【实用资料】七制临床呼吸常见病PPT

七制临床呼吸常见病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2harmatomauncommonasymptomatic;symptomstypicallyarepresentwithcentralendobronchiallesions，includehemoptysis,recurrentpneumonia,anddyspnea.3harmatomatypicallyround,well-marginatedperipheralmassessmallerthan4cm(range,1to30cm).typicalpattern：‘popcorn’calcification爆米花样的钙化Calcification钙化probablyispresentinlessthan5%oflesions,Fat脂肪canbedetectedbyCT(attenuation,-40to-120HU)inupto50%ofcasesandisadiagnosticfeature.456primarybronchogeniccarcinoma

原发性支气管肺癌mostcommonmalignancyriskfactor

：cigarettesmoking

Environmentalandoccupationalexposure（3%to17%）Interstitialpulmonaryfibrosisandfocalscarringhavebeenreportedtoincreasetheriskforbronchialcarcinoma.7Lungcarcinoma(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Lungneoplasm8LungneoplasmSCLC(smallcelllungcancer)Smallcellcarcinomaisarapidlygrowingtumorthathasthemostirrefutableassociationwithsmoking.Likesquamouscellcarcinoma,itispredominantlyacentraltumor(90%),butgrowthismainlyalonganatomictissueplanes.metastasizesearly;systemicspreadispresentintwo-thirdsofcasesatpresentation.生长迅速，中央型，转移早，全身9LungneoplasmNSCLC(non-smallcelllungcncer)squmouscellcarcinomaismostcommonlyacentraltumordevelopingatthelevelofthesegmentalandsubsegmentalbronchiin66%ofcases.Thesetumorsarefrequentlylobulatedandhaveatendencytocavitate.Adenocarcinomaisaperipheraltumorin75%ofcaseswithapredilectionfortheupperlobesandforregionsofparenchymalfibrosis(“scar”carcinomas).bronchioloavelarcarcinomagrowsmainlywithinthealveolirespectinginterstitialboundaries,maybeunifocalormultifocal,whenmultifocal,itmayproducealveolarcellcarcinosis.10bronchialcarcinomaasymptomatic，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。其他，肾上腺，肝脏，淋巴结。。。11AccordingtotypeofgrowthCentraltype:Inter-tuber管内Walloftuber管壁Extra-tuber管外Peripheraltype:MassinflammationDiffuseLungneoplasm12CentraltumorDirectsignofbronchialcarcinoma

lungmassBronchiallumen:Bronchialstenosis，endoluminalortransmuralgrowth13Centraltumor:massintherightlowloberandrighthilarenlarge,14massintherighthilar15CentraltumorlungmassinthehilumBronchiallumen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16MousetailIrregularstenosisFillingdefectCuplike1718MousetailCentraltumor19Fillingdefect20Bronchialstenosis21CentraltumorIndirectsign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，同一部位反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

22Partialorcompleteatelectasis

：Segments,lobes,oranentirelungarenolongeraeratedandundergopartial(dystelectasis)orcompletecollapse(atelectasis).Thisismanifestaspatchyorhomogeneouspulmonaryopacificationoflobarorsegmentaldistribution.23Rightupperlobeatelectasis

24Rightupperlobeatelectasis25leftupperlobeatelectasis26Leftlowlobeatelectasis27LeftlowlobeatelectasisBronchialstenosis28Leftlowlobeatelectasis29CentraltumorIndirectsignofbronchialcarcinoma:Distalpneumoniapresentsaslobarorsegmentalconsolidation,whichmaypartiallyresolvewithantibiotictherapy.Inpatientswithappropriateriskfactorsandrecurrentorpersistentpneumonia,furtherevaluationtoexcludeacentralendobronchialtumorismerited.30Distalpneumonia31pneumoniamassPleuraleffusion32CentraltumorIndirectsignofbronchialcarcinoma:Intrathoracicspreadofbronchialcarcinoma.33RightsideCentraltumor34CentraltumorIndirectsignofbronchialcarcinoma:Mediastinallymphnodeenlargement.Mediastinalwideningmaybethefirstradiographicsignoflungcancer,especiallyincasesofsmallcellcarcinoma.3536CentraltumorHematogenousspreadofbronchialcarcinoma.37Costalbonedamage38Rightlungmetastasis394041CentraltumorMRImanifestationBronchiwallthickenBronchiwallstenosisMassinthehilumEmphysema;pneumonia;atlectasisofobstructionAffectmediastinum，enlargementoflymphnode(diameter>15mm)424344plainfilm、CT、MRICentraltumor45Plainfilm46CT平扫CTscannocontrast47CT增强CTscancontrast48MRI495051Peripheraltumor

