医学影像--七年制chest课件

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,Lung neoplasm,Benign:,harmatoma, adenoma, angioma, fibroma,malignancy:,carcinoma, blastoma,Lung neoplasmBenign:,1,Lung neoplasm,Neoplasms of the lung may be benign or malignant. The incidence of primary lung carcinoma is increasing in all over the world. Most lung tumors (over 90%) are carcinomas.,Lung neoplasmNeoplasms of the,2,Lung neoplasm,Pulmonary hamartomas are uncommon in patients younger than 30 years of age and have a peak incidence in the sixth decade (range, 0 to 76 years). Most patients with hamartomas are asymptomatic; symptoms typically are present with central endobronchial lesions and include hemoptyisis, recurrent pneumonia, and dyspnea.,Lung neoplasmPulmonary hamarto,3,Lung neoplasm,Hamartomas typically are round, well-marginated peripheral masses smaller than 4cm (range, 1 to 30cm). The presence of the typical pattern of popcorn calcification is almost pathognomonic of hamartoma. Calcification probably is present in less than 5% of lesions, Fat can be detected by CT (attenuation ,-40 to -120 HU) in up to 50% of cases and is a diagnostic feature.,Lung neoplasmHamartomas typica,4,医学影像-七年制chest课件,5,医学影像-七年制chest课件,6,医学影像-七年制chest课件,7,Bronchial Carcinoma,Bronchial carcinoma is the most common malignancy in our country these days. The strongest risk factor for bronchial carcinoma development is cigarette smoking. Environmental and occupational exposure have been implicated in an estimated 3% to 17% of cases of bronchial carcinoma. Interstitial pulmonary fibrosis and focal scarring have been reported to increase the risk for bronchial carcinoma.,Bronchial CarcinomaBronchial c,8,Lung carcinoma(cancer),SCLC(small cell lung cancer),NSCLC(non-small cell lung cncer),。,Adenocarcinoma,squamous cell,compound carcinoma,。,bronchioloavelar carcinoma,。,Lung neoplasm,Lung carcinoma(cancer)Lung neo,9,Lung neoplasm,SCLC(small cell lung cancer),Small cell carcinoma is a rapidly growing tumor that has the most irrefutable association with smoking. Like squamous cell carcinoma, it is predominantly a central tumor (90%), but growth is mainly along anatomic tissue planes. Small cell carcinoma metastasizes early; systemic spread is present in two-thirds of cases at presentation.,Lung neoplasmSCLC(small cell l,10,Lung neoplasm,NSCLC(non-small cell lung cncer),。,squmous cell carcinoma is most commonly a central tumor developing at the level of the segmental and subsegmental bronchi in 66% of cases. These tumors are frequently lobulated and have a tendency to cavitate.,Adenocarcinoma is a peripheral tumor in 75% of cases with a predilection for the upper lobes and for regions of parenchymal fibrosis (“scar” carcinomas).,compound carcinoma,。,bronchioloavelar carcinoma grows mainly within the alveoli respecting interstitial boundaries,may be unifocal of multifocal, and, when multifocal, it may produce alveolar cell carcinosis.,Lung neoplasmNSCLC(non-small c,11,bronchial carcinoma,The clinical features of bronchial carcinoma generally are elderly, with 75% of cases occurring in the fifth and sixth decades of life. Although some patients are asymptomatic and tumors are detected incidentally, most patients (up to 90%) are symptomatic at the time of diagnosis. Most bronchial carcinomas arise within airways, producing cough, hemoptysis, dyspnea, and chest pain,bronchial carcinoma The clinic,12,bronchial carcinoma,About 33% of patients with bronchial carcinoma present with symptoms related to extrathoracic metastases, most commonly to the bones and central nervous system (CNS). Metastases can produce local symptoms, although this depends on the site and tumor burden. Patients with metastases to the adrenal glands, liver, abdominal lymph nodes, and lung can be asymptomatic.,bronchial carcinomaAbout 33% o,13,Neoplasm type,central type,peripheral type,bronchioloalveolar carcinoma,Lung neoplasm,Neoplasm