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单击鼠标编辑大纲正文格式,第二个大纲级,第三个大纲级,第四个大纲级,第五个大纲级,第六个大纲级,第七个大纲级,第八个大纲级,第九个大纲级,*,医学影像教研室,单击鼠标编辑大纲正文格式,第二个大纲级,第三个大纲级,第四个大纲级,第五个大纲级,第六个大纲级,第七个大纲级,第八个大纲级,第九个大纲级,*,*,医学影像教研室,呼吸系统影像诊断学,Imaging diagnostics of the respiratory system,郑州大学第一附属医院放射科,the first affiliated hospital radiology department,of Zhengzhou University,张焱,Zhang Yan,(,六,),肺肿瘤,pulmonary tumours,分类：,.,原发性,Primary,：,（,1,）良性,benign,（少见,singularly,）,（,2,）恶性,malignant,支气管肺癌,bronchiogenic cancer,（,98%,）,肺肉瘤,sarcoma,.,继发性,secondary,（肺转移瘤,metastasis,）,1.,原发性支气管肺癌,（,Primary bronchogenic carcinoma of lung,）,:,近年来肺癌的发病率与死亡率急剧上升,incidence and mortality of lung cancer sharp rised,吸烟,smoking,、大气污染,atmospheric pollution,及工业致癌物质,industrial carcinogen,为主要的致病因素,causative agent,（,1,）病理,pathology,：,癌起源于支气管上皮,bronchial epithelium,，,腺体,glandular organ,或细支气管及肺泡上皮,epithelium of the bronchiole or alveolus,肺癌组织学分型,histological type,：,小细胞肺癌,small cell lung cancer,; SCLC,及非小细胞肺癌,nonsmall-cell lung cancer,; NSCLC,非小细胞肺癌,nonsmall-cell lung cancer,; NSCLC,分为：,鳞癌,squamocellular cancer,腺癌,adenocarcinoma,腺鳞癌,adenosquamous carcinoma,大细胞癌,large cell carcinoma,大体病理分型,macropathology,：,中央型,central type,：,周围型,peripheral,：,弥漫型,diffuse,：,按照肺癌的发生部位可以分为三型,position,：,中心型,central type,：,系指发生于肺段以上支气管的肺癌,above the segmental bronchi,外围型,peripheral,：,系指发生于肺段支气管以下的肺癌,below the segmental bronchi,细支气管肺泡癌,bronchioalveolar carcinoma,：系指发生于细支气管或肺泡上皮的肺癌,epithelium of the bronchiole or alveolus,生长方式,growth pattern,：,管内型,intracanalicular type,（息肉,polypus,、菜花状,cauliflowwer,）,管壁型,wall type,（管腔狭窄或闭塞,straitness,or occlusion,）,管外型,extratubal type,（肺内肿块,intrapulmonary mass,）,（,2,）临床,clinic,：,咳嗽,cough,、咳血,emptysis,、胸痛,chest pain,、气促,polypnea,压迫症状,pressure symptom,：,上腔静脉综合征,superior vena cava,syndrom,e,，膈神经,nervi phrenicus,和喉返神经,recurrent laryngeal nerve,麻痹,paralysis,等,肺外症状,extrapulmonary symptom,：,杵状指,achropachy,、肺性肥大性骨关节病,hypertrophic pulmonary arthropathy,等,不同部位的肺癌可有以下几种生长方式,growth pattern,：,管内型,intracanalicular type,：,癌瘤向管腔内生长，形成息肉样或菜花样肿块，逐渐引起,支气管阻塞,intracanalicular,polypoid or cauliflower-like,mass block bronchus,管壁型,wall type,：,癌瘤沿支气管壁浸润生长,along bronchus,，可使管壁增厚,the,wall,thickening,，造成支气管狭窄或阻塞,straitness or occlusion,管外型,extratubal type,：,癌瘤穿透支气管壁向外生长，在肺内形成肿块,penetrate the,wall excentric growth,，,intrapulmonary mass,型多为中心型肺癌的生长方式,growth pattern of the central lung cancer,肺段以下较小支气管的肺癌，很易侵入肺内形成肿块,intrapulmonary mass,is,usual in,the lung cancer,below the segmental bronchi,细支气管或肺泡上皮的肺癌,the cancer from,epithelium of the bronchiole or alveolus,初期可沿肺泡壁生长，形成孤立结节状肿块,initial stage,，,grow,along the wall of,alveolus,，,form a isolated node,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,advanced stage disseminated along,bronchus and,lymph vessel form diffuse carcinomatosis,（,3,）影像表现：,中心型,central type,：,A.,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,）,the wall,thickening and straitness,B.,肺门肿块,mass in hilus pulmonis,，常伴有,go with,阻塞性肺气肿,obstructive