呼吸系统常见疾病专家讲座

ImagingDiagnosisofRspirotaryDisease

part2

AiPingChen呼吸系统常见疾病第1页Lungneoplasm肺肿瘤Theincidenceofprimarylungcarcinomaisincreasinginallovertheworld.Mostmalignentlungtumors(over98%)arebronchiogeniccarcinoma支气管肺癌.呼吸系统常见疾病第2页Lungneoplasm肺肿瘤Benign:良性harmatoma,adenoma,angioma,fibroma错构瘤，腺瘤，血管瘤，纤维瘤malignancy:恶性primary：lungcarcinoma肺癌，sarcoma肉瘤Secondary：metastasis转移瘤呼吸系统常见疾病第3页harmatomauncommonasymptomatic;symptomstypicallyarepresentwithcentralendobronchiallesions，includehemoptysis,recurrentpneumonia,anddyspnea.呼吸系统常见疾病第4页harmatomatypicallyround,well-marginatedperipheralmassessmallerthan4cm(range,1to30cm).typicalpattern：‘popcorn’calcification爆米花样钙化

Calcification钙化

probablyispresentinlessthan5%oflesions,Fat脂肪canbedetectedbyCT(attenuation,-40to-120HU)inupto50%ofcasesandisadiagnosticfeature.呼吸系统常见疾病第5页呼吸系统常见疾病第6页呼吸系统常见疾病第7页primarybronchogeniccarcinoma

原发性支气管肺癌mostcommonmalignancyriskfactor

：cigarettesmoking

Environmentalandoccupationalexposure

（3%to17%）Interstitialpulmonaryfibrosisandfocalscarringhavebeenreportedtoincreasetheriskforbronchialcarcinoma.呼吸系统常见疾病第8页Lungcarcinoma(cancer)SCLC(smallcelllungcancer)小细胞肺癌NSCLC(non-smallcelllungcncer）非小细胞肺癌squamouscellcarcinoma鳞癌Adenocarcinoma腺癌LargeCellCarcinoma大细胞癌compoundcarcinoma混合癌bronchioloavelarcarcinomaBAC细支气管肺泡癌Lungneoplasm呼吸系统常见疾病第9页LungneoplasmSCLC(smallcelllungcancer)Smallcellcarcinomaisarapidlygrowingtumorthathasthemostirrefutableassociationwithsmoking.Likesquamouscellcarcinoma,itispredominantlyacentraltumor(90%),butgrowthismainlyalonganatomictissueplanes.metastasizesearly;systemicspreadispresentintwo-thirdsofcasesatpresentation.生长快速，中央型，转移早，全身呼吸系统常见疾病第10页LungneoplasmNSCLC(non-smallcelllungcncer)squmouscellcarcinomaismostcommonlyacentraltumordevelopingatthelevelofthesegmentalandsubsegmentalbronchiin66%ofcases.Thesetumorsarefrequentlylobulatedandhaveatendencytocavitate.Adenocarcinomaisaperipheraltumorin75%ofcaseswithapredilectionfortheupperlobesandforregionsofparenchymalfibrosis(“scar”carcinomas).bronchioloavelarcarcinomagrowsmainlywithinthealveolirespectinginterstitialboundaries,maybeunifocalormultifocal,whenmultifocal,itmayproducealveolarcellcarcinosis.呼吸系统常见疾病第11页bronchialcarcinomaasymptomatic，detectedincidentallymostpatients(upto90%)aresymptomatic气道起源多数表现为producingcough,hemoptysis,dyspnea,andchestpain约33%会出现胸外转移症状，多见于骨骼系统和神经系统。其它，肾上腺，肝脏，淋巴结。。。呼吸系统常见疾病第12页AccordingtotypeofgrowthCentraltype:Inter-tuber管内Walloftuber管壁Extra-tuber管外Peripheraltype:MassinflammationDiffuseLungneoplasm呼吸系统常见疾病第13页CentraltumorDirectsignofbronchialcarcinoma

lungmassBronchiallumen:Bronchialstenosis，endoluminalortransmuralgrowth呼吸系统常见疾病第14页Centraltumor:massintherightlowloberandrighthilarenlarge,呼吸系统常见疾病第15页massintherighthilar呼吸系统常见疾病第16页CentraltumorlungmassinthehilumBronchiallumen支气管改变支气管壁增厚支气管腔内肿块支气管腔狭窄/闭塞呼吸系统常见疾病第17页MousetailIrregularstenosisFillingdefectCuplike呼吸系统常见疾病第18页呼吸系统常见疾病第19页MousetailCentraltumor呼吸系统常见疾病第20页Fillingdefect呼吸系统常见疾病第21页Bronchialstenosis呼吸系统常见疾病第22页CentraltumorIndirectsign间接征象：支气管阻塞所致改变阻塞性肺肺气肿阻塞性肺炎：不易吸收，同一部位重复发作阻塞性肺不张：肺不张合并肿块，肺不张合并转移是其特点