Peripheralpulmonarynodule.round，usuallylessthan5cmindiameter.Thefollowingfeaturessuggestadiagnosisofbronchialcarcinoma:ill-definedmarginin85%ofmalignanttumors;radialstriatedmarkingsattheinterfacewithlungparenchymarepresentingtumorspreadalongthelymphatics;notchingofthecontour;acavitatinglesiontypicalofsquamouscellcarcinoma.52PeripheraltumorPulmonarynoduleintheearlystage.Lobulation，Spiculatedmargin.Airbronchogram.Cavitary.Bubble-likelucencieswithinthenodule.空泡征Retractionofpleura-pleuralindentationsign胸膜凹陷征53Peripheraltumor分叶征象:生长不均衡，周围血管和支气管的限制毛刺征象:肿瘤沿血管及间质浸润有关空洞形成:偏心性，内壁不规则或呈结节状54notchingofthecontour55notchingofthecontour56Cavitary.57Retractionofpleura.Spiculatemargin.notchingofthecontour58Retractionofpleura.Spiculatemargin.notchingofthecontour59Retractionofpleura.Spiculatemargin.notchingofthecontour60

Spiculatemargin.notchingofthecontour61Spiculatemargin.notchingofthecontour62Bonemetastasis6364Bronchiolo-alveolarcarcinomaIsolatedmasstypePneumoniatypeDiffusenoduletype65IsolatedmasstypeBronchiolo-alveolarcarcinoma

66Bronchiolo-alveolarcarcinoma

Pneumoniatype

676869ill-definedmarginpulmonarynoduleBronchiolo-alveolarcarcinoma70Bronchiolo-alveolarcarcinoma71Bronchiolo-alveolarcarcinoma72LungmestastasisThemostcommonprimarytumorsitewaslung,followedbylargebowel,prostate,breast,uterus,andesophagus.Between20%and40%ofprimarycarcinomasofthelungproducedpulmonarymetastases.Tumorswiththegreatestrateofmetastasestothelungincludechoriocarcinoma绒毛膜癌,germinaltumorsofthetestis睾丸的生殖细胞瘤,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.73LungmestastasisHematogenousmestastasisLymphaticvesselmestastasis

74Hematogeneousmestastasis75Hematogeneousmestastasis76Hematogeneousmestastasis77Hematogeneousmestastasis78Lymphaticvesselmestastasis79Pleuralcarcinomatosis

8081

Mediastinaltumor纵隔肿瘤主要诊断依据：position,shape，density.82TumoroftheanteriormediastinumThymoma

TeratomaIntrathoracicthyroid

MalignantlymphomaBronchogeniccystNeurogenictumors83Mediastinaltumor

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84IntrathoracicthyroidIntrathoracicthyroidisusuallyadownwardprolongationoroutgrowthofacervicalthyroidenlargement.Onradiolographmostcasesshowwideningofoneorothersideoftheanteriorsuperiormediastinumanddisplacementofthetracheatotheoppositesideandcompressionofthetracheaonthesideofthetumor.85Anatomicalcontinuityusuallycanbedemonstratedwiththecervicalthyroid.Indirectsignofbronchialcarcinoma:round，usuallylessthan5cmindiameter.squmouscellcarcinomaismostcommonlyacentraltumordevelopingatthelevelofthesegmentalandsubsegmentalbronchiin66%ofcases.钙化和囊变是特征性表现HematogeneousmestastasisWalloftuber管壁Retractionofpleura.cigarettesmokingFocalcalcificationsandinhomogeneityarefrequentfeatures.阻塞性肺不张：肺不张合并肿块，肺不张合并转移是其特点Extra-tuber管外好发于20~40岁，绝大多数属良性Thymomashaveintermediatesignalintensity(equaltothatofskeletalmuscle)inT1W1andincreasedsignalintensity(approachingthatoffat)onT2W1.恶性畸胎瘤常较大，边缘不规则胸内甲状腺肿

