肺先天性囊性腺瘤样畸形2例误诊分析

肺先天性囊性腺瘤样畸形与先天性大叶肺气肿 ,支气管源性囊肿同属先天性囊肿性疾病。因临床症状及 X线表现与肺其他疾病有相似之处 ,故常误诊。现将我院术前误诊的 2例肺先天性囊性腺瘤样畸形 ,结合文献就其临床和病理检查及误诊原因作粗略分析。1　临床资料例 1,男 ,2 5岁 ,间断性左侧胸痛、低热 6年 ,受凉后加重 ,当时在外院诊断为“结核性胸膜炎”,给予抗结核治疗 3个月后自行停药。此后 ,每逢受凉后上述症状复发 ,间断服药 6年 ,后来我院就诊 ,疑为“支气管扩张症”收入院。查体 :体温 37.6℃ ,脉搏 90次 /分 ,呼吸 2 2次 /分 ,血压 18…     

先天性肺囊性腺瘤样畸形1例

患儿,男,1岁4月,因＂进行性呼吸困难1年余,加重3月＂入院,患儿自出生后不久,家人发现其呼吸较正常婴儿费力,饮食发育尚正常,近3月来,患儿反复出现气喘,尤其在激动后较为明显,平静后逐渐好转,病程中伴有反复咳嗽发热,保守治疗效果不佳。     

肺淋巴瘤的影像学表现

<正>肺淋巴瘤是指淋巴瘤的肺内浸润,是肺内少见的恶性肿瘤,其影像学表现复杂多样,临床及放射科医师对本病的影像学表现缺乏足够认识,误诊率很高[1~3],常被误诊为肺癌、肺炎、肺结核、肺结节病等,因此,有必要提高对其影像学表现的认识。肺淋巴瘤分为4种类型:原发性肺淋巴瘤(primary pulmonary lymphoma,PPL)、继发性肺淋巴瘤(secondary pulmonary lymphoma,SPL)、获得性免疫缺陷综合征     

肺原位腺癌的影像学分析

目的:探讨肺原位腺癌(AIS)影像学及病理学特征,提高影像诊断水平。方法:对12例经外科手术切除病理证实的肺AIS,进行影像学分析并结合病理学显微镜下观察及免疫组织化学分析;结果:12例患者男性5例,女性7例,发病年龄39~76岁(平均59.75岁)。8例发生肺上叶,4例肺下叶。低剂量螺旋CT检查12例均显示发生在胸膜下边界清楚的磨玻璃阴影,直径0.3~2.3cm,其中2例周围细小毛刺,3例牵拉胸膜。病理学显微镜下,肿瘤细胞均沿先前存在的肺泡壁呈贴壁生长,无间质、脉管或胸膜浸润,免疫组织化学12例TTF-1、CK7均强阳性表达,NapsinA弱阳性,3例P63阳性表达。结论:肺AIS的影像学特征表现为胸膜下肺外周的圆形或类圆形磨玻璃密度影,密度多均匀,边界清楚。CT在定性诊断方面具有重要价值。     

成人肺囊性腺瘤样畸形1例并文献复习

肺囊性腺瘤样畸形( CCAM)是儿童较常见的病变之一,然而在成年人中病例报道较少见,国内外搜索文献,大多是对儿童及婴幼儿的报道,对非儿科医师,此病经验缺乏,易造成误诊.此例患者为成人,主要表现为同一部位反复感染,抗感染效果差,结合患者影像学表现,考虑不排除恶性疾病或先天性发育不良,术后病理提示CCAM.肺叶切除为该病的...     

肺癌肺内转移的多形性CT影像表现

目的评价肺癌肺内转移在CT影像上的各种形态表现。方法194例病例，其中男106例，女88例，平均45岁。原发肿瘤包括鳞癌56例（28．9％），腺癌107例（55．2％），小细胞肺癌26例（13．4％），腺鳞癌5例（2．6％）。结果肺癌肺内血行转移主要以实性结节最为常见，其少见影像可表现为空洞转移、磨玻璃转移、转移病灶边缘毛糙和/或胸膜凹陷征以及转移灶内可见含气支气管气像，并主要见于肺腺癌；淋巴道转移表现为支气管血管柬不规则结节状增厚。小叶间隔增厚呈串珠状或胸膜下多角形细线结构。结论肺癌肺内转移可呈多形性影像表现。     

