肺转移瘤PPT.ppt

肺转移瘤Metastatic tumor of pulmonary ;肺部是转移瘤最多发的部位。常见的是肾癌、骨肉瘤和绒毛膜上皮癌。 转移途径有血行转移和淋巴道转移，以血行转移最多见。血行转移灶多出现于肺血管末梢部位。肺淋巴道转移的方式有两种：一是先有肺内血行转移灶，经肺淋巴管引流到肺门淋巴结；二是先转移到纵隔肺门淋巴结，再发展到肺内淋巴管。 肺与纵隔淋巴转移后，可因淋巴回流障碍引起胸腔积液。 ;X线表现;2.??淋巴道转移 两中下肺野网状及多发小结节粟粒状阴影。 3. 直接蔓延 表现为原发病灶附近出现结节或肿块，见于纵隔、胸膜或胸壁软组织恶性肿瘤； 恶性胸腺瘤可沿纵隔胸膜蔓延形成单发或多发性肿块。 ;肺转移癌。胸部正位片示双肺布满大小不等的球形结节影。A，肾癌肺转移；B，肝癌肺转移 ;骨肉瘤肺转移瘤。胸部正位片示双肺多发高密度大结节影 ;双肺淋巴道??移癌。胸部正位片示双侧中下肺野多发结节状及网格状高密度结节影，可见克氏B线 ;乳腺癌肺转移。胸部平片示右下肺大小不等的两个类圆形高密度病灶。 ;乳腺癌肺转移;CT与MRI表现;;肺转移瘤。肺窗像（A）示双肺野可见大小不等的圆形高密度结节影，纵隔增宽；纵隔窗像（B）示肺内肿块呈实性，纵隔满布大小不等的肿大淋巴结 ;;肺癌纵隔淋巴结转移。 T1WI（A、B）于上腔静脉后方见肿大淋巴结，右侧胸膜腔少量积液，T2WI（C、D）示肿大淋巴结信号略高 ;诊断、鉴别诊断及比较影像学 ;肺错构瘤Hamartoma of Lung ;病理与临床;X线表现;Posteroanterior (PA) chest radiograph in a man shows an incidental coin lesion within the right mid zone with characteristic popcorn calcification ;Posteroanterior (PA) chest radiograph shows an incidental finding of a solitary pulmonary nodule adjacent to the left hilum.;Degree of Confidence;CT与MRI表现;CT scans in the same patient obtained with (a) soft tissue and (b) lung window settings confirm the presence of a well-defined nodule, with a mean Hounsfield value of 26 HU.;Nonenhanced axial CT scan through the mid thorax shows a sharply marginated, smooth, fat-containing lesion in the right lung. CT is more sensitive than chest radiography in the depiction of fat and calcification. ;右肺上叶错构瘤。CT示右肺上叶前段可见直径约1cm的类圆形结节影，边界清楚，无分叶和毛刺 ;Degree of Confidence;右肺下叶错构瘤;;;;左肺上叶错构瘤(中央型);;诊断、鉴别诊断及比较影像学 ;肺炎性假瘤inflammatory pseudotumor;病理与临床;影像学表现 ;左下肺炎性假瘤;;;;右肺中叶炎性假瘤;;;;;胸膜间皮瘤Mesothelioma of Pleura ;病理与临床;X线表现;胸膜间皮瘤;CT与MRI;CT肺窗像（A）见右侧胸壁大小不等的球形结节；纵隔窗像（B）示胸壁结节呈实性，邻近肋骨无破坏 ;右侧恶性胸膜间皮瘤;;;;;Localized fibrous tumor of the　pleura ;局限性胸膜间皮瘤;chest radiograph reveals a large homogeneous opacity in the left hemithorax; this is partially obscured by associated pleural effusion.;same patient ;extensive pleural thickening characteristic of mesothelioma, effusion, and reduction in volume of the affected hemithorax ;patient with increasing dyspnea and hi