影像教学片3呼吸系统

DepartmentofRadiologyWMC呼吸系统呼吸系统疾病的X线、

CT表现（三）DepartmentofRadiologyWMC胸部外伤DepartmentofRadiologyWMC左侧多条肋骨骨折伴气胸及皮下肌间积气DepartmentofRadiologyWMC肺挫伤表现为：肺纹理边缘模糊不清，这是由于肺血管周围出现渗液DepartmentofRadiologyWMC右皮下气肿、肋骨骨折外伤性湿肺DepartmentofRadiologyWMC右肋骨骨折、皮下气肿，肺挫伤DepartmentofRadiologyWMC肺血肿呈密度增高的球形阴影，吸收慢，吸收后可见囊肿显示DepartmentofRadiologyWMC左上肺血肿DepartmentofRadiologyWMC肺肿瘤分为：原发性和继发性。原发性又分为：良性和恶性肿瘤。良性肿瘤少见，恶性肿瘤中98%是支气管肺癌。DepartmentofRadiologyWMC中央型肺癌肿瘤体征象：肺门肿块阴影，位于一侧肺门，突向肺野，边缘清楚支气管阻塞征象：阻塞性肺气肿阻塞性肺不张阻塞性支气管扩张（手套征）阻塞性肺炎DepartmentofRadiologyWMCDepartmentofRadiologyWMC右上中央型肺癌横S征DepartmentofRadiologyWMC左中央肺癌伴阻塞性肺炎DepartmentofRadiologyWMC右上肺癌伴不张DepartmentofRadiologyWMC左上叶中央型肺癌上叶不张DepartmentofRadiologyWMC肺癌增强后：一般CT值增加20HU以上伴有肺不张，可肺不张内的肿块轮廓，其密度较肺不张增强的密度低DepartmentofRadiologyWMC左上肺癌伴不张；增强前后对比DepartmentofRadiologyWMC周围型肺癌肿瘤密度：早期表现为实性结节、磨玻璃密度结节，两者混合密度结节，肿瘤空洞的洞壁厚薄不均，内壁可见结节，外缘清楚，有分叶肿瘤的周围：胸膜凹陷征分叶征毛刺征空泡征DepartmentofRadiologyWMC空泡征：瘤灶内未受肿瘤累及的正常含气的肺泡和扩张扭曲的细支气管表现为肿块影内点状、蜂窝状的低密度透亮影多见于直径<3cm的腺癌、鳞腺癌和细支气管肺泡癌DepartmentofRadiologyWMC右上肺癌(空泡征)DepartmentofRadiologyWMC右上肺癌DepartmentofRadiologyWMC分叶征：由于肿瘤各部分生长速度不均匀，或由于肿瘤在生长过程中受到血管、支气管的阻挡而造成的肿瘤表面凹凸不平。DepartmentofRadiologyWMC右周围型肺癌分叶征DepartmentofRadiologyWMCDepartmentofRadiologyWMC胸膜凹陷征：一般认为系肿瘤的成纤维作用，即瘤灶内纤维瘢痕组织收缩，其收缩力通过瘤体邻近纤维网架传递到脏层胸膜面，将脏层胸膜拉近肿瘤内，凹入的胸膜与壁层胸膜之间构成空隙，内为生理性液体充填。凹入区肺组织形成沟槽，与凹陷的胸膜一起被周围膨胀的含气肺野衬托，表现为连接于胸壁与肿瘤之间的“Y”或“V”形细线条密影或喇叭状影，亦可称为“兔耳征”。DepartmentofRadiologyWMCDepartmentofRadiologyWMC毛刺征：因恶性肿瘤向周围浸润生长，造成边缘模糊，形成自瘤灶向周围伸展的，无分支的细短线条影，呈毛刷状，称毛刺征。DepartmentofRadiologyWMCDepartmentofRadiologyWMC周围性肺癌肿瘤空洞的洞壁厚薄不均，内壁可见结节，外缘清楚，有分叶DepartmentofRadiologyWMC偏心性空洞

癌性DepartmentofRadiologyWMC左上叶下舌段肺癌厚壁空洞癌性空洞癌性空洞DepartmentofRadiologyWMCDepartmentofRadiologyWMCDepartmentofRadiologyWMCDepartmentofRadiologyWMC左上肺癌（分叶状）DepartmentofRadiologyWMCDepartmentofRadiologyWMCDepartmentofRadiologyWMCDepartmentofRadiologyWMCDepartmentofRadiologyWMC左上肺周围型肺癌双上肺结核DepartmentofRadiologyWMC肺癌伴转移DepartmentofRadiologyWMC肺癌伴纵隔、胸膜转移DepartmentofRadiologyWMC右周围型肺癌右肺门及

纵隔淋巴结转移

DepartmentofRadiologyWMC左肺癌，左4、7后肋骨转移及纵隔转移DepartmentofRadiologyWMC两肺腺癌肺内转移DepartmentofRadiologyWMC肺内转移性肿瘤主要表现为：两肺多发结节状及肿块阴影，以两肺中下肺野常见DepartmentofRadiologyWMC两

肺

转

移

性

肿

瘤DepartmentofRadiologyWMCDepartmentofRadiologyWMC两肺转移瘤DepartmentofRadiologyWMC肝癌伴两肺转移DepartmentofRadiologyWMC结肠癌两肺转移伴空洞形成DepartmentofRadiologyWMC肺良性肿瘤错构瘤：是由内胚层及间胚层发育异常而形成；表现为：直径多为2.5cm以下，伴有斑点状或爆米花状钙化，部分具有脂肪密度，CT值约-90HU~-40HUDepartmentofRadiologyWMC

错构瘤DepartmentofRadiologyWMCDepartmentofRadiologyWMC纵隔原发肿瘤DepartmentofRadiologyWMC纵隔增宽DepartmentofRadiologyWMC纵膈淋巴结结核平扫可见多发结节影，增强呈环形强化，一般肺内多有结核病变鉴别：淋巴瘤：多发密度一致可融合成大片圆形整体强化DepartmentofRadiologyWMC纵隔淋巴结结核DepartmentofRadiologyWMC胸腺瘤X线表现为纵膈增宽CT示肿瘤呈类圆形，可又分叶，多位于前纵膈，增强后肿瘤呈近似均匀性强化DepartmentofRadiologyWMC小胸腺瘤DepartmentofRadiologyWMC胸腺瘤（囊性变）DepartmentofRadiologyWMC恶性胸腺瘤表现为：呈浸润性生长，边缘不规则DepartmentofRadiologyWMC侵袭性胸腺瘤DepartmentofRadiologyWMC畸胎瘤CT表现：1、后壁囊肿2、可见脂肪密度

3、可见钙化或骨骼浸润性生长，即边缘分界欠清，提示恶性DepartmentofRadiologyWMC纵隔畸胎瘤伴胸水DepartmentofRadiologyWMC支气管囊肿表现为：位于中纵膈的中上部，紧邻气道，壁薄而光滑，密度均匀而低，增强未见明显强化DepartmentofRadiologyWMC支气管