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Neoplastic disease

Carcinoma of the bronchus


Carcinoma of the bronchus is one of
the most common primary
malignant tumours.

It has a clear association with


cigarette smoking.
The majority of bronchial
carcinomas arise in larger bronchi
at, or close to, the hilum.

 It is convenient to consider the


radiological features of central and
peripheral tumours separately.
Signs of a central tumor:
The tumour itself. may present as
hilar mass (fig.2.106) and / or
narrowing of a major bronchus.

The narrowing may be irregular or


smooth.
左上叶中央型腺癌,左上叶支气管狭窄
(左图),肿块已包饶左肺动脉(右图,
箭)
(1)
The effect of obstruction by the
tumour (Fig.2.107) is usually a
combination of collapse and
consolidation.
The collapse because air is absorbed
beyond the obstructed bronchus and
cannot be replaced , whereas
consolidation is the consequence of
retained secretions and secondary
infection .
Signs of a peripheral tumour
A peripheral tumour (Fig. 2.108)
usually present as a solitary pulmonary
mass.
The signs of a peripheral
primary carcinoma are :
A rounded shadow with an irregular
border. Lobulation, notching and
infiltrating edges are the common
patterns. (fig.2.33,p40)
Cavitation within the mass:

The walls of the cavity are classically


thick and irregular, but thin-walled
smooth cavities due to carcinoma do
occur.
细支气管肺泡癌
(Bronchiolar carcinoma)
 孤立肿块 (single tumor) :
 肺炎型: as if inflammatory infiltration.
 弥漫型 (type of suffusion):Both sides of
the lung have many scobinations and
patchings which are showed
inequality of size
CT 表现
对小泡征、含气支气管征、毛剌及胸
膜凹陷征等显示更为清楚。因含有较多
粘液,癌性浸润及实变常密度较低,其
中可见血管影,有一定特征性
Spread of bronchial carcinoma
 Evidence of spread on bronchial
carcinoma may be visible on plain chest
radiography,
 but CT and, in highly selected cases,
MRI have made a major contribution
to the staging of lung cancer.
 Both(CT and MRI) may show enlarged
mediastinal lymph node suggesting
involvement by tumour or direct invasion of
the mediastinum that is either not visible or
is questionable on the plain chest film
information, So that may save the patient
unnecessary thoracotomy.
Hilar and mediastinal lymph
node enlargement due to
lymphatic spread of tumor
Only greatly enlarged lymph node
can be recognized on plain chest
radiograph.
CT, on the other hand, has the ability
to show even mildly enlarged nodes,
nodes that are not identifiable on plain
film.
右肺上叶中央型肺癌并纵隔、肺
门淋巴结转移
肺癌胸膜转移 (pleural
metastasis)
In practice, the role of CT is to decide
which patients need preoperative
lymph node biopsy, and to tell the
surgeon which nodes to biopsy.
Pleural effusion in a
patient with lung cancer is
usually due to malignant
involvement of the pleura.
lnvasion of the mediastinum
 On plain films, the signs are widening of
the mediastinal shadow and elevation of a
hemideaphragm suggesting involvement of
the phrenic nerve by tumour (Fig.2.107).

 Mediastinal widening can be a difficult


sign to evaluate, particularly in elder people
with aortic unfolding.
CT and MRI are much more
sensitive and accurate methods of
assessing mediastinal invasion by
tumour .









MRI 显示肿瘤已侵犯了主动脉
(箭)
Invasion of the chest wall (Fig.2.113).
Destruction of a rib immediately
adjacent to a pulmonary shadow is
virtually diagnostic of bronchial
carcinoma with chest wall invasion.
 Recognizing the rib destruction can
be difficult sometimes.
 It is important therefore to make a
conscious effort to look at the ribs
directly.
 Oblique views may be helpful in
detecting bone destruction.
CT and MRI can demonstrate rib and
soft tissue invasion when the bone is not
visibly eroded on plain films.
Rib metastases:

Carcinoma of the lung frequently


metastasizes to the ribs where it
produces bone destruction.
Pulmonary metastases:
Primary lung carcinoma sometimes
metastasizes to other parts of the lungs.

The rounded shadows that result are


similar to secondary deposits from
other primary tumours .
Metastatic neoplasms
Pulmonary metastases

Typically, metastases are well defined ,


although irregular borders are
occasionally seen. Usually, they are
multiple and vary in size.
CT scanning can demonstrate

metastases as small as 3-6mm.


Pleural metastases

These usually give rise to pleural effusion.


The individual pleural metastases are
rarely seen.
Metastases to ribs
 these are common with those primary
tumours that metastasize to bone, namely
bronchus, breast, kidney, thyroid and
prostate.

.
纵隔原发性肿瘤 (Primary tumor
of mediastinum)
 前纵隔常见肿瘤 (The common tumors of the anterior mediastinum)
 胸内甲状腺肿 (struma endothoracica) :气管旁 close to the air
tube ,密度高 high-density ,可有钙化 (calcif)
 胸腺瘤 (thymoma) : Usually located the root of the great vessels.
 畸胎瘤 (teratoid tumor) :其中有钙化 (calcification) ,脂肪 (fattiness)
 中纵隔常见肿瘤
 后纵隔常见肿瘤
struma endothoracica
thymoma
thymoma
thymoma
teratoid tumor
•中纵隔常见肿瘤 (The common tumor of
middle mediastinum) :

–恶性淋巴瘤 (Hodgkin's disease) : The


common manifestations of Hodgkin's disease are
mediastial and hilar adenopathy and pleural effusion and
involve many groups of lymph.

–支气管囊肿 (bronchial cysts) : The edge


of bronchial cysts is clear and density is
equal of water.
•后纵隔 (posterior mediastinum)

–神经源性肿瘤 (neurogenic tumour) : It is


clear association with the back bone
and ribs.
The end

谢 谢 !

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