影像教學(xué)片3呼吸系統(tǒng)

DepartmentofRadiologyWMC呼吸系統(tǒng)呼吸系統(tǒng)疾病的X線、

CT表現(xiàn)（三）DepartmentofRadiologyWMC胸部外傷DepartmentofRadiologyWMC左側(cè)多條肋骨骨折伴氣胸及皮下肌間積氣DepartmentofRadiologyWMC肺挫傷表現(xiàn)為：肺紋理邊緣模糊不清，這是由于肺血管周圍出現(xiàn)滲液DepartmentofRadiologyWMC右皮下氣腫、肋骨骨折外傷性濕肺DepartmentofRadiologyWMC右肋骨骨折、皮下氣腫，肺挫傷DepartmentofRadiologyWMC肺血腫呈密度增高的球形陰影，吸收慢，吸收后可見囊腫顯示DepartmentofRadiologyWMC左上肺血腫DepartmentofRadiologyWMC肺腫瘤分為：原發(fā)性和繼發(fā)性。原發(fā)性又分為：良性和惡性腫瘤。良性腫瘤少見，惡性腫瘤中98%是支氣管肺癌。DepartmentofRadiologyWMC中央型肺癌腫瘤體征象：肺門腫塊陰影，位于一側(cè)肺門，突向肺野，邊緣清楚支氣管阻塞征象：阻塞性肺氣腫阻塞性肺不張阻塞性支氣管擴(kuò)張（手套征）阻塞性肺炎DepartmentofRadiologyWMCDepartmentofRadiologyWMC右上中央型肺癌橫S征DepartmentofRadiologyWMC左中央肺癌伴阻塞性肺炎DepartmentofRadiologyWMC右上肺癌伴不張DepartmentofRadiologyWMC左上葉中央型肺癌上葉不張DepartmentofRadiologyWMC肺癌增強(qiáng)后：一般CT值增加20HU以上伴有肺不張，可肺不張內(nèi)的腫塊輪廓，其密度較肺不張?jiān)鰪?qiáng)的密度低DepartmentofRadiologyWMC左上肺癌伴不張；增強(qiáng)前后對(duì)比DepartmentofRadiologyWMC周圍型肺癌腫瘤密度：早期表現(xiàn)為實(shí)性結(jié)節(jié)、磨玻璃密度結(jié)節(jié)，兩者混合密度結(jié)節(jié)，腫瘤空洞的洞壁厚薄不均，內(nèi)壁可見結(jié)節(jié)，外緣清楚，有分葉腫瘤的周圍：胸膜凹陷征分葉征毛刺征空泡征DepartmentofRadiologyWMC空泡征：瘤灶內(nèi)未受腫瘤累及的正常含氣的肺泡和擴(kuò)張扭曲的細(xì)支氣管表現(xiàn)為腫塊影內(nèi)點(diǎn)狀、蜂窩狀的低密度透亮影多見于直徑<3cm的腺癌、鱗腺癌和細(xì)支氣管肺泡癌DepartmentofRadiologyWMC右上肺癌(空泡征)DepartmentofRadiologyWMC右上肺癌DepartmentofRadiologyWMC分葉征：由于腫瘤各部分生長速度不均勻，或由于腫瘤在生長過程中受到血管、支氣管的阻擋而造成的腫瘤表面凹凸不平。DepartmentofRadiologyWMC右周圍型肺癌分葉征DepartmentofRadiologyWMCDepartmentofRadiologyWMC胸膜凹陷征：一般認(rèn)為系腫瘤的成纖維作用，即瘤灶內(nèi)纖維瘢痕組織收縮，其收縮力通過瘤體鄰近纖維網(wǎng)架傳遞到臟層胸膜面，將臟層胸膜拉近腫瘤內(nèi)，凹入的胸膜與壁層胸膜之間構(gòu)成空隙，內(nèi)為生理性液體充填。凹入?yún)^(qū)肺組織形成溝槽，與凹陷的胸膜一起被周圍膨脹的含氣肺野襯托，表現(xiàn)為連接于胸壁與腫瘤之間的“Y”或“V”形細(xì)線條密影或喇叭狀影，亦可稱為“兔耳征”。DepartmentofRadiologyWMCDepartmentofRadiologyWMC毛刺征：因惡性腫瘤向周圍浸潤生長，造成邊緣模糊，形成自瘤灶向周圍伸展的，無分支的細(xì)短線條影，呈毛刷狀，稱毛刺征。DepartmentofRadiologyWMCDepartmentofRadiologyWMC周圍性肺癌腫瘤空洞的洞壁厚薄不均，內(nèi)壁可見結(jié)節(jié)，外緣清楚，有分葉DepartmentofRadiologyWMC偏心性空洞

癌性DepartmentofRadiologyWMC左上葉下舌段肺癌厚壁空洞癌性空洞癌性空洞DepartmentofRadiologyWMCDepartmentofRadiologyWMCDepartmentofRadiologyWMCDepartmentofRadiologyWMC左上肺癌（分葉狀）DepartmentofRadiologyWMCDepartmentofRadiologyWMCDepartmentofRadiologyWMCDepartmentofRadiologyWMCDepartmentofRadiologyWMC左上肺周圍型肺癌雙上肺結(jié)核DepartmentofRadiologyWMC肺癌伴轉(zhuǎn)移DepartmentofRadiologyWMC肺癌伴縱隔、胸膜轉(zhuǎn)移DepartmentofRadiologyWMC右周圍型肺癌右肺門及

縱隔淋巴結(jié)轉(zhuǎn)移

DepartmentofRadiologyWMC左肺癌，左4、7后肋骨轉(zhuǎn)移及縱隔轉(zhuǎn)移DepartmentofRadiologyWMC兩肺腺癌肺內(nèi)轉(zhuǎn)移DepartmentofRadiologyWMC肺內(nèi)轉(zhuǎn)移性腫瘤主要表現(xiàn)為：兩肺多發(fā)結(jié)節(jié)狀及腫塊陰影，以兩肺中下肺野常見DepartmentofRadiologyWMC兩

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瘤DepartmentofRadiologyWMCDepartmentofRadiologyWMC兩肺轉(zhuǎn)移瘤DepartmentofRadiologyWMC肝癌伴兩肺轉(zhuǎn)移DepartmentofRadiologyWMC結(jié)腸癌兩肺轉(zhuǎn)移伴空洞形成DepartmentofRadiologyWMC肺良性腫瘤錯(cuò)構(gòu)瘤：是由內(nèi)胚層及間胚層發(fā)育異常而形成；表現(xiàn)為：直徑多為2.5cm以下，伴有斑點(diǎn)狀或爆米花狀鈣化，部分具有脂肪密度，CT值約-90HU~-40HUDepartmentofRadiologyWMC

錯(cuò)構(gòu)瘤DepartmentofRadiologyWMCDepartmentofRadiologyWMC縱隔原發(fā)腫瘤DepartmentofRadiologyWMC縱隔增寬DepartmentofRadiologyWMC縱膈淋巴結(jié)結(jié)核平掃可見多發(fā)結(jié)節(jié)影，增強(qiáng)呈環(huán)形強(qiáng)化，一般肺內(nèi)多有結(jié)核病變鑒別：淋巴瘤：多發(fā)密度一致可融合成大片圓形整體強(qiáng)化DepartmentofRadiologyWMC縱隔淋巴結(jié)結(jié)核DepartmentofRadiologyWMC胸腺瘤X線表現(xiàn)為縱膈增寬CT示腫瘤呈類圓形，可又分葉，多位于前縱膈，增強(qiáng)后腫瘤呈近似均勻性強(qiáng)化DepartmentofRadiologyWMC小胸腺瘤DepartmentofRadiologyWMC胸腺瘤（囊性變）DepartmentofRadiologyWMC惡性胸腺瘤表現(xiàn)為：呈浸潤性生長，邊緣不規(guī)則DepartmentofRadiologyWMC侵襲性胸腺瘤DepartmentofRadiologyWMC畸胎瘤CT表現(xiàn)：1、后壁囊腫2、可見脂肪密度

3、可見鈣化或骨骼浸潤性生長，即邊緣分界欠清，提示惡性DepartmentofRadiologyWMC縱隔畸胎瘤伴胸水DepartmentofRadiologyWMC支氣管囊腫表現(xiàn)為：位于中縱膈的中上部，緊鄰氣道，壁薄而光滑，密度均勻而低，增強(qiáng)未見明顯強(qiáng)化DepartmentofRadiologyWMC支氣管