pleural disease 胸膜疾病課件

Pleuraldisease

（胸膜疾病）ZhouLiuCancerHospitalofChineseAcademyofMedicalSciences,ShenzhenCenterPleuralDiseaseEpidemiology（流行病學(xué)）:300/100,000eachyearBasicImagingFindingsPleuraleffusion（胸腔積液）Pleuralthickening（胸膜增厚）Masses（腫物）Pneumothrorax（氣胸）ClassificationAsbestos-relatedbenignPleuralThickening（石棉相關(guān)的良性胸膜增厚）Non-asbestosrelatedbenignPleuraldisease（非石棉相關(guān)的良性胸膜疾?。㎝alignantPleuralthickening（惡性胸膜增厚）Pleuralfluid(includingEmpyema)胸腔積液（包括膿胸）Pneumothorax（氣胸）RarePleuraltumors（罕見胸膜腫瘤）Fibroma（纖維瘤）Lipomasandliposarcomas（脂肪瘤和脂肪肉瘤）

Normalappearance（正常表現(xiàn)）Fig.2.NormalCTwithpleural“intercostalstripe”(Arrow).

Fig.1.Ultrasound:normallungwithpleuralstripe(WhiteArrow)and“comettail”artefacts偽影(outlinedbysmallwhitearrows).Asbestos-relatedbenignPleuralThickening

（石棉相關(guān)的良性胸膜增厚）

Fig.3.x-rayshowingdiffusethickening(arrow)andbluntingofcostophrenicangle(Right).Pleuralplaques(parietalinorigin)胸膜斑塊（壁層胸膜起源）DiffusevisceralPleuralthickening彌漫性臟層胸膜增厚Asbestos-relatedbenignPleuralplaque

（石棉相關(guān)良性胸膜斑塊）Fig.4.A:CTimageshowingpleuralplaquesandassociatedinterstitiallines(“hairyplaques”)(Arrows).B:Roundedatelectasis球形肺不張(arrow)C:Pleurallesionsmimickingsuperimposednodularityinacasewithasbestos-relatedbenignpleuraldisease.Fig.6Increasedsubpleuralfattissueinacasewithasbestos-relatedbenignpleuraldiseaseFig.5Bilateralpleuralthickeninginacasewithasbestos-related

benignpleuraldisease.TuberculouspleurisyTP

結(jié)核性胸膜炎Fig.7CircumferentialsmoothpleuralthickeningandeffusionwithmediastinalpleuralinvolvementappearanceinaTPcase,pleuralthickeningislessthan1cm.Fig.8Irregularpleuralthickeningwithpleuralrindappearanceinapatientcausedbypleuraltuberculosis.Fig.10Empyemawithpleuralsplitsign.50-year-oldwomanwithprogressivedyspneaandfever.CTshowscollectedleftpleuraleffusionswithpleuralsplitsign(arrow)(a,c)andpneumonicinfiltrate(b,d).TheMRIshowsonT2-weighted(T2W)imageshypointensebandsinthehyperintensepleuralfluid(e,f).Pneumoniaismorerestrictivethanthepleuraltransudateondiffusion-weightedimaging(DWI)(g,h).MalignantPleuralthickening

惡性胸膜增厚Metastaticdisease:majority&PrimaryPleuralmalignancy(Mesothelioma)Commonradiologicalappearance共性Irregularthickening＞1cmNodularopacityPleuraleffusion:60%UsuallyunilateralChestwallinvasionandribdestructionMetastasisMesothelioma間皮瘤特性VolumelossCoexistedCalcifiedandnon-calcifiedPleuralplaquesInterstitialdiseaseorasbestosis:20%PriorasbestosexposureMalignantPleuralMesotheliomaMPM

惡性胸膜間皮瘤Fig.12CircumferentialpleuralthickeningwithmediastinalpleuralinvolvementinMPMcases(pleuralrind).MesotheliomaInflammatoryPleuritisMetastasis

Fig.13ThreeCTimagesshowingfeaturesofmalignantdisease:nodularthickening(cross)andmediastinalinvolvement(arrow),bothinthepresenceofpleuraleffusion(E).MalignantPleuralThickening

惡性胸膜增厚Fig.14(A)AsofttissuemassinaMPDcase.(B)Asoft-tissuemasswithcircumferentiallypleuralinvolvementinaMPMcase.Pleuralfluid(includingEmpyema)

胸腔積液（包括膿胸）Figa:Pleuraleffusion“meniscussign”Figb:LoculatedPleuraleffusionCauses:Empyema&HemothoraxAppearindifferentareassharpmedialmariginandhazylateralmarginOnlyevidentover200ml500mlmightappearnormal

Fig.16x-ray(A)pleuraleffusion(B)loculatedpleuraleffusionFig.17

A:USshowingpleuraleffusion(E)withearlyseptations(arrows).

“Infectedormalignanteffusions”

B:USshowingorganisingpleuraleffusionwithheavymatureseptations(arrow).

“honeycomb-likeappearance”

Pleuralfluid(includingEmpyema)

胸腔積液（包括膿胸）Fibroma（纖維瘤）

Fig.19A:CTshowinglargepleuralfibroma(*)withheterogeneouspatternpost-contrastB:MRI(STIRimage)showinglargepleuralfibroma(*).HomogeneousonunenhancedCTVaryinsizeCausingatelectasisinadjacentlungSmoothtaperingmarginObtuseangleatthejunctionofthemassandpleuraHeterogeneousaftercontrast(40%)Fig.20Solitaryfibroustumorwithnidussign.A40-year-oldwomanwithimpressionofelevatedrightdiaphagm(a,b).APET-CT(c,d,e)showsasupradiaphragmaticmass,withnoobviousFDGavidity(e).ThecoronalT2-weighted(T2W)withfatsaturationconfirmsthelesion(f),

anddiffusionrestrictivepatternatb=0(g)andb=100su