医学影像学课件：七年制chest2

1、Lung neoplasmBenign:harmatoma, adenoma, angioma, fibroma malignancy:carcinoma, blastomaLung neoplasmNeoplasms 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 neoplasmPulmonary hamarto

2、mas 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.

3、Lung neoplasmHamartomas 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

4、CT (attenuation ,-40 to -120 HU) in up to 50% of cases and is a diagnostic feature. Bronchial CarcinomaBronchial 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 expos

5、ure 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. Lung carcinoma(cancer)SCLC(small cell lung cancer) NSCLC(non-small cell lung cncer)。Adenocarcinoma s

6、quamous cellcompound carcinoma。bronchioloavelar carcinoma。Lung neoplasmLung neoplasmSCLC(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

7、 is mainly along anatomic tissue planes. Small cell carcinoma metastasizes early; systemic spread is present in two-thirds of cases at presentation. Lung neoplasmNSCLC(non-small cell lung cncer)。squmous cell carcinoma is most commonly a central tumor developing at the level of the segmental and subs

8、egmental 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 carci

9、noma grows mainly within the alveoli respecting interstitial boundaries,may be unifocal of multifocal, and, when multifocal, it may produce alveolar cell carcinosis.bronchial carcinoma The clinical features of bronchial carcinoma generally are elderly, with 75% of cases occurring in the fifth and si

10、xth 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 painbronchial carcinomaAbout 33% of p

11、atients 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, a

12、bdominal lymph nodes, and lung can be asymptomatic. Neoplasm typecentral typeperipheral typebronchioloalveolar carcinomaLung neoplasmAccording to type of growth Central type:Inter-tuberWall of tuberExtra-tuberPeripheral type:MassinflammationDiffuseLung neoplasmImaging manifestationof lung neoplasmCe

13、ntral tumorDirect sign of bronchial carcinoma lung massBronchial 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 directl

14、y visible on the chest radiograph.Central tumor: mass in the right low lober and right hilar enlarge,Central tumorlung mass in the hilumBronchail lumenMouse tail Irregular stenosisFilling defectCup like Mouse tail Central tumorFilling defectBronchial stenosisCentral tumorIndirect sign of bronchial c

15、arcinoma: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 segmenta

16、l distribution.Right upper lobe atelectasis left upper lobe atelectasisLeft low lobe atelectasisLeft low lobe atelectasisBronchial stenosisCentral tumorIndirect sign of bronchial carcinoma:Distal pneumonia presents as lobar or segmental consolidation, which may partially resolve with antibiotic ther

17、apy. In patients with appropriate risk factors and recurrent or persistent pneumonia, further evaluation to exclude a central endobronchial tumor is merited.Distal pneumoniapneumoniamassPleural effusionCentral tumorIndirect sign of bronchial carcinoma:Intrathoracic spread of bronchial carcinoma. Rig

18、ht side Central tumorCentral tumorIndirect 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 tumorHematogenous spread of bronchial carcinoma. Osteolytic bone lesi

19、ons and pathologic fractures signify hematogenous spread of disease.Costal bone damage Right lung metastasisCentral tumorMRI manifestationBronchi wall thickenBronchi wall stenosisMass in the hilumEmphesema; pneumonia; atlectasis of obstructionAffect mediastinum，enlargement of lymph node(diameter15mm

20、)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 str

21、iated 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 tumorPulmonary nodule in the early stage.Air bronchogram.Pseudocaviation.Bubble-like lucencies within the no

22、dule.Retraction of pleura. Spiculate margin.Cavitary.notching of the contourCavitary.Retraction of pleura. Spiculate margin. notching of the contourRetraction of pleura. Spiculate margin. notching of the contourSpiculate margin. notching of the contourBone metastasisBronchiolo-alveolar carcinomaIsol

23、ated mass typePneumonia typeDiffuse nodule typeIsolated mass type Bronchiolo-alveolar carcinoma Bronchiolo-alveolar carcinomaPneumonia typeill-defined margin pulmonary nodule Bronchiolo-alveolar carcinomaBronchiolo-alveolar carcinomaLung mestastasisThe most common primary tumor site was lung, follow

24、ed 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, car

25、cinoma 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 mestastasisHematogeneous mestastasisLymphatic vessel mestastasi

26、s Hematogeneous mestastasisHematogeneous mestastasisHematogeneous mestastasisLymphatic vessel mestastasisPleural carcinomatosis Mediastinal tumorThe majority of the mediastinal tumors are benign.We diagnose them mainly based on the position, shape and density.Tumor of the anterior mediastinumThymoma

27、 TeratomaIntrathoracic thyroid Malignant lymphomaBronchogenic cystNeurogenic tumors Mediastinal tumorAnterior mediastinal tumorIntra-thoracia thyroid mass: upper of mediastinumThymoma: anterior, defined marginTeratoma：calcification; fatMiddle mediastinal tumorPosterior mediastinal tumorIntrathoracic

28、 thyroidIntrathoracic 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 t

29、he side of the tumor. Intrathoracic thyroidIntrathoracic thyroidThe 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

30、 definite prolonged rise in the CT Hounsfield number.Intrathoracic thyroidIntrathoracic thyroidMR 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 c

31、haracteristics on T1W1 and T2W1. ThymomaThymomas 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.ThymomaCT is the im

32、aging 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 encounte

33、red in which hyperplasia is found in nodular glands, simulating the presence of a thymoma.ThymomaThymomaThymomaThymomaThymomas 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 h

34、emorrhage have low signal intensity on T1W1 and high signal intensity on T2W1.胸腺瘤MRITeratomaMost 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 tera

35、tomas. 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 C

36、T scan.teratomateratomateratomaMediastinal tumorAnterior mediastinal tumor：Middle mediastinal tumor：Malignant lymphomaBronchogenic cystPosterior mediastinal tumorMalignant lymphomaThe thorax is frequently involved in patients with Hodgkins and non-Hodgkins lymphomas. It has been estimate that lympho

37、ma 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 lymphomaMalignant lymphomaCT and MRI are more sensitive than radiograph. The enlarged lymph nodes or mass mostly show soft tissue density or signal intensity.Malignant lymphoma淋巴瘤MRIBronchogenic cystThese cysts are congenital in origin and are probably the result of some fault in the later stages of developm