呼吸系统常见疾病第23页Partialorcompleteatelectasis

：Segments,lobes,oranentirelungarenolongeraeratedandundergopartial(dystelectasis)orcompletecollapse(atelectasis).Thisismanifestaspatchyorhomogeneouspulmonaryopacificationoflobarorsegmentaldistribution.呼吸系统常见疾病第24页Rightupperlobeatelectasis

呼吸系统常见疾病第25页Rightupperlobeatelectasis呼吸系统常见疾病第26页leftupperlobeatelectasis呼吸系统常见疾病第27页Leftlowlobeatelectasis呼吸系统常见疾病第28页LeftlowlobeatelectasisBronchialstenosis呼吸系统常见疾病第29页Leftlowlobeatelectasis呼吸系统常见疾病第30页CentraltumorIndirectsignofbronchialcarcinoma:Distalpneumoniapresentsaslobarorsegmentalconsolidation,whichmaypartiallyresolvewithantibiotictherapy.Inpatientswithappropriateriskfactorsandrecurrentorpersistentpneumonia,furtherevaluationtoexcludeacentralendobronchialtumorismerited.呼吸系统常见疾病第31页Distalpneumonia呼吸系统常见疾病第32页pneumoniamassPleuraleffusion呼吸系统常见疾病第33页CentraltumorIndirectsignofbronchialcarcinoma:Intrathoracicspreadofbronchialcarcinoma.呼吸系统常见疾病第34页RightsideCentraltumor呼吸系统常见疾病第35页CentraltumorIndirectsignofbronchialcarcinoma:Mediastinallymphnodeenlargement.Mediastinalwideningmaybethefirstradiographicsignoflungcancer,especiallyincasesofsmallcellcarcinoma.呼吸系统常见疾病第36页呼吸系统常见疾病第37页CentraltumorHematogenousspreadofbronchialcarcinoma.Osteolyticbonelesionsandpathologicfractures溶骨性破坏和病理性骨折signifyhematogenousspreadofdisease.血行播散呼吸系统常见疾病第38页Costalbonedamage呼吸系统常见疾病第39页Rightlungmetastasis呼吸系统常见疾病第40页呼吸系统常见疾病第41页呼吸系统常见疾病第42页CentraltumorMRImanifestationBronchiwallthickenBronchiwallstenosisMassinthehilumEmphysema;pneumonia;atlectasisofobstructionAffectmediastinum，enlargementoflymphnode(diameter>15mm)呼吸系统常见疾病第43页呼吸系统常见疾病第44页呼吸系统常见疾病第45页plainfilm、CT、MRICentraltumor呼吸系统常见疾病第46页Plainfilm呼吸系统常见疾病第47页CT平扫CTscannocontrast呼吸系统常见疾病第48页CT增强CTscancontrast呼吸系统常见疾病第49页MRI呼吸系统常见疾病第50页呼吸系统常见疾病第51页呼吸系统常见疾病第52页Peripheraltumor

Peripheralpulmonarynodule.round，usuallylessthan5cmindiameter.Thefollowingfeaturessuggestadiagnosisofbronchialcarcinoma:ill-definedmarginin85%ofmalignanttumors;radialstriatedmarkingsattheinterfacewithlungparenchymarepresentingtumorspreadalongthelymphatics;notchingofthecontour;acavitatinglesiontypicalofsquamouscellcarcinoma.呼吸系统常见疾病第53页PeripheraltumorPulmonarynoduleintheearlystage.Lobulation，Spiculatedmargin.Airbronchogram.Cavitary.Bubble-likelucencieswithinthenodule.空泡征Retractionofpleura-pleuralindentationsign胸膜凹陷征

呼吸系统常见疾病第54页Peripheraltumor分叶征象:生长不均衡，周围血管和支气管限制毛刺征象:肿瘤沿血管及间质浸润相关空洞形成:偏心性，内壁不规则或呈结节状呼吸系统常见疾病第55页notchingofthecontour呼吸系统常见疾病第56页notchingofthecontour呼吸系统常见疾病第57页Cavitary.呼吸系统常见疾病第58页Retractionofpleura.Spiculatemargin.notchingofthecontour呼吸系统常见疾病第59页Retractionofpleura.Spiculatemargin.notchingofthecontour呼吸系统常见疾病第60页Retractionofpleura.Spiculatemargin.notchingofthecontour呼吸系统常见疾病第61页

Spiculatemargin.notchingofthecontour呼吸系统常见疾病第62页Spiculatemargin.notchingofthecontour呼吸系统常见疾病第63页Bonemetastasis呼吸系统常见疾病第64页呼吸系统常见疾病第65页Bronchiolo-alveolarcarcinomaIsolatedmasstypePneumoniatypeDiffusenoduletype呼吸系统常见疾病第66页IsolatedmasstypeBronchiolo-alveolarcarcinoma

呼吸系统常见疾病第67页Bronchiolo-alveolarcarcinoma

Pneumoniatype

呼吸系统常见疾病第68页呼吸系统常见疾病第69页呼吸系统常见疾病第70页ill-definedmarginpulmonarynoduleBronchiolo-alveolarcarcinoma呼吸系统常见疾病第71页Bronchiolo-alveolarcarcinoma呼吸系统常见疾病第72页Bronchiolo-alveolarcarcinoma呼吸系统常见疾病第73页LungmestastasisThemostcommonprimarytumorsitewaslung,followedbylargebowel,prostate,breast,uterus,

andesophagus.Between20%and40%ofprimarycarcinomasofthelungproducedpulmonarymetastases.Tumorswiththegreatestrateofmetastasestothelungincludechoriocarcinoma绒毛膜癌,germinaltumorsofthetestis睾丸生殖细胞瘤,melanoma黑色素瘤,Ewing’ssarcoma尤文氏肉瘤,osteosarcoma,骨肉瘤carcinomaofthethyroid,甲状腺癌carcinomaofthebreast乳腺癌,andrhabdomyosarcoma横纹肌肉瘤.呼吸系统常见疾病第74页LungmestastasisHematogenousmestastasisLymphaticvesselmestastasis

呼吸系统常见疾病第75页Hematogeneousmestastasis呼吸系统常见疾病第76页Hematogeneousmestastasis呼吸系统常见疾病第77页Hematogeneousmestastasis呼吸系统常见疾病第78页Hematogeneousmestastasis呼吸系统常见疾病第79页Lymphaticvesselmestastasis呼吸系统常见疾病第80页Pleuralcarcinomatosis

呼吸系统常见疾病第81页呼吸系统常见疾病第82页

Mediastinaltumor纵隔肿瘤主要诊疗依据：position,shape，density.呼吸系统常见疾病第83页TumoroftheanteriormediastinumThymoma

TeratomaIntrathoracicthyroid

MalignantlymphomaBronchogeniccystNeurogenictumors呼吸系统常见疾病第84页Mediastinaltumor

Anteriormediastinaltumor前纵隔Intra-thoraciathyroidmass胸内甲状腺肿:upperofmediastinumThymoma胸腺瘤:anteriorTeratoma畸胎瘤：calcification;fatMiddlemediastinaltumor中纵隔Posteriormediastinaltumor后纵隔呼吸系统常见疾病第85页IntrathoracicthyroidIntrathoracicthyroidisusuallyadownwardprolongationoroutgrowthofacervicalthyroidenlargement.Onradiolographmostcasesshowwideningofoneorothersideoftheanteriorsuperiormediastinumanddisplacementofthetracheatotheoppositesideandcompressionofthetracheaonthesideofthetumor.呼吸系统常见疾病第86页胸内甲状腺肿

intrathoracicgoiter病理：多数为结节性甲状腺肿X线表现前纵隔上部边缘光滑，与颈部肿物相连气管受肿块推压呼吸系统常见疾病第87页Intrathoracicthyroid呼吸系统常见疾病第88页IntrathoracicthyroidTheCTappearancesofthyroidgoitersarespecific.Anatomicalcontinuityusuallycanbedemonstratedwiththecervicalthyroid.Focalcalcificationsandinhomogeneityarefrequentfeatures.Afterinjectingcontrastmaterial,thereisadefiniteprolongedriseintheCTHounsfieldnumber.呼吸系统常见疾病第89页结甲伴腺瘤样增生女，62岁肿物与甲状腺相连呼吸系统常见疾病第90页IntrathoracicthyroidMRimagingparticularlyinthecoronalandsagittalplanes,canshowtheextentofintrathoracicthyroidtissueanditsrelationshiptoadjacentstructures.MultinodulargoitershaveheterogeneoussignalcharacteristicsonT1W1andT2W1.呼吸系统常见疾病第91页呼吸系统常见疾病第92页呼吸系统常见疾病第93页Thymoma胸腺瘤anteriorsuperiormediastinum.round,lobulatedorplaque-like,andproduceunilateralwideningofthemediastinum.Calcificationorcysticdegenerationmaybeseeninasmallpercentageofcases.呼吸系统常见疾病第94页胸腺瘤thymoma占前纵隔肿瘤50%多见于中年人多数无症状，少数有压迫或侵犯表现三分之一伴有重症肌无力良性：包膜完整，无周围浸润恶性：包膜不完整，向周围侵犯转移呼吸系统常见疾病第95页呼吸系统常见疾病第96页ThymomaCTistheimagingmethodofchoiceforevaluatingthepossibilityofthymicdisease.Differentiationbetweenthymomaandthymichyperplasiaisdifficultinpatientslessthan40yearsofage.Thymichyperplasiatendstoenlargebutpreservethenormalshapeofthegland.However,exceptionstothisareencounteredinwhichhyperplasiaisfoundinnodularglands,simulatingthepresenceofathymoma.呼吸系统常见疾病第97页胸腺瘤X线表现：单侧或双侧纵隔增宽突出，边缘普通较清楚。CT表现：前纵隔内类圆形肿块，恶性表现为包膜不完整，累及周围组织，胸膜和肺，淋巴结增大呼吸系统常见疾病第98页Thymoma呼吸系统常见疾病第99页Thymoma呼吸系统常见疾病第100页Thymoma呼吸系统常见疾病第101页呼吸系统常见疾病第102页胸腺瘤，可疑包膜侵润男性，47岁，查体发觉呼吸系统常见疾病第103页ThymomaThymomashaveintermediatesignalintensity(equaltothatofskeletalmuscle)inT1W1andincreasedsignalintensity(approachingthatoffat)onT2W1.CysticregionsareareasofhemorrhagehavelowsignalintensityonT1W1andhighsignalintensityonT2W1.呼吸系统常见疾病第104页胸腺瘤MRI呼吸系统常见疾病第105页畸胎瘤teratoma先天性肿瘤，属生殖细胞瘤好发于20~40岁，绝大多数属良性病理起源于原始胚胎组织残留物皮样囊肿：主要含有外胚层衍生物实质性畸胎瘤：含有内、中、外三个胚层衍生物，可为良性或恶性呼吸系统常见疾病第106页畸胎瘤teratomaX线表现及CT表现含有各种组织而密度不均钙化和囊变是特征性表现囊变部分CT值近似水恶性畸胎瘤常较大，边缘不规则呼吸系统常见疾病第107页TeratomaMostmediastinalteratomasareseenonradiographasalocalizedmassintheanteriorcompartmentclosetotheoriginofthemajorvesselsfromtheheart.Calcificationisevidentonradiographinmatureteratomas.OnCT,mosttumorshavewell-definedmarginsthatweresmoothorlobulatedwithroundorovalinshapeandhaveheterogeneousattenuationwithsofttissue,fluidandfat.Fat-depressedMRIsequencescandemonstratefatbetterthanCT.occasionallyafat-fluidlevelisseenonradiographandCTscan.呼吸系统常见疾病第108页teratoma呼吸系统常见疾病第109页teratoma呼吸系统常见疾病第110页teratoma呼吸系统常见疾病第111页呼吸系统常见疾病第112页呼吸系统常见疾病第113页精原细胞瘤男，16岁，面部浮肿1月，咳嗽20天恶性生殖细胞肿瘤

呼吸系统常见疾病第114页MediastinaltumorAnteriormediastinaltumor：Middlemediastinaltumor：MalignantlymphomaBronchogeniccystPosteriormediastinaltumor呼吸系统常见疾病第115页MalignantlymphomaThethoraxisfrequentlyinvolvedinpatientswithHodgkin’sandnon-Hodgkin’slymphomas.Ithasbeenestimatethatlymphomaconstitutesabout20%ofallmediastinalneoplasmsinadultsand50%inchildren.Lymphnodeenlargementisevidentontheinitialradiographofapproximately50%ofpatients,especiallybilateralenlargementofhilarandparatracheallymphnodes.呼吸系统常见疾病第116页恶性淋巴瘤淋巴组织恶性肿瘤发烧，周围淋巴结增大及全身衰弱上腔静脉阻塞综合征纵隔淋巴结增大，常见于血管前、气管旁、主肺动脉窗、肺门等部位呼吸系统常见疾病第117页恶性淋巴瘤X线表现肿块向纵隔两侧突出，气管受压CT表现纵隔内多组淋巴结增大，可融合成块侵及邻近结构呼吸系统常见疾病第118页Malignant

lymphoma呼吸系统常见疾病第119页Malignantlymphoma呼吸系统常见疾病第120页Malignantlymphoma

CTandMRIaremoresensitivethanradiograph.Theenlargedlymphnodesormassmostlyshowsofttissuedensityorsignalintensity.呼吸系统常见疾病第121页Malign