不通itisbladdercontainsliquidwiththinwallandblindtothebronchi25编辑ppt影像学表现：1.囊肿位于上、中纵隔气管和其分叉附近thecystisneartothebifurcatiotracheaeandsuperiorandmiddlemediastinumtracheae2.囊肿呈边缘光滑锐利的椭圆形均匀密度增高影symmetricalellipsishighdensitylesionwithsmoothandsharpnessboarder一般无分叶、无钙化withoutsublobeandcalcification3.囊肿随呼吸活动及变形moveandtransmutatewithbreath26编辑ppt支气管囊肿bronchocele27编辑ppt支气管囊肿CT表现28编辑ppt2.食管囊肿〔esophagalcyst〕：食管囊肿的发病机制与支气管囊肿类似thepathogenesisissimilartobronchogeniccyst常发生于纵隔内食管中1／3处之左、右侧lieinleftorrightsideof1/3epimerepartofesophagusinmediastinum29编辑ppt较多见于小儿child囊肿具有腺体功能，故逐渐增大，较早出现近结构的压迫病症可出现气急breathlessness、发绀cyanosis、吞咽困难hardtoswallow等亦可继发肺炎pneumonia及胸膜炎pleurisy30编辑ppt食管囊肿位于食管旁paraesophageal密度均匀densityissymmetrical，CT值多在10-15HU边缘光滑boarderissmooth，变换体位可见轻度变形slightlytransmutatewhenposturealternated增强检查仅见囊壁轻度强化Intensiveexaminationonlyshowslightintensificationofthecystwall31编辑ppt食管囊肿esophagalcyst

32编辑ppt

3.心包囊肿

pericardialcyst33编辑ppt

影像学表现：病变多呈圆形或椭圆形shapeofthecystismostlyrotundityorellipse轮廓光整、清楚thecontourissmoothandclear多位于右侧心膈角处mostlylieinrightcardiodiaphragmaticangle，心包pericardial其它部位亦可发生侧位胸片lateralchestfilm呈滴水状dripshape，上尖下圆theupissharpandtheunderisrotundity，变换体位后囊肿形态亦会发生变化34编辑pptCT：平扫：pre-contrastimages病变与心包不能分割thecystcouldnotseparatefrompericardial壁光整，多无钙化thewallissmothand

integratedandwithoutcalcification腔内为液体密度intracavityisliquiddensity增强：囊内无强化，囊壁强化亦不明显withoutintensificationinthecystandintensificationofthewallisnotobvious35编辑pptMRI：

T1WI低信号lowsignalintensityonT1weghtedimaging，但略高于游离水slightlyhigherthanfreewater，囊壁呈线状略高信号影thewallisslightlylinearhighsignalintensitylesion粘液性囊肿myxoidcystT1WI呈均匀的高信号，说明囊液中蛋白含量较高T2WI多为信号均匀的高信号symmetricalhighsignalintensity36编辑ppt心包囊肿pericardialcyst〔MRI〕37编辑ppt38编辑ppt鉴别诊断differentialdiagnosis：Differentwith主要应与心包憩室pericardialdiverticulum鉴别:主要鉴别点是应该观察其是否与心包相通communicatewithpericardiaornotisthemaindifferentialpoint有时鉴别困难，如果改变体位病变缩小那么可以提示心包憩室之可能Alteringpositionwhenhardtodifferentiate.Itmaybepericardialdiverticulumifthepathylogicalchangeslessen39编辑ppt心包憩室pericardialdiverticula

40编辑ppt附：生殖细胞肿瘤

germinoma：良性畸胎瘤benigndermoidtumor占纵隔生殖细胞肿瘤mediastinumgerminoma的75%以上纵隔恶性生殖细胞肿瘤malignantmediastinumgerminoma较少，以精源细胞瘤seminoma最常见，其他有内胚窦瘤endodermalsinustumor、胚胎癌embryonalcarcinoma、绒毛膜上皮癌chorionepithelioma等大多位于前纵隔majorityinanterior

mediastinum，少数在后纵隔minorityinposteriormediastinum41编辑ppt精源细胞瘤42编辑ppt〔六〕神经原性肿瘤〔Neurogenictumors〕后纵隔最常见肿瘤包括：神经纤维瘤neurofibroma神经鞘瘤neurilemmoma节细胞神经瘤ganglioneuroma神经纤维肉瘤neurofibrosarcoma神经母细胞瘤neuroblastoma肿块一般位于脊柱旁沟paravertebralchimb或椎间孔anteriorforaminavertebral偶尔也位于前、中纵隔