typeLung neopla,14,According to type of growth,Central type:,Inter-tuber,Wall of tuber,Extra-tuber,Peripheral type:,Mass,inflammation,Diffuse,Lung neoplasm,According to type of growth,15,Imaging manifestationof lung neoplasm,Imaging manifestationof lung,16,Central tumor,Direct sign of bronchial carcinoma,lung mass,Bronchial lumen : Bronchial stenosis, Since most bronchial carcinomas exhibit either endoluminal or transmural growth, bronchial stenosis and associated distal parenchymal changes are a common finding. Occasionally, bronchial stenosis is directly visible on the chest radiograph.,Central tumorDirect sign of br,17,Central tumor: mass in the right low lober and right hilar enlarge,Central tumor: mass in the rig,18,Central tumor,lung mass in the hilum,Bronchail lumen,Central tumorlung mass in the,19,Mouse tail,Irregular stenosis,Filling defect,Cup like,Mouse tail Irregular stenosisF,20,Mouse tail,Central tumor,Mouse tail Central tumor,21,Filling defect,Filling defect,22,Bronchial stenosis,Bronchial stenosis,23,Central tumor,Indirect sign of bronchial carcinoma:,Partial or complete atelectasis is a common finding in bronchial carcinoma. Segments, lobes, or an entire lung are no longer aerated and undergo partial (dystelectasis) or complete collapse (atelectasis). This is manifest as patchy or homogeneous pulmonary opacification of lobar or segmental distribution.,Central tumorIndirect sign of,24,Right upper lobe,atelectasis,Right upper lobe atelectasis,25,left upper lobe,atelectasis,left upper lobe atelectasis,26,Left low lobe,atelectasis,Left low lobe atelectasis,27,Left low lobe,atelectasis,Bronchial stenosis,Left low lobe atelectasisBronc,28,Central tumor,Indirect sign of bronchial carcinoma:,Distal pneumonia presents as lobar or segmental consolidation, which may partially resolve with antibiotic therapy. In patients with appropriate risk factors and recurrent or persistent pneumonia, further evaluation to exclude a central endobronchial tumor is merited.,Central tumorIndirect sign of,29,Distal pneumonia,Distal pneumonia,30,pneumonia,mass,Pleural effusion,pneumoniamassPleural effusion,31,Central tumor,Indirect sign of bronchial carcinoma:,Intrathoracic spread of bronchial carcinoma.,Central tumorIndirect sign of,32,Right side Central tumor,Right side Central tumor,33,Central tumor,Indirect sign of bronchial carcinoma:,Mediastinal lymph node enlargement. Mediastinal widening may be the first radiographic sign of lung cancer, especially in cases of small cell carcinoma.,Central tumorIndirect sign of,34,医学影像-七年制chest课件,35,Central tumor,Hematogenous spread of bronchial carcinoma. Osteolytic bone lesions and pathologic fractures signify hematogenous spread of disease.,Central tumorHematogenous spr,36,Costal bone damage,Costal bone damage,37,Right lung metastasis,Right lung metastasis,38,医学影像-七年制chest课件,39,医学影像-七年制chest课件,40,Central tumor,MRI manifestation,Bronchi wall thicken,Bronchi wall stenosis,Mass in the hilum,Emphesema; pneumonia; atlectasis of obstruction,Affect mediastinum,，,enlargement of lymph node(diameter15mm),Central tumorMRI manifestation,41,医学影像-七年制chest课件,42,医学影像-七年制chest课件,43,医学影像-七年制chest课件,44,Peripheral tumor,Peripheral pulmonary nodule. This is a round, homogeneous pulmonary opacity usually less than 5cm in diameter. The following features suggest a diagnosis of bronchial carcinoma: a pulmonary mass greater than 6cm in diameter; ill-defined margin in 85% of malignant tumors; radial striated markings at the interface with lung parenchyma representing tumor spread along the lymphatics; notching of the contour; a cavitating lesion typical of squamous cell carcinoma.,Peripheral tumor Peripheral pu,45,Peripheral tumor,Pulmonary nodule in the early stage.,Air bronchogram.,Pseudocaviation.,Bubble-like lucencies within the nodule.,Retraction of pleura.,Spiculate margin.,Cavitary.,Peripheral tumorPulmonary nodu,46,notching of the contour,notching