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1、呼吸系统影像诊断学 Imaging diagnostics of the respiratory system 郑州大学第一附属医院放射科 the first affiliated hospital radiology department of Zhengzhou University 张焱 Zhang Yan,呼吸系统疾病 Disease of the Respiratory system,五.纵隔原发肿瘤（mediastinal tumor） 指原发于纵隔的肿瘤 primary mediastinal tumor 原发性纵隔肿瘤繁多 The tumor primary in medias
2、tinum,which are various,常见的纵隔肿瘤： Common primary mediastinum tumor 神经源性肿瘤Neurogenic tumor 淋巴瘤Lymphoma 畸胎瘤Teratoma 胸腺瘤Thymoma 胸内甲状腺等intrathoracic thyroid,临床症状： clinlcal symptom 胸骨后不适及隐痛 retrosternal malaise and vague pain 与肿瘤的大小、部位、良恶性有关 related to the size, position and nature(benign or malignant),纵隔
3、肿瘤所引起的症状以压迫症状为主 该类症状的出现，对肿瘤的定位及定性亦有帮助 cardinal symptom:pressure symptom is the cardinal symptom of mediastinal tumor Which has helps to localization and qualitative analysis of the tumor,压迫邻近组织器官：press adjacent tissue and organa 上腔静脉综合征 superior vena cava syndrome ; SVCS 声嘶（喉反神经）trachyphonia Horner综
4、合征（交感神经）Horners syndrome (sympathetic nerve) 心率慢（迷走神经）slow heart rate (vagus nerve ) 吞咽困难（食道）hard to swallow (esophagus) 心脏受压oppression of heart 食管受压oppression of esophagus 气管受压等oppression of tracheal,（一）胸腺瘤（Thymoma）： 较常见usual 约30%患者有重症肌无力myasthenia gravis 良性：benign 有完整包膜integrated integument ，可有囊变c
5、ystic change 侵袭性（恶性）：invasion (malignancy) 向邻近组织局部侵犯local invasion of adjacent tissue 常发生胸膜种植转移membrana pleuralisimplantation metastasis is usual 很少有血行或淋巴转移hematogenous metastasis or lymphatic metastasis is singularly,影像表现：imaging 1.多位于前中纵隔偏上antemedial mediastina ，多向一侧突出extrude to one side 2.肿瘤为圆、椭圆
6、或梭形致密影round , oval or fusiform high density lesion ，偶呈片状lamellar lesion 边界清楚the border is clear (well-defined) 3.恶性者呈分叶状therioma is sublobe ，部分边界毛糙part border Of them is coarse ，邻近胸膜受侵the adjacent pleura was invaded 4.瘤内可有斑片状钙化patchy calcification in the tumor 5.囊变者可有蛋壳状钙化 egg shell calcification wi
7、th cystic change,（二）畸胎类肿瘤（Teratoma） 系原始胚胎组织残留物形成的先天性肿瘤 congenital tumor which grow up by residual primordial germ tissue 分为囊性cystic（皮样囊肿dermoid cyst）和实性畸胎瘤Solid teratoma 皮样囊肿：dermoid cyst 为良性benign，含外胚层animal-germ layer和少量中胚层衍生物mesoderm ramification（毛发hair、皮脂sebum等） 实性畸胎瘤：Solid teratoma 含三个胚层衍生物incl
8、ude three germ layer ramifacation（毛发hair、牙teeth、骨bone、腺体gland、呼吸respiratory和胃肠道组织gastrointestinal tissue等） 可为良或恶性benign or malignant,影像学表现：imaging 1.多位于心大血管交界区的前中纵隔antemedial mediastina ，向一侧突出extrude to one side 2.肿瘤呈圆或椭圆形密度不均匀肿块inhomogeneous density tumor （可含透明间隙、牙teeth 、骨bone等） 皮样囊肿可见囊壁发生蛋壳状钙化 egg