43编辑ppt影像表现：1.肿块常位于后上纵隔posteriorsuperiormediastinum，向一侧突出侧位lateralposition与脊柱spine重叠overlap2.肿块一般呈圆形或椭圆形，边界清楚的密度增高影44编辑ppt3.肿块位于椎间孔anteriorforaminavertebra，那么呈哑铃形dumbbell，并破坏骨质destructionofbone而出现边界光滑的压迹4.节细胞神经瘤常呈三角形shapeofganglioneuromaistrianglemostly神经母细胞瘤可发生钙化neuroblastomaiscalcificationable5.恶性肿块呈分叶状，破坏邻近骨骼themalignancyissublobeanddestroythenearbone45编辑ppt神经原性肿瘤〔节细胞神经瘤ganglioneuroma〕46编辑ppt神经源性肿瘤47编辑ppt神经鞘瘤CT表现椎间孔扩大、破坏enlargementanddestructionofanteriorforaminavertebra48编辑ppt〔七〕纵隔肿块与肺内肿块的鉴别诊断：Differentialdiagnosisofintramediastinalmassandintrapulmonarymass1、鉴别方法：〔1〕透视转动患者观察rotatethepatientandobservation〔2〕体层摄影tomography〔3〕CT及MRI

49编辑ppt2.鉴别：〔1〕肺内肿块随呼吸动，纵隔肿块那么无theintrapulmonarymasswouldbemovingwithbreathbuttheintramediastinalmassnot〔2〕肺内肿块与纵膈之间有一密度减低带，纵隔肿块那么无Thereislesionoflowdensitybetweentheintrapulmonarymassandmediastinal50编辑ppt〔3〕肺内肿块与纵隔交界为锐角，纵隔肿块为钝角theincludedangleofmediastinalandintrapulmonarymassissharpbuttheintramediastinalisobtuse.〔4〕肿块的最大纵径在肺内为肺内肿块，在纵隔内为纵隔肿块maximaldiameteroftheintrapulmonarymassisinpulmonaryandtheintramediastinalmassinmediastinal〔5〕肺内肿块使气、食管轻度移位，纵膈块那么显著theintrapulmonarymasscausethetrachealandesophagusshiftslightly51编辑ppt〔八〕纵隔肿瘤与纵隔淋巴结结核的鉴别诊断Differentialdiagnosisofmediastinalmassandintramediaseinallymphnodituberculosis1.淋巴结核多见于青少年adolescent2.淋巴结核多发生在右上纵隔旁rightsuperiormediastinum，80%为单侧unilateral3.淋巴结核肿块边界清楚well-defined，有时呈分叶状sometimeslobulated4.结核菌素试验tubercalintest52编辑ppt53编辑ppt郑州大学第一附属医院54编辑ppt呼吸系统影像诊断学

Imagingdiagnosticsoftherespiratorysystem

郑州大学第一附属医院放射科

thefirstaffiliatedhospitalradiologydepartmentofZhengzhouUniversity

张焱

ZhangYan55编辑ppt(六)肺肿瘤

pulmonarytumours56编辑ppt分类：Ⅰ.原发性Primary：〔1〕良性benign〔少见singularly〕〔2〕恶性malignant①支气管肺癌bronchiogeniccancer〔98%〕②肺肉瘤sarcomaⅡ.继发性secondary〔肺转移瘤metastasis〕57编辑ppt1.原发性支气管肺癌〔Primarybronchogeniccarcinomaoflung〕:近年来肺癌的发病率与死亡率急剧上升incidenceandmortalityoflungcancersharprised吸烟smoking、大气污染atmosphericpollution及工业致癌物质industrialcarcinogen为主要的致病因素causativeagent58编辑ppt〔1〕病理pathology：①癌起源于支气管上皮bronchialepithelium，腺体glandularorgan或细支气管及肺泡上皮epitheliumofthebronchioleoralveolus59编辑ppt肺癌组织学分型histologicaltype：小细胞肺癌smallcelllungcancer;SCLC及非小细胞肺癌nonsmall-celllungcancer;NSCLC非小细胞肺癌nonsmall-celllungcancer;NSCLC分为：鳞癌squamocellularcancer腺癌adenocarcinoma腺鳞癌adenosquamouscarcinoma

