后纵隔支气管囊肿二例报告

1病例报告 病例1:女,50岁.因咳嗽、咳痰3个月于2011-01-05入院,无发热,无夜间憋喘.查体未见异常.支气管镜检查未见异常.入院后CT检查示,左肺下叶近脊柱旁示一类椭圆形软组织密度影,大小约2.8 cm×2.0 cm×4.0 cm,与隔肌胸膜关系密切,边界清,其内可见点状及斑片状致密影,CT值20～40HU,未见明显强化,纵隔内未见肿大淋巴结,考虑左肺下叶良性病变(图1A).入院5d后予手术切除,术中所见,肿瘤位于左后下纵隔近左下肺韧带处,大小约3.0 cm×4.0 cm,质软,呈囊性,包膜完整,与周围边界清晰,内含黄白色胶壮液体.术后病理:支气管源性囊肿.     

成人支气管囊肿的CT诊断

目