七年制临床-呼吸常见病2.ppt

淋巴管瘤 女性，43岁，咳嗽半月 多房，张力低 食管囊肿 男性，47岁，进食不顺1周 Mediastinal tumor Anterior mediastinal tumor： Middle mediastinal tumor： Posterior mediastinal tumor: Neurogenic tumor Posterior mediastinal tumor Neurogenic tumors are the most common tumors of the posterior mediastinum. They may arise from peripheral nerves (i.e., neurofibromas and neurilemomas), from sympathetic ganglia ,they are the neurofibroma and neurilemoma (schwannoma), most of which are benign. Posterior mediastinal tumor The tumors are well defined, oval or occasionally round in shape. Few are lobulated. All the tumors lie posteriorly in the paravertebral sulcus, growing close to the spine and the posterior part of the ribs. A dumb-bell neurofibroma may have its intraspinal part compressing the cord. 神经源性肿瘤neurogenic tumour 好发于后纵隔脊柱旁沟，与脊柱关系密切 良性为主 最常见类型：神经鞘瘤，神经纤维瘤 MRI检查较CT好 伪影少，软组织分辨力高 冠状位很好显示肿瘤形态及与周围关系 神经源性肿瘤 圆形或哑铃状肿块 边界清楚，信号均匀 CT可清晰显示椎间孔变大 MRI表现：T1WI稍低信号，T2WI稍高信号 较大肿瘤可发生囊变、坏死，呈混杂信号 Neurogenic tumors 神经源性肿瘤MRI * 支气管截断 * 4-1 * 6-3 * 6-3 * 6-9 * 10-1 * 支气管囊肿 * 7-1 * 9-2 胸腺瘤thymoma 占前纵隔肿瘤50%多见于中年人 多数无症状，少数有压迫或侵犯表现 三分之一伴有重症肌无力 良性：包膜完整，无周围浸润 恶性：包膜不完整，向周围侵犯转移 Thymoma CT is the imaging method of choice for evaluating the possibility of thymic disease. Differentiation between thymoma and thymic hyperplasia is difficult in patients less than 40 years of age. Thymic hyperplasia tends to enlarge but preserve the normal shape of the gland. However, exceptions to this are encountered in which hyperplasia is found in nodular glands, simulating the presence of a thymoma. 胸腺瘤 X线表现：单侧或双侧纵隔增宽突出，边缘一般较清晰。 CT表现：前纵隔内类圆形肿块，恶性表现为包膜不完整，累及周围组织，胸膜和肺，淋巴结增大 Thymoma Thymoma Thymoma 胸腺瘤，可疑包膜侵润 男性，47岁，查体发现 Thymoma Thymomas have intermediate signal intensity (equal to that of skeletal muscle) in T1W1 and increased signal intensity (approaching that of fat) on T2W1. Cystic regions are areas of hemorrhage have low signal intensity on T1W1 and high signal intensity on T2W1. 胸腺瘤MRI 畸胎瘤 teratoma 先天性肿瘤，属生殖细胞瘤 好发于20~40岁，绝大多数属良性 病理 来源于原始胚胎组织的