g孤立性肺结节的诊断现状

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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