修.翻译七年制)呼吸影像肺肿瘤

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ZhangYan 六 肺肿瘤pulmonarytumours 分类 原发性Primary 1 良性benign 少见singularly 2 恶性malignant 支气管肺癌bronchiogeniccancer 98 肺肉瘤sarcoma 继发性secondary 肺转移瘤metastasis 1 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causativeagent 1 病理pathology 癌起源于支气管上皮bronchialepithelium 腺体glandularorgan或细支气管及肺泡上皮epitheliumofthebronchioleoralveolus 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largecellcarcinoma 大体病理分型macropathology 中央型centraltype 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centraltype 系指发生于肺段以上支气管的肺癌abovethesegmentalbronchi 外围型peripheral 系指发生于肺段支气管以下的肺癌belowthesegmentalbronchi 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 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 2 临床clinic 咳嗽cough 咳血emptysis 胸痛chestpain 气促polypnea压迫症状pressuresymptom 上腔静脉综合征superiorvenacavasyndrome 膈神经nerviphrenicus和喉返神经recurrentlaryngealnerve麻痹paralysis等肺外症状extrapulmonarysymptom 杵状指achropachy 肺性肥大性骨关节病hypertrophicpulmonaryarthropathy等 不同部位的肺癌可有以下几种生长方式growthpattern 管内型intracanaliculartype 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intracanalicularpolypoidorcauliflower likemassblockbronchus 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straitnessorocclusion 管外型extratubaltype 癌瘤穿透支气管壁向外生长 在肺内形成肿块penetratethewallexcentricgrowth intrapulmonarymass 型多为中心型肺癌的生长方式growthpatternofthecentrallungcancer 肺段以下较小支气管的肺癌 很易侵入肺内形成肿块intrapulmonarymassisusualinthelungcancerbelowthesegmentalbronchi 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 3 影像表现 中心型centraltype 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 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lymphadenectasisinmediastinumandhiluspulmonis 右肺上叶不张atelectasisinsuperiorlobeofrightlung 中央型肺癌 癌块 肺不张 横S征 centrallungcancer 外围型肺癌peripherallungcancer 肿瘤位于肺段以下到细支气管之间的支气管betweenthesegmentalbronchiandthebronchiole 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averagedoublingtimeisabout3months B 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 pleuraisencroached 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homolateralptosisandmyosis 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 发展则融合成大片絮状影patchyshadow 周围型肺癌peripherallungcancer 早期earlystage 周围型肺癌peripherallungcancer 中晚期middlelatestage Age Sex 57 MChiefcomplaints cough sputum andmildfeverfor6monthsSquamouscelllungcancer withcysticlungtolungmetastasis 周围型肺癌 空洞 胸膜凹陷征 peripherallungcancer 肺上沟癌Pancoastcancer MRI显示肿瘤已侵犯了主动脉 箭 肺上沟癌伴骨转移Pancoastcancerwithosseousmetastasis 双肺细支气管肺泡癌bilateralbronchioalveolarcarcinoma 2 肺转移性肿瘤 Metastatictumorsoflung 临床特点clinicalfeature 原发瘤经血行 淋巴或直接方式至肺hematogenousmetastasis lymphaticmetastasisordirectmetastasis 主要症状有咳嗽cough 咳血emptysis 气短polypnea和胸痛chestpain等 2 影像学表现imaging 血行转移hematogenousmetastasis A 多见于两肺中 下肺野外带bilateralbesidesmiddleandlowerfield常多发multiple 少单发B 呈大小不等Inequalityofsize 密度均匀homogeneousdesity 边界清楚的棉球状致密影sharplymarginatedglobularhighdensitylesionC 少数呈粟粒状或片状模糊影 也可出现空洞或钙化fewismiliaryorpatchyfuzzyimage mayhavecavityorcalcification 淋巴转移lymphaticmetastasis A 单侧或双侧肺门 纵隔淋巴结肿大unilateralorbilaterallymphadenectasisinmediastinumandhiluspulmonisB 自肺门向肺野呈放射状分布索条状 条点状或网状致密影 radialcord stippleorreticularshadow 直接转移directmetastasis A 邻近肺的组织如纵隔 胸壁 胸膜有肿瘤massinadjacenttissuesuchasmediastinum chestwallandpleuraB 肺内出现大小不等转移灶intrapulmonarymetastasisinequalityofsize 肺转移瘤两例 血行转移