纵隔周围型肺癌的CT诊断和鉴别诊断  

CT Diagnosis and Differential Diagnosis of Peripheral Lung Cancer of Mediastinal Type

作　　者：彭波[1] 陈金龙[2] 张玉东[1] 胡琳[1] 谢明国[1] 

机构地区：[1]成都中医药大学附属医院放射科,610075 [2]四川省第四人民医院放射科,成都610016

出　　处：《临床放射学杂志》2014年第5期707-710,共4页Journal of Clinical Radiology

摘　　要：目的分析纵隔周围型肺癌的CT表现特征,探讨纵隔周围型肺癌与纵隔肿瘤的CT鉴别诊断要点,以提高对其影像诊断的准确率、减少误诊。方法回顾性分析15例经病理证实的纵隔周围型肺癌的CT影像表现,着重观察病变生长部位、形态、边缘、密度以及继发肺内改变。结果 15例纵隔周围型肺癌的肿块均紧贴纵隔生长或大部分位于纵隔内,其中9例大部分位于前上纵隔内,3例紧贴于前、中纵隔边缘,2例紧贴于后纵隔边缘,1例大部分位于后纵隔内;11例呈不规则状,其中9例肿瘤边缘呈分叶状、瘤肺界面毛糙,7例可见短毛刺或棘状突起,4例呈类圆形或椭圆形、边缘较光整;6例呈均匀软组织密度影、增强后较均匀强化,9例密度不均、增强后不均匀强化、其中5例病灶中央明显液化坏死、1例病灶边缘点状钙化;7例有邻近胸膜凹陷征,2例可见纵隔脂肪线影,3例远端肺野可见阻塞性肺炎改变。影像学表现类似胸腺肿瘤者5例,类似淋巴瘤者3例,类似淋巴结转移者3例,类似食管癌者1例,类似神经源性肿瘤者1例,其他2例。结论纵隔周围型肺癌虽易误诊为其他纵隔肿瘤,但其CT表现具有一定特征性,密切结合早期临床症状,认真分析其影像学表现,可提高对其影像诊断的准确率、减少误诊。Objective To analyze CT manifestations of peripheral lung cancer of mediastinal type and to discuss the differential points with mediastinal tumors in order to improve the diagnosis accuracy. Methods CT findings in 15 patients with pathologically proved peripheral lung cancer of mediastinal type were retrospectively analyzed with an observation focus on its location, shape, margin, density and secondary pulmonary changes. Results The tumor was closely attached to the mediastinum or mainly located within the mediastinal region in all the 15 patients. Among them, the lesion was mainly located at the upper anterior mediastinum in 9 and was closely attached to the border of the posterior mediastinum in 2, while in one case the lesion was mainly situated in the posterior mediastinum. Eleven lesions were irregular in shape with coarse and lobulated border （n = 9） or with short prickles and spines （ n = 7 ）. Four lesions were round or oval in shape with smooth margin. In 6 cases, the lesion presented as a homogeneous soft tissue density mass with homogeneous enhancementon enhanced CT scans. In 9 cases the lesion＇ s density was inhomogeneous with inhomogeneous enhancement on enhanced CT scans, among them obvious qualification necrosis could be seen in five and peripheral spot-like calcification were detected in one. Pleural indentation sign was seen in 7 cases, mediastinal fat line shadow was displayed in two cases, and obstructive pneumonia at distal lung field was demonstrated in 3 cases. The imaging manifestations could be similar to thymic tumor （ n = 5 ）, lymphoma （ n = 3 ）, lymph node metastasis （ n = 3）, esophageal cancer （ n = 1 ）, neurogenic tumor （ n = 1 ） or other tumors （n = 2）. Conclusion The peripheral lung cancer of mediastinal type is easily misdiagnosed as other mediastinal tumor. As its CT manifestations have certain characteristics, careful analysis of CT findings and close combination with clinical symptoms can effectively improve the imaging diagnosis accuracy and re

关 键 词：肺癌 纵隔型 体层摄影术 X线计算机 

分 类 号：R734.2[医药卫生—肿瘤]