肺癌与肺结核 的影像学诊断

肺癌分类  Lung cancer, bronchogenic carcinoma  病理分型：鳞、小、腺、大  临床分型：中央型、周围型、纵隔 型

Squamous cell Ca  30-40% ， generally central (70% hilar or perihilar in subsegmental or larger bronchi)  strong association with cigarette smoking  about 15% bronchogenic carcinomas are cavitary, and of these, nearly 60% are squamous cell lesions, wall typically thick and nodular

 intralumenal growth pattern- often resulting in distal atelectasis or post-obstructive pneumonitis (a non-infectious process).  the lowest frequency of distant metastases, spreads to involve local nodes by direct extension  the most favorable prognosis  Hypertrophic osteoarthropathy

adenocarcinoma  as common as squamous cell carcinoma (30-40%).  generally peripheral (75%)  uncommonly cavitate  commonly metastasizes early to lymph nodes, the pleura, adrenal glands, CNS, and bone.

Small cell Ca  15-20% of primary lung malignancies  the strongest association with cigarette smoking  the most likely to produce ectopic hormones- most commonly resulting in Cushings syndrome (ACTH) or syndrome of inappropriate antidiuretic hormone (SIADH)

 generally central (85-90% within a lobar or mainstem bronchi) and has a tendency to invade longitudinally along the bronchial wall, in a submucosal and intramural fashion  Internal necrosis is common, but cavitation is extremely rare  the worst prognosis, despite typically good response to initial chemotherapy

Large Cell Ca  only 5-10%  strongly associated with cigarette smoking  typically peripheral and generally large (over 4 to 6 cm), with rapid growth, early metastases, and a poor prognosis

Pancoast tumor  apical density (superior pulmonary sulcus) apical density  destruction or adjacent rib or vertebra  Horner's syndrome  pain in arm  usually bronchogenic Ca (squamous type)  also: mets, malignant neurogenic tumor

影像诊断  目的：明确诊断， TNM 分期  手段： X 线平片、 CT 、 MRI 、 PET 等

T1: A tumor less than or equal to 3 cm in greatest dimension, surrounded by lung or visceral pleura, without bronchoscopic evidence of invasion more proximal than the lobar bronchus (i.e., not in the main bronchus). TUMOR

T2: A tumor with any of the following features: i) Larger than 3 cm in largest dimension

ii) Associated with atelectasis or post-obstructive pneumonitis that extends to the hilar region, but does not involve the entire lung

iii) Invades the visceral pleura

T3: A tumor of any size that directly invades any of the following: the chest wall (including superior sulcus tumors), diaphragm, mediastinal pleura, parietal pericardium; or tumor in the main bronchus less than 2 cm distal to the carina (but without involvement of the carina); or tumor associated with atelectasis or obstructive pneumonitis of the entire lung.

T4: A tumor of any size that invades any of the following: mediastinum, heart, great vessels, trachea, esophagus, vertebral body, carina; or any tumor with a malignant pleural or pericardial effusion; or with satellite tumor nodules within the ipsilateral primary-tumor lobe of the lung.

Regional Lymph Node Status (N) N1: Ipsilateral peribronchial or hilar nodal metastases; or intrapulmonary nodes involved by direct extension of the primary tumor. All N1 nodes lie distal to the mediastinal pleural reflection.

N2: Ipsilateral mediastinal and subcarinal lymph nodal metastases. Midline pre-vascular and retrotracheal nodes are considered ipsilateral [5], while nodes to the contralateral side of midline are considered N3

N3: Contralateral mediastinal or contralateral hilar nodal metastases; also includes ipsilateral or contralateral scalene or supraclavicular nodes. Other cervical nodes are classified M1

Distant Metastasis (M) M0: No distant metastasis M1: Distant metastasis present; or separate tumor nodules in the ipsilateral nonprimary-tumor lobes of the lung. Separate tumor nodules in the contralateral lung are considered M1 if they are of the same histologic cell type as the primary lesion. A contralateral lung tumor with a different cell type is considered a synchronous primary lesion and should be staged independently

原发综合 征

支气管淋巴结结核 tuberculosis of bronchial lymph nodes

肺浸润及增殖 infiltration and proliferation

2 、 TB 浸润、空 洞及支气管播散 infiltrative pulmonary tuberculosis with cavity

结核球 tuberculoma 浸润肺结核

断层片 tomography

急性粟粒性 TB Miliary TB

急性粟粒性肺结核