emphysema,、阻塞性肺炎,obstructive pneumonia,、阻塞性肺不张,obstructive atelectasis,C.,侵犯纵隔,mediastinum encroachment,D.,纵隔及肺门淋巴结肿大,lymphadenectasis in mediastinum and hilus pulmonis,右肺上叶不张,atelectasis in,superior lobe of right lung,中央型肺癌,（癌块、肺不张、横,S,征）,central lung cancer,外围型肺癌,peripheral,lung cancer,：,肿瘤位于肺段以下到细支气管之间的支气管,between the segmental bronchi and the bronchiole,主要征象,main character,：,A.,肿块征,mass,：,早期,early stage,直径,diameter2cm,，轮廓模糊,weakened contours,，密度稍高之结节,slightly high density lesion,、,球状或小片状影,globosity or lamellar,密度有时不均、出现空泡征,vacuole sign,等,the density is inhomogeneous,中晚期呈分叶状肿块，边缘有短毛刺，亦可有癌洞等,middlelate stage the mass is lobulated, shallow needling and cavity,癌块倍增时间平均约,3,月,average doubling time is about 3 months,B.,转移征 同中央型,metastatic is the same as,central lung cancer,C.,阻塞征 在病灶周围，较中央型范围小,obstruction is less-than,central lung cancer,D.,胸膜受侵征（局限性增厚,localized,thickening,，胸膜凹陷征,pleural indentation sign,等）,pleura is encroached,发生于肺尖部的癌称肺上沟癌,（,pancoast tumor,）,apical,可侵蚀邻近肋骨及椎体并可压迫臂丛引起臂痛,encroach rib and vertebrae ,press brachial plexus,也可压迫颈部交感神经而引起,Horner,综合征,press,cervical sympathetic nerve,表现为同侧眼睑下垂、瞳孔缩小,homolateral ptosis and myosis,细支气管肺泡癌,bronchioalveolar,carcinoma,：,肿瘤位于细支气管或肺泡上皮,epithelium of the bronchiole or alveolus,A.,早期,early stage,：为孤立的结节状或肺炎样浸润影,isolated invasion lesion,，内有含气的小透明区,aerated transparent zone,（空泡征,vacuole sign,）,B.,晚期,later period,：一侧肺或两肺出现多数大小不等,unilateral or bilateral multiply inequality of size,、,境界不清,ill-defined,的结节或斑片状影,nodular or patchy lesion,，,发展则融合成大片絮状影,patchy shadow,周 围 型 肺 癌,peripheral,lung cancer,（早期,early stage,）,周围型肺癌,peripheral lung cancer,（中晚期,middlelate stage,）,Age/Sex:,57/M Chief complaints:,cough, sputum, and mild fever for 6 months,Squamous cell lung cancer (with cystic lung to lung metastasis),周围型肺癌（空洞、胸膜凹陷征,）,peripheral,lung cancer,肺上沟癌,Pancoast cancer,MRI,显示肿瘤已侵犯了主动脉（箭）,肺上沟癌伴骨转移,Pancoast cancer with osseous metastasis,双肺细支气管肺泡癌,bilateral,bronchioalveolar,carcinoma,2.,肺转移性肿瘤,（,Metastatic tumors of lung,）,临床特点,clinical feature,：,原发瘤经血行、淋巴或直接方式至肺,hematogenous metastasis,lymphatic metastasis or direct metastasis,主要症状有咳嗽,cough,、咳血,emptysis,、气短,polypnea,和胸痛,chest pain,等,（,2,）影像学表现,imaging,：,血行转移,hematogenous metastasis,：,A.,多见于两肺中、下肺野外带,bilateral besides middle and lower field,常多发,multiple,，少单发,B.,呈大小不等,I nequality of size,，密度均匀,homogeneous desity,，边界清楚的棉球状致密影,sharply marginated globular high density lesion,C.,少数呈粟粒状或片状模糊影，也可出现空洞或钙化,few is miliary or patchy fuzzy image ,may have cavity or calcification,淋巴转移,lymphatic metastasis,：,A.,单侧或双侧肺门、纵隔淋巴结肿大,unilateral or,bilateral lymphadenectasis in mediastinum and hilus pulmonis,B.,自肺门向肺野呈放射状分布索条状、条点状或网状致密影。,radial cord, stipple or reticular shadow,直接转移,direct metastasis,：,A.,邻近肺的组织如纵隔、胸壁、胸膜有肿瘤,mass in adjacent tissue such as mediastinum, chest wall and pleura,B.,肺内出现大小不等转移灶,intrapulmonary metastasis inequality of size,肺 转 移 瘤 两 例（血行转移）,
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