of the contour,47,Cavitary.,Cavitary.,48,Retraction of pleura. Spiculate margin. notching of the contour,Retraction of pleura. Spicula,49,Retraction of pleura. Spiculate margin. notching of the contour,Retraction of pleura. Spicula,50,Spiculate margin. notching of the contour,Spiculate margin. notching of,51,医学影像-七年制chest课件,52,Bone metastasis,Bone metastasis,53,Bronchiolo-alveolar carcinoma,Isolated mass type,Pneumonia type,Diffuse nodule type,Bronchiolo-alveolar carcinomaI,54,Isolated mass type,Bronchiolo-alveolar carcinoma,Isolated mass type Bronchiolo-,55,Bronchiolo-alveolar carcinoma,Pneumonia type,Bronchiolo-alveolar carcinoma,56,医学影像-七年制chest课件,57,医学影像-七年制chest课件,58,ill-defined margin pulmonary nodule,Bronchiolo-alveolar carcinoma,ill-defined margin pulmonary n,59,Bronchiolo-alveolar carcinoma,Bronchiolo-alveolar carcinoma,60,Lung mestastasis,The most common primary tumor site was lung, followed by large bowel, prostate, breast, uterus, and esophagus. Between 20% and 40% of primary carcinomas of the lung produced pulmonary metastases. Tumors with the greatest rate of metastases to the lung include choriocarcinoma, germinal tumors of the testis, melanoma, Ewings sarcoma, osteosarcoma, carcinoma of the thyroid, carcinoma of the breast, and rhabdomyosarcoma. Metastatic disease from extrathoracic primaries to intrathoracic lymph nodes occurs with much less frequency than does metastatic disease to pulmonary parenchyma.,Lung mestastasisThe most commo,61,Lung mestastasis,Hematogeneous,mestastasis,Lymphatic vessel,mestastasis,Lung mestastasisHematogeneous,62,Hematogeneous,mestastasis,Hematogeneous mestastasis,63,Hematogeneous,mestastasis,Hematogeneous mestastasis,64,Hematogeneous,mestastasis,Hematogeneous mestastasis,65,Lymphatic vessel,mestastasis,Lymphatic vessel mestastasis,66,Pleural carcinomatosis,Pleural carcinomatosis,67,医学影像-七年制chest课件,68,Mediastinal tumor,The majority of the mediastinal tumors are benign.,We diagnose them mainly based on the position, shape and density.,Mediastinal tumorThe majority,69,Tumor of the anterior mediastinum,Thymoma,Teratoma,Intrathoracic thyroid,Malignant lymphoma,Bronchogenic cyst,Neurogenic tumors,Tumor of the anterior mediasti,70,Mediastinal tumor,Anterior mediastinal tumor,Intra-thoracia thyroid mass: upper of mediastinum,Thymoma: anterior, defined margin,Teratoma,：,calcification; fat,Middle mediastinal tumor,Posterior mediastinal tumor,Mediastinal tumorAnterior med,71,Intrathoracic thyroid,Intrathoracic thyroid is usually a downward prolongation or outgrowth of a cervical thyroid enlargement. On radiolograph most cases show widening of one or other side of the anterior superior mediastinum and displacement of the trachea to the opposite side and compression of the trachea on the side of the tumor.,Intrathoracic thyroidIntrathor,72,Intrathoracic thyroid,Intrathoracic thyroid,73,Intrathoracic thyroid,The CT appearances of thyroid goiters are specific. Anatomical continuity usually can be demonstrated with the cervical thyroid. Focal calcifications and inhomogeneity are frequent features. After injecting contrast material, there is a definite prolonged rise in the CT Hounsfield number.,Intrathoracic thyroidThe CT ap,74,Intrathoracic thyroid,Intrathoracic thyroid,75,Intrathoracic thyroid,MR imaging particularly in the coronal and sagittal planes, can show the extent of intrathoracic thyroid tissue and its relationship to adjacent structures. Multinodular goiters have heterogeneous signal characteristics on T1W1 and T2W1.,Intrathoracic thyroidMR imagin,76,医学影像-七年制chest课件,77,Thymoma,Thymomas are usually in the anterior superior mediastinum. The tumor may be round, lobulated or plaque-like, and produce unilateral widening of the mediastinum. Calcification or cystic degeneration may be seen in a small percentage of cases.,ThymomaThymomas are usually in,78,医学影像-七年制chest课件,79,Thymoma,CT is the imaging method of choice for evaluating the possibility of thymic disease. Differentiation between thymoma and thymic hyperplasia is difficult in patients less than 40 years of age. Thymic hyperplasia tends to enlarge but preserve the normal shape of the gland. However, exceptions to this are encountered in which hyperplasia is found in nodular glands, simulating the presence of a thymoma.,ThymomaCT is the imaging metho,80,Thymoma,Thymoma,81,Thymoma,Thymoma,82,Thymoma,Thymoma,83,Thymoma,Thymomas have intermediate signal intensity (equal to that of skeletal muscle) in T1W1 and increased signal intensity (approaching that of fat) on T2W1. Cystic regions are areas of hemorrhage have low signal intensity on T1W1 and high signal intensity on T2W1.,ThymomaThymomas have intermedi,84,胸腺瘤,MRI,胸腺瘤MRI,85,Teratoma,Most mediastinal teratomas are seen on radiograph as a localized mass in the anterior compartment close to the origin of the major vessels from the heart. Calcification is evident on radiograph in mature teratomas. On CT, most tumors have well-defined margins that were smooth or lobulated with round or oval in shape and have heterogeneous attenuation with soft tissue, fluid and fat. Fat-depressed MRI sequences can demonstrate fat better than CT. occasionally a fat-fluid level is seen on radiograph and CT scan.,TeratomaMost mediastinal terat,86,teratoma,teratoma,87,teratoma,teratoma,88,teratoma,teratoma,89,Mediastinal tumor,Anterior mediastinal tumor,：,Middle mediastinal tumor,：,Malignant lymphoma,Bronchogenic cyst,Posterior mediastinal tumor,Mediastinal tumorAnterior medi,90,Malignant lymphoma,The thorax is frequently involved in patients with Hodgkins and non-Hodgkins lymphomas. It has been estimate that lymphoma constitutes about 20% of all mediastinal neoplasms in adults and 50% in children. Lymph node enlargement is evident on the initial radiograph of approximately 50% of patients, especially bilateral enlargement of hilar and paratracheal lymph nodes.,Malignant lymphomaThe thorax i,91,Malignant,lymphoma,Malignant lymphoma,92,Malignant lymphoma,CT and MRI are more sensitive than radiograph. The enlarged lymph nodes or mass mostly show soft tissue density or signal intensity.,Malignant lymphomaCT and MRI,93,Malignant lymphoma,Malignant lymphoma,94,淋巴瘤,MRI,淋巴瘤MRI,95,Bronchogenic cyst,These cysts are congenital in origin and are probably the result of some fault in the later stages of development of the tracheo-bronchial tree.,Most bronchogenic cysts are oval or round; the shape may vary with inspiration and expiration. On CT, it shows a homogeneous attenuation at or near water density (0 to 20 HU). But in approximately 50% of patients, the cysts have higher attenuation (130 HU) and are indistinguishable from soft tissue lesions. MRI can resolve this question. They show variable signal intensity on T1W1 but characteristically have homogeneous high signal intensity on T2W1.,Bronchogenic cystThese cysts a,96,医学影像-七年制chest课件,97,支气管囊肿,MRI,Bronchogenic cyst,支气管囊肿MRIBronchogenic cyst,98,Mediastinal tumor,Anterior mediastinal tumor,：,Middle mediastinal tumor,：,Posterior mediastinal tumor:,Neurogenic tumor,Mediastinal tumorAnterior medi,99,Posterior mediastinal tumor,Neurogenic tumors are the most common tumors of the posterior mediastinum. They may arise from peripheral nerves (i.e., neurofibromas and neurilemomas), from sympathetic ganglia ,they are the neurofibroma and neurilemoma (schwannoma), most of which are benign.,Posterior mediastinal tumor Ne,100,Posterior mediastinal tumor,The tumors are well defined, oval or occasionally round in shape. Few are lobulated. All the tumors lie posteriorly in the paravertebral sulcus, growing close to the spine and the posterior part of the ribs. A dumb-bell neurofibroma may have its intraspinal part compressing the cord.,Posterior mediastinal tumorThe,101,Neurogenic tumors,Neurogenic tumors,102,神经源性肿瘤,MRI,神经源性肿瘤MRI,103,Thank You !,Thank You !,104,