先天性单侧肺动脉缺如25例影像学诊断

目的:评价先天性一侧肺动脉缺如(UAPA)多排螺旋CTA的影像学诊断价值。方法:回顾分析25例我院明确诊断为先天性一侧肺动脉缺如的胸X线片、经胸超声心动图检查、胸部多排螺旋CTA及心血管造影表现。结果:15(15/25)例为右肺动脉缺如,10(10/25)例为左肺动脉缺如。单发UAPA 4例,均为右肺动脉缺如。UAPA合并其他心血管畸形21例,其中合并简单心血管畸形9例,合并复杂畸形12例,简单畸形中包括动脉导管未闭、房间隔缺损、室间隔缺损等,复杂畸形中包括肺动脉闭锁、法洛四联症各4例,肺动脉狭窄3例,另有大动脉转位等。9例经外科手术证实,12例经心血管造影证实。结论:对于一侧肺动脉缺如的诊断,多排螺旋CTA检查作为一种无创的检查方法与心血管造影同样具有明确诊断价值,CTA所显示的客观的解剖结构,为治疗方案的选择提供依据。     

肝脏局灶性实性病变的影像学诊断思路

正肝脏疾病种类繁多,按照发病部位和机制的不同,可分为局灶性病变(focal liver lesions,FLL)和弥漫性病变。肝脏局灶性病变可进一步分为囊性或者实性病变[1]。肝脏局灶性病变的临床症状和血清学指标缺乏特异性,影像学检查对病变的检出率高,可以通过定位、定性和鉴别诊断来指导临床治疗。在诊断过程中需要掌握不同疾病的常见影像学特征,同时也需要结合病史和实验室检查结果。实性良性病变包括血管瘤、局灶性结节性增生(focal     

颈动脉间隙占位性病变16例影像学特点分析

目的提高颈动脉间隙占位性病变的诊断水平。方法回顾性分析16例经手术病理证实的颈动脉间隙占位性病变患者的影像学表现。结果 MRI表现：颈动脉体瘤呈分叶状,边界清楚,纵向生长,有特征性血管流空信号,分离并包绕颈内、外动脉;颈静脉球瘤呈不规则形,边界不清楚,斜行生长,有特征性血管流空信号;神经鞘瘤呈梭形或卵圆形,边界清楚,纵向生长,呈不伴血管流空的混杂信号,分离颈动、静脉;脑膜瘤呈哑铃形,边界清楚,纵向生长,呈均匀等信号伴脑膜尾征,包绕颈内动脉。CT表现：颈动脉体瘤和颈静脉球瘤致颈静脉孔边缘呈虫蚀状骨质破坏;神经鞘瘤致颈静脉孔边缘光整,无骨质破坏;脑膜瘤致颈静脉孔边缘呈渗透性骨质硬化。DSA表现：颈动脉体瘤和颈静脉球瘤呈明显肿瘤染色,神经鞘瘤呈轻度肿瘤染色。结论颈动脉间隙占位病变有特征性影像学表现,影像学检查可对病变做出定位、定量和定性诊断;MRI可作为非创伤性检查首选,对累及颈静脉孔的肿瘤可行CT检查,诊断不明确时可行DSA检查。     

原发性肺肉瘤样癌的CT表现

目的探讨原发性肺肉瘤样癌的CT影像特点,提高对原发性肺肉瘤样癌的认识,增加术前诊断的准确率。 方法回顾性分析2013年11月至2016年9月苏北人民医院收治的12例经病理证实为原发性肺肉瘤样癌的临床资料、CT影像特点及治疗方法。 结果12例患者均为单发,周围型8例,中央型4例,直径为0.7～8.6(4.5±1.9)cm,5例位于左肺,7例位于右肺。CT均表现为肺内肿块(n＝11)或结节(n＝1),病灶呈类圆形伴有钙化(n＝1),棘突征(n＝5),分叶征(n＝5),毛刺征(n＝2),累及胸膜(n＝8),伴纵隔淋巴结肿大(n＝3),肺门淋巴结肿大(n＝3),骨转移(n＝2),左下肢及脾转移(n＝1)。CT平扫均呈不均匀软组织密度肿块,CT值为14～38(21±14)HU,增强扫描肿块呈分层强化(n＝11),增强后边缘CT值为47～60(57.2±14)HU,低密度区CT值为19～29(25.3±6.3)HU。本组病例中发现占位后行手术切除的4例患者中有2例好转后出院,余放弃治疗。 结论肺肉瘤样癌以周围型为主,生长迅速,CT上有相对特征性的表现,平扫可见不均匀软组织密度肿块,增强扫描肿块大多呈分层强化方式,确诊需依靠组织病理学检查。     

