左侧中央型肺癌CT病例！

2018-06-12 佚名影像园

xin.C

医生/ 住院医师

女，41岁，因“反复咳嗽1年余”入院，无血痰。

【病史临床】

女，41岁，因“反复咳嗽1年余”入院，无血痰。

【影像图片】

胸部CT平扫肺窗（B）、纵隔窗（A）及增强扫描纵隔窗（C）

【影像表现】

肺窗示左肺下叶见不规则稍高密度肿块影，大小约8.5×6.5cm，病灶边缘见不规则斑片状模糊影；纵隔窗示肿块密度较均匀，其内可见充气支气管，管腔狭窄，纵隔内可见多个肿大淋巴结。

【诊断】

(左侧）中央型肺癌

【鉴别诊断】

1．中央型肺癌 2．错构瘤 3．炎性假瘤 4．单发转移瘤 5．结核球

【讨论】

支气管肺癌 (即肺癌)是一种原发于支气管上皮、细支气管肺泡上皮及腺体的恶性肿瘤。其中鳞癌及腺癌发病率最高。中央型肺癌发生于肺段或肺段以上支气管，主要为鳞癌；早期中央型肺癌指肿瘤局限于支气管腔内、或在肺叶或肺段支气管壁内浸润生长，未侵及周围肺实质，无转移。临床表现：主要临床表现为咯血、刺激性咳嗽和胸痛。

影像诊断要点：

①早期CT可显示支气管轻度狭窄、管壁增厚或腔内结节；②中、晚期显示局部肿块，增强扫描肿块明显强化；③常有继发阻塞性肺炎、肺不张等。

鉴别诊断：

阻塞性肺炎应与一般肺炎或浸润型肺结核鉴别。肺癌引起者经抗感染不易吸收，或在同一位置反复出现。肺不张应与结核及慢性肺炎肺不张区别。结核性肺不张有含气支气管像，并常见支气管扩张、钙化、周围有卫星灶，结核及慢性肺炎均无肺门肿块。CT增强扫描对鉴别有意义，一般认为肺癌强化高峰强化值＞17Hu，不强化或轻度强化结节良性可能性大。必要时需CT引导下经皮穿刺活检定性。

【问题】

1．Ture OR False？

1.病灶位于左侧肺门对: 错

2.病灶边缘略呈结节状分叶对: 错

3.增强扫描病灶中等度强化对: 错

4.左肺下叶背段斑片影可能是阻塞性肺不张引起对: 错

5.肿块位于此位置，易于行CT引导下穿刺活检对: 错

正确答案： 1:√ 2:√ 3:√ 4:√ 5:×

2．最可能的诊断是？

A．淋巴瘤

B、转移瘤

C、肺曲霉菌病

D、肺炎性假瘤

E、中央型肺癌

正确答案：E

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2019-03-22 yinhl1978

#CT病例#

69 0
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2019-02-26 huagfeg

#中央型#

62 0
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2018-06-14 神功盖世

学习

90 0
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level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2ac82155377, createdName=1201e5c5m39暂无昵称, createdTime=Tue Jun 12 23:32:09 CST 2018, time=2018-06-12, status=1, ipAttribution=)]
2018-06-14 sunfeifeiyang

学习

97 0
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2018-06-14 liuyiping

#中央型肺癌#

62 0
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2018-06-13 明月清辉

谢谢分享.学习了

78 0
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objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a8f22260741, createdName=121832a9m88暂无昵称, createdTime=Tue Jun 12 23:36:23 CST 2018, time=2018-06-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=323669, encodeId=e4d132366930, content=不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/2EVCwc9WmQS6ec99H2TX8ejmR40xYjwrIcrqjAnibV36aicL1sLxc21rhpZnqTOxk33HP44iayEwo6qYXqgZvdRtA/132, createdBy=d0d01573846, createdName=329523732, createdTime=Tue Jun 12 23:33:31 CST 2018, time=2018-06-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=323668, encodeId=cbbd3236683d, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2ac82155377, createdName=1201e5c5m39暂无昵称, createdTime=Tue Jun 12 23:32:09 CST 2018, time=2018-06-12, status=1, ipAttribution=)]
2018-06-13 飛歌

学习了很有用不错

91 0
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objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a8f22260741, createdName=121832a9m88暂无昵称, createdTime=Tue Jun 12 23:36:23 CST 2018, time=2018-06-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=323669, encodeId=e4d132366930, content=不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/2EVCwc9WmQS6ec99H2TX8ejmR40xYjwrIcrqjAnibV36aicL1sLxc21rhpZnqTOxk33HP44iayEwo6qYXqgZvdRtA/132, createdBy=d0d01573846, createdName=329523732, createdTime=Tue Jun 12 23:33:31 CST 2018, time=2018-06-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=323668, encodeId=cbbd3236683d, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2ac82155377, createdName=1201e5c5m39暂无昵称, createdTime=Tue Jun 12 23:32:09 CST 2018, time=2018-06-12, status=1, ipAttribution=)]
2018-06-12 121832a9m88暂无昵称

学习了

96 0
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level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2ac82155377, createdName=1201e5c5m39暂无昵称, createdTime=Tue Jun 12 23:32:09 CST 2018, time=2018-06-12, status=1, ipAttribution=)]
2018-06-12 329523732

不错

43 0
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level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2ac82155377, createdName=1201e5c5m39暂无昵称, createdTime=Tue Jun 12 23:32:09 CST 2018, time=2018-06-12, status=1, ipAttribution=)]
2018-06-12 1201e5c5m39暂无昵称

学习了

53 0

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