大细胞癌

largecellcarcinoma60编辑ppt大体病理分型macropathology：①中央型centraltype

：②周围型peripheral：③弥漫型diffuse：61编辑ppt按照肺癌的发生部位可以分为三型position

：①中心型centraltype

：系指发生于肺段以上支气管的肺癌abovethesegmentalbronchi

②外围型peripheral

：系指发生于肺段支气管以下的肺癌belowthesegmentalbronchi③细支气管肺泡癌bronchioalveolarcarcinoma

：

系指发生于细支气管或肺泡上皮的肺癌epitheliumofthebronchioleoralveolus

62编辑ppt③生长方式growthpattern：管内型intracanaliculartype〔息肉polypus、菜花状cauliflowwer〕管壁型walltype〔管腔狭窄或闭塞straitnessorocclusion〕管外型extratubaltype〔肺内肿块intrapulmonarymass〕63编辑ppt64编辑ppt〔2〕临床clinic：咳嗽cough、咳血emptysis、胸痛chestpain、气促polypnea压迫病症pressuresymptom：上腔静脉综合征superiorvenacavasyndrome，膈神经nerviphrenicus和喉返神经recurrentlaryngealnerve麻痹paralysis等肺外病症extrapulmonarysymptom：杵状指achropachy、肺性肥大性骨关节病hypertrophicpulmonaryarthropathy等65编辑ppt不同部位的肺癌可有以下几种生长方式growthpattern：①管内型intracanaliculartype：癌瘤向管腔内生长，形成息肉样或菜把戏肿块，逐渐引起支气管阻塞intracanalicularpolypoidorcauliflower-likemassblockbronchus②管壁型walltype：癌瘤沿支气管壁浸润生长alongbronchus，可使管壁增厚thewallthickening，造成支气管狭窄或阻塞straitnessorocclusion③管外型extratubaltype：癌瘤穿透支气管壁向外生长，在肺内形成肿块penetratethewallexcentricgrowth，intrapulmonarymass①～③型多为中心型肺癌的生长方式growthpatternofthecentrallungcancer66编辑ppt④肺段以下较小支气管的肺癌，很易侵入肺内形成肿块intrapulmonarymassisusualinthelungcancerbelowthesegmentalbronchi⑤细支气管或肺泡上皮的肺癌thecancerfromepitheliumofthebronchioleoralveolus

初期可沿肺泡壁生长，形成孤立结节状肿块initialstage

，growalongthewallofalveolus

，formaisolatednode晚期可经支气管及淋巴管播散，形成弥散性斑片状或粟粒状癌灶

advancedstagedisseminatedalongbronchusandlymphvesselformdiffusecarcinomatosis

67编辑ppt〔3〕影像表现：

①中心型centraltype：68编辑pptA.支气管改变bronchus：支气管管壁增厚和管腔狭窄〔正常支气管壁厚度均匀，约为1-3mm〕thewallthickeningandstraitnessB.肺门肿块massinhiluspulmonis，常伴有gowith阻塞性肺气肿obstructiveemphysema、阻塞性肺炎obstructivepneumonia、阻塞性肺不张obstructiveatelectasisC.侵犯纵隔mediastinumencroachmentD.纵隔及肺门淋巴结肿大lymphadenectasisinmediastinumandhiluspulmonis69编辑ppt70编辑ppt右肺上叶不张atelectasisinsuperiorlobeofrightlung

71编辑ppt72编辑ppt中央型肺癌〔癌块、肺不张、横S征〕

centrallungcancer73编辑ppt

②外围型肺癌peripheral

lungcancer

：肿瘤位于肺段以下到细支气管之间的支气管betweenthesegmentalbronchiandthebronchiole

74编辑ppt主要征象maincharacter：A.肿块征

mass：早期earlystage直径diameter<2cm，轮廓模糊weakenedcontours

，密度稍高之结节slightlyhighdensitylesion、球状或小片状影globosityorlamellar

密度有时不均、出现空泡征vacuolesign等thedensityisinhomogeneous

中晚期呈分叶状肿块，边缘有短毛刺，亦可有癌洞等middlelatestagethemassislobulated,shallowneedlingandcavity癌块倍增时间平均约3月averagedoublingtimeisabout3months75编辑pptB.转移征同中央型metastaticisthesameascentrallungcancerC.阻塞征在病灶周围，较中央型范围小obstructionisless-thancentrallungcancerD.胸膜受侵征〔局限性增厚localizedthickening，胸膜凹陷征pleuralindentationsign等〕pleuraisencroached76编辑ppt发生于肺尖部的癌称肺上沟癌〔pancoasttumor〕apical可侵蚀邻近肋骨及椎体并可压迫臂丛引起臂痛encroachribandvertebrae,pressbrachialplexus也可压迫颈部交感神经而引起Horner综合征presscervicalsympatheticnerve表现为同侧眼睑下垂、瞳孔缩小homolateralptosisandmyosis77编辑ppt③细支气管肺泡癌bronchioalveolarcarcinoma：肿瘤位于细支气管或肺泡上皮epitheliumofthebronchioleoralveolusA.早期earlystage：为孤立的结节状或肺炎样浸润影isolatedinvasionlesion，内有含气的小透明区aeratedtransparentzone〔空泡征vacuolesign〕B.晚期laterperiod：

一侧肺或两肺出现多数大小不等unilateralorbilateralmultiplyinequalityofsize、境界不清ill-defined的结节或斑片状影nodularorpatchylesion，开展那么融合成大片絮状