Late presentation of congenital cystic adenomatoid malformation of lung in ten-year-old girl

Congenital cystic adenomatoid malformation of the lung (CCAML) is uncommon, and usually presents in children with respiratory distress. We describe a girl presenting with pneumonia at age 10 years. She had been previously healthy and active, and with no previous hospitalizations or X-rays. A chest CT scan showed right lower lobe cystic lesions suggestive of CCAML.     

Yellow nail syndrome and bilateral cystic lung disease

In patients with yellow nail syndrome (YNS), highly characteristic nail changes are often associated with lymphedema and respiratory disorders due to pleural effusions or bronchiectasis. We describe a 4-year-old girl with the YNS who also had cystic lesions of the lung, affecting first the left lower lobe and, after surgical resection of the involved segments, also the right lower lobe. We discuss the etiology of the pulmonary cysts and hypothesize that abnormalities in pulmonary lymphatic flow, characteristic of YNS, may have decreased lung tissue compliance and determined the unusual progression of the cystic lesions in this patient. Pediatr Pulmonol. 1998; 26:429–433. © 1998 Wiley-Liss, Inc.     

Type II congenital pulmonary airway malformation in an esophageal lung

A seven-month-old girl, born prematurely (birth weight 1000 g) from a twin pregnancy, was admitted to hospital due to recurrent pneumonia and atelectasis. She experienced cough and respiratory distress during feeding. The right hemithorax was smaller than the left, with diminished breath sounds and dullness. Chest x-rays revealed decreased lung volume and multiple radiolucent images in the right lung, as well as overdistention of the left lung. An esophagogram revealed three bronchial branches arising from the lower one-third of the esophagus, corresponding to the right lung and ending in a cul-de-sac. A diagnosis of esophageal lung was established. On bronchography, the right lung was absent and the trachea only continued into the left main bronchus. Echocardiography and angiotomography revealed agenesis of the pulmonary artery right branch. The surgical finding was an esophageal right lung, which was removed; the histopathological diagnosis was type II congenital pulmonary airway malformation in an esophageal lung.     

Application of ultrasound in a congenital cystic adenomatoid malformation in an adult: A case report

Introduction:Congenital cystic adenomatoid malformation (CCAM) is a rare developmental lung abnormality, that typically manifests in neonates and infants but rarely in adults. Ultrasound is an important method of diagnosing CCAM in neonates and infants; however, few articles have reported the value of transthoracic lung ultrasound in the diagnosis of CCAM in adults.Patient concerns:We present a case of a 34-year-old woman with a cavitary lesion in her left lower lobe, that suggested chronic inflammation.Diagnosis:The patient underwent ultrasound examination and contrast-enhanced ultrasound-guided transthoracic core biopsy; histology suggested the diagnosis of lung hamartoma. Surgical resection of the lesion followed by histopathological analysis confirmed the diagnosis of CCAM.Interventions:The patient underwent transthoracic core biopsy under contrast-enhanced ultrasound guidance. A left lower lobectomy was then performed subsequently.Outcomes:The patient had a smooth recovery and remained asymptomatic during the 12-months of postoperative follow-up.Conclusion:We report a rare case of CCAM to suggest that transthoracic ultrasound combined with contrast-enhanced ultrasound is a safe and effective method of diagnosing the subpleural lung malformations in adults, thereby avoiding multiple radiation exposures and associated complications.     

Congenital cystic adenomatoid malformation of the lung in adults: clinical and CT evaluation of seven patients

Congenital cystic adenomatoid malformation (CCAM) of the lung is a rare congenital developmental abnormality that usually presents in childhood. Some associated malignancies have been reported. This study aimed to describe the clinical and multidetector CT (MDCT) image characteristics of CCAM of the lung in adults. Adult patients with congenital cystic lung diseases in association with surgery for CCAM were evaluated over a five and a half year period. Seven (four women, age range 17-64 years) of 109 congenital cystic lung disease patients were histologically confirmed as having CCAM. The most frequent symptom was productive cough (n = 5) and one patient was admitted with haemoptysis. The diagnosis was based on clinical and radiological findings and one patient was not diagnosed until surgery. MDCT images consisted of having a multiple loculated unilobar cystic mass in six patients and a cavitary mass in one and/or normal systemic arteries. The lesion was present in the right lung in four and in the left lung in three patients. The involved lobe was the upper in three, lower in three and middle lobe in one. Six patients underwent lobectomy and there was no associated malignancy or mortality. The mean length of hospital stay was 17.5 +/- 7.3 days. In adult patients who suffer from a recurrent productive cough and who have a multiloculated cystic mass in one lobe and normal vascular images in MDCT, CCAM, although rare, should be considered.     

The glandular component in congenital cystic adenomatoid malformation of the lung

Although severe congenital cystic changes (CCC) of the lung may be fatal, less severe forms may regress or vanish spontaneously. With recent advances in sonography, asymptomatic CCC are increasingly found. Whether all CCC should be promptly excised, or not, is uncertain. Congenital cystic changes conceptually are bronchopulmonary foregut malformations (BPFM) with a predilection for malignant degeneration. Among all BPFM, congenital cystic adenomatoid malformation (CCAM) is most common. We therefore searched for evidence of early malignant transformation in five surgically excised and three autopsy lungs with CCAM. By light microscopy, CCAM resembled poorly formed and dilated bronchi, bronchioles and respiratory air spaces. Four lungs had multiple nodular aggregates of mucus producing cells; the glandular component (GC). By scanning electron microscopy, GC appeared as multiple micropolyps, resembling neuroepithelial bodies. By transmission electron microscopy, GC had a surface proliferation of cells with granules of the mucous type and a basal increase in cells with owl-eyed neuroendocrine granules. The glandular component in CCAM appeared similar to the mucous cells in hyperplastic polyps of the colon and a type of mucus producing bronchioloalveolar carcinoma. Our findings support the hypothesis that CCAM is caused by dysregulated paracrine growth of mature cells and extracellular matrices and that GC could have the potential for malignant transformation. Further clinical and laboratory studies of BPFM are needed for the appropriate management of congenital cystic changes.     

Bronchioloalveolar carcinoma arising in congenital cystic adenomatoid malformation in a child: A case report and review on malignancies originating in congenital cystic adenomatoid malformation

A type I congenital cystic adenomatoid malformation (CCAM) in the left lower lobe was removed from a 11-year-old boy with a 3-month history of recurrent pneumonia. As incidental finding, a bronchioloalveolar carcinoma (BAC) was found in the lung parenchyma adjacent to the cyst. A left lower lobectomy was performed. At 18 months after surgery the patient is well and free of neoplastic disease. To the best of our knowledge, this association has not been reported previously in a pediatric patient. Malignancies complicating CCAM are rarely seen, but have been reported in adults. Including our case, eight cases of BAC and five cases of rhabdomyosarcoma (RMS) in association with CCAM have been reported so far. As CCAM can host metaplastic mucous cells, primitive mesenchymal cells and differentiated but poorly organized striated muscle fibers, it has been proposed that CCAM may act as a predisposing condition for oncogenesis. Our experience adds further support that CCAM can act as a premalignant lesion. Previous reports of both BAC and RMS in asymptomatic CCAM suggest prompt resection shortly after diagnosis. Pediatr. Pulmonol. 1998; 25:62–66. © 1998 Wiley-Liss, Inc.     

Congenital cystic adenomatoid malformation of the lung: Hazards of delayed diagnosis

Congenital cystic adenomatoid malformation is a rare pulmonary developmental anomaly, which typically manifests in neonates and infants. Presentation in adulthood is uncommon, with <60 cases reported in the literature. The majority of cases involve one lobe only. We report a case of type 1 congenital cystic adenomatoid malformation in an adult presenting with a respiratory tract infection and haemoptysis. At thoracotomy, complex cystic masses were noted in the right upper and lower lobes. Lung-sparing surgery, in the form of two segmentectomies and a non-anatomical resection, was performed in order to avoid pneumonectomy. Such presentations may be problematic as potentially incomplete resections may increase the risk of complications and malignant transformation. This suggests the importance of appropriate clinical and radiological follow up.