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ID:18664238
大小:4.83 MB
页数:95页
时间:2018-09-20
《g孤立性肺结节的诊断现状》由会员上传分享,免费在线阅读,更多相关内容在教育资源-天天文库。
1、孤立性肺结节的诊断现状长海医院呼吸内科孙沁莹SolitaryPulmonaryNodule(SPN)定义:(coinleision)任何肺内或胸膜的病灶,在X线上表现直径在2-30mm,边缘清晰或不清晰的圆形或类圆形阴影。FleischerSocietyGlossary肺实质内直径《3cm圆形或类圆形的病灶,不伴有淋巴结肿大,阻塞性肺炎或肺不张。Chest2003;123:89-96概况0.09%-0.20%所有胸片150,000/年(预计)病因:肉芽肿性疾病、肺癌、错构瘤恶性结节:10-70%占手术切除肺结节的60-80%IA期肺癌术后5年生存率61-75%良性结节:感染性肉芽肿80%错构
2、瘤10%病因Figure1a.Ribfractureina50-year-oldwomanwithmultiplemyeloma.(a)Close-upposteroanteriorradiographoftherightupperlungshowsapoorlymarginatednodularareaofincreasedopacityoverlyingtheanterioraspectoftherightsecondrib(arrow).(b)CTscanshowsahealedfractureoftherightsecondrib(arrow).Notethelyticlesions
3、inthevertebralbodysecondarytomultiplemyeloma.Figure2a.Pseudonoduleina50-year-oldman.(a)Close-upposteroanteriorradiographoftherightlungshowsasmoothlymarginatednodularareaofincreasedopacityprojectingoverthelung(arrow).Notetheadjacentelectrocardiographicleadattachmentpad(arrowhead).Onafollow-upradiogr
4、aphobtainedafterremovaloftheattachmentpad(notshown),nonodulewasobserved.(b)Frontandbackviewsoftheelectrocardiographicleadattachmentpadshowaneccentricallylocatedsilvernitratepad,whichexplainsthecontiguousnodularareaofincreasedopacityonthechestradiograph.Figure4a.Osteophyteoftheleftfirstribina60-year
5、-oldwoman.(a)Posteroanteriorchestradiographshowsapoorlydefinednodularareaofincreasedopacityoverlyingtheanterioraspectoftheleftfirstrib(arrow).(b)Posteroanteriorchestradiographobtained2yearsearliershowsthatintervalgrowthhasoccurred(cfa).Thisintervalgrowthraisedsuspicionformalignancy.(c)Contiguousche
6、stCTscans(imageonrightobtainedatalowerlevel)revealthattheareaofincreasedopacityisalargeosteophyteofthefirstrib.Hadfluoroscopybeenperformed,costlyCTcouldhavebeenavoided.Figure5a.Cutaneousnodulesina51-year-oldmanwithneurofibromatosisandprostaticadenocarcinoma.(a)Posteroanteriorradiographshowsnumerous
7、well-marginatednodularareasofincreasedopacityprojectingovertheloweraspectofthethoraxandapoorlymarginatednoduleoverlyingtheupperaspectofthelefthemithorax(arrow).Becausethelocationoftheuppernodulewasuncertain
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