呼吸系统影像诊断-肿瘤部分

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1、呼吸系统影像诊断肺肿瘤分为原发性和转移性两大类原发性又分为良性、恶性恶性肺肿瘤98%为原发性支气管肺癌（primarybronchogeniccarcinoma）简称肺癌Lungcancer一肺癌(Lungcancer)临床表现：早期无症状.最常见症状:呛咳无痰或偶有白色粘液痰表现,偶有痰中血丝副肿瘤综合征肿瘤累及其它组织出现的症状与体征Lungcancer肺癌组织学类型Histologycategory：小细胞肺癌SCLC[=smallcelllungcarcinoma]非小细胞肺癌non-small-celllungcarcinoma

2、鳞癌Squamouscellcarcinoma腺癌adenocarcinoma腺鳞癌adenosquamousCarcinoma大细胞癌LargeCellCarcinomaLungcancer按发生部位分型中央型centralbronchogeniccarcinoma：肺段或肺段以上的支气管，包括主、叶、段支气管周围型peripheralbronchogeniccarcinoma：肺段以下-细支气管以上的支气管弥漫型diffusebronchogeniccarcinoma：细支气管或肺泡肺癌的扩散途径淋巴转移lymphaticmetast

3、asis:最常见.血行转移blood-bornemetastasis:常转移至脑肾上腺骨肝与肺直接蔓延directspread.中央型肺癌centralbronchogeniccarcinomaX线表现X-rayfeatures直接征象directsigns支气管改变：腔内充盈缺损intraluminalfillingdefect管壁增厚increasedthickness不规则狭窄irregularstenosis管腔截断interrupt杯口状锥状鼠尾状肺门区块影hilarmass肺门影增大、密度增高Lungcancercent

4、ralbronchogeniccarcinomaLungcancer支气管改变示意图centralbronchogeniccarcinomaX线间接征象indirectsigns管腔阻塞--阻塞征象:阻塞性肺气肿obstructiveemphysema阻塞性肺不张obstructiveatelectasis阻塞性肺炎obstructivepneumonia:病变使支气管阻塞,阻塞以远肺组织发生的肺炎阻塞性支气管扩张与粘液嵌塞obstructivebronchiectasisLungcancercentralbronchogeniccarc

5、inoma左上叶阻塞性肺不张obstructiveatelectasisLungcancerInvertedScurvesign反S征或横S征obstructiveatelectasiscentralbronchogeniccarcinomaCTfeatures肺门肿块hilarmass：边缘呈分叶状或不规则支气管壁改变，超过3mmbronchialwallthickingorintraluminalfillingdefect,luminalcavityirregularstenosisorinterrupt阻塞性肺炎、肺气肿、肺不张o

6、bstructiveemphysema,obstructiveatelectasisobstructivepneumoniaobstructivebronchiectasis肺门、纵隔淋巴结肿大enlargementofhilarlymphnodesormediastinallymphnodes侵犯纵隔Lungcancer中央型肺癌CT表现支气管杯口状阻塞Lungcancer中央型肺癌centralbronchogeniccarcinomaCT表现右下叶支气管闭塞obliteration右下肺不张atelectasis肺门、纵膈淋巴结增大

7、enlargementoflymphnodes侵犯右肺动脉Lungcancer周围型肺癌peripherallungcancer基本表现：肺肿块性或结节病变noduleandmass早期癌earlycarcinoma肿块直径小于2cm，无他处转移肺内球形肿块周围型肺癌肿块特点ImagingfeaturesLungcancerShapeMargedensityLobulationsign周围型肺癌肿块特点细、短的毛刺Lungcancerspiculation胸膜凹陷征pleuralindentationsignLungcancer周围型肺癌

8、peripherallungcancer肿块特点MPR重建胸膜凹陷征pleuralindentationsignLungcancer血管集束征convergenceofbronchovascu