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86Intrathoracicthyroid87IntrathoracicthyroidTheCTappearancesofthyroidgoitersarespecific.Anatomicalcontinuityusuallycanbedemonstratedwiththecervicalthyroid.Focalcalcificationsandinhomogeneityarefrequentfeatures.Afterinjectingcontrastmaterial,thereisadefiniteprolongedriseintheCTHounsfieldnumber.88结甲伴腺瘤样增生女，62岁肿物与甲状腺相连89IntrathoracicthyroidMRimagingparticularlyinthecoronalandsagittalplanes,canshowtheextentofintrathoracicthyroidtissueanditsrelationshiptoadjacentstructures.MultinodulargoitershaveheterogeneoussignalcharacteristicsonT1W1andT2W1.909192Thymoma胸腺瘤anteriorsuperiormediastinum.round,lobulatedorplaque-like,andproduceunilateralwideningofthemediastinum.Calcificationorcysticdegenerationmaybeseeninasmallpercentageofcases.93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9495ThymomaCTistheimagingmethodofchoiceforevaluatingthepossibilityofthymicdisease.Differentiationbetweenthymomaandthymichyperplasiaisdifficultinpatientslessthan40yearsofage.Thymichyperplasiatendstoenlargebutpreservethenormalshapeofthegland.However,exceptionstothisareencounteredinwhichhyperplasiaisfoundinnodularglands,simulatingthepresenceofathymoma.96胸腺瘤X线表现：单侧或双侧纵隔增宽突出，边缘一般较清晰。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97Thymoma98Thymoma99Thymoma100101胸腺瘤，可疑包膜侵润男性，47岁，查体发现102ThymomaThymomashaveintermediatesignalintensity(equaltothatofskeletalmuscle)inT1W1andincreasedsignalintensity(approachingthatoffat)onT2W1.CysticregionsareareasofhemorrhagehavelowsignalintensityonT1W1andhighsignalintensityonT2W1.103胸腺瘤MRI104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来源于原始胚胎组织的残留物皮样囊肿：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105畸胎瘤teratomaX线表现及CT表现含有多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106TeratomaMostmediastinalteratomasareseenonradiographasalocalizedmassintheanteriorcompartmentclosetotheoriginofthemajorvesselsfromtheheart.Calcificationisevidentonradiographinmatureteratomas.OnCT,mosttumorshavewell-definedmarginsthatweresmoothorlobulatedwithroundorovalinshapeandhaveheterogeneousattenuationwithsofttissue,fluidandfat.Fat-depressedMRIsequencescandemonstratefatbetterthanCT.occasionallyafat-fluidlevelisseenonradiographandCTscan.107teratoma108teratoma109teratoma110111112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113MediastinaltumorAnteriormediastinaltumor：Middlemediastinaltumor：MalignantlymphomaBronchogeniccystPosteriormediastinaltumor114MalignantlymphomaThethoraxisfrequentlyinvolvedinpatientswithHodgkin’sandnon-Hodgkin’slymphomas.Ithasbeenestimatethatlymphomaconstitutesabout20%ofallmediastinalneoplasmsinadultsand50%inchildren.Lymphnodeenlargementisevidentontheinitialradiographofapproximately50%ofpatients,especiallybilateralenlargementofhilarandparatracheallymphnodes.115恶性淋巴瘤淋巴组织恶性肿瘤发热，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116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117发热，周围淋巴结增大及全身衰弱Anteriormediastinaltumor：Rightupperlobeatelectasis钙化和囊变是特征性表现LungmestastasisWalloftuber管壁NSCLC(non-smallcelllungcncer）非小细胞肺癌Thymomashaveintermediatesignalintensity(equaltothatofskeletalmuscle)inT1W1andincreasedsignalintensity(approachingthatoffat)onT2W1.Fat-depressedMRIsequencescandemonstratefatbetterthanCT.好发于20~40岁，绝大多数属良性Indirectsignofbronchialcarcinoma:BronchiwallstenosisOnradiolographmostcasesshowwideningofoneorothersideoftheanteriorsuperiormediastinumanddisplacementofthetracheatotheoppositesideandcompressionofthetracheaonthesideofthetumor.良性：包膜完整，无周围浸润Spiculatemargin.LymphaticvesselmestastasisMalignant

lymphoma118Malignantlymphoma119Malignantlymphoma

CTan