9、 shell calcification in dermoid cyst 3.良性者边清楚the border of the benign tumor is clear 4.恶性者分叶、边界不规则，发生粘连 therioma is sublobe, irregularity boundary and adhesion,（三）胸内甲状腺肿（Intrathoracic goitre） 包括先天性异位甲状腺及胸骨后甲状腺肿 性质为甲状腺肿、囊肿或癌 congenital aberrant thyroid and retrosternal struma 甲状腺肿struma、囊肿cyst或癌cance
10、r,影像学表现： 1.多位于前上纵隔antero-superior mediastina，与颈部甲状腺相连 connect with thyroid 2.肿块呈卵圆或梭形orbicular-ovate or fusiform ， 边界清楚 well-defined 3.随吞咽移动 move with swallow 4.肿块内可发生斑片状钙化 patchy calcification occurred in the tumor 5.压迫气管，甚至食管移位 the tracheal is pressed and the esophagus shift indeed,胸 腺 瘤 thymoma,t
11、hymoma A high density lesion in the antero-superior mediastina It is well-defined and slightly enhanced.,胸腺瘤CT表现 the CT film of thymoma,畸 胎 瘤 Teratoma,畸胎瘤CT表现,胸 内 甲 状 腺 肿 Intrathoracic goitre,（四）淋巴瘤（Malignant lymphoma） 系发生于淋巴结的全身性肿瘤lymph nodes derived general tumor 病理及临床：pathology and clinic 分为霍奇金病H
12、odgkin disease及非霍奇金淋巴瘤non-Hodgkin lymphoma 好发于青少年the callan及老年人the elderly 病程短，进展快 the course is short and the progress is fast 常有发热fever、浅表淋巴结肿大 enlargement of superficial lymph nodes 淋巴瘤对放射线敏感sensitivity to radiotherapy，小剂量照（2030Gy）即可明显缩小，但不能完全治愈 It maybe shrink obviously after small dose(20-30Gy)
13、 irradiate but could not cure.,影像表现： 1.常见两侧上、中纵隔淋巴结肿大 lymphadenectasis of bilateral superior and middle mediastinum，呈分叶状向两侧肺野突出extrude to both lung field lobatusly 侧位见纵隔、肺门淋巴结肿大enlargement of hilar or mediastinal lymph nodes at lateral position，生长较大时可侵犯前纵隔 invasion anterior mediastinal when grow lar
14、ge. 2.气管常受压变窄 the tracheal is oppressed and narrowing 3.有时向肺内逆行浸润和侵犯胸膜和心包 Retrogradely infiltrate in the lung and invading pleura and pericardium sometimes.,淋 巴 瘤 lymphoma,（五）囊肿 cyst 支气管囊肿Bronchogenic cyst 食管囊肿esophagal cyst 心包囊肿pericardial cyst,1.支气管囊肿（Bronchogenic cyst） 系胚胎原始前肠的气管芽突脱落的胚胎组织演变而成 Gro
15、w up by fall off tissue of tracheal gemmule of priming foregut. 属良性病变，位于气管旁paratracheal和气管分叉bifurcatio tracheae附近 病理： 为薄壁含液囊状物与支气管不通 it is bladder contains liquid with thin wall and blind to the bronchi,影像学表现： 1.囊肿位于上、中纵隔气管和其分叉附近 the cyst is near to the bifurcatio tracheae and superior and middle me
16、diastinum tracheae 2.囊肿呈边缘光滑锐利的椭圆形均匀密度增高影symmetrical ellipsis high density lesion with smooth and sharpness boarder 一般无分叶、无钙化 without sublobe and calcification 3.囊肿随呼吸活动及变形 move and transmutate with breath,支 气 管 囊 肿 bronchocele,支气管囊肿CT表现,2.食管囊肿（esophagal cyst） ： 食管囊肿的发病机制与支气管囊肿类似 the pathogenesis is similar to bronchogenic cyst 常发生于纵隔内食管中13处之左、右侧 lie in left or right side of 1/3 epimere part of esophagus in mediastinum,较多见于小儿child 囊肿具有腺体功能，故逐渐增大，较早出现近结构的压迫症状 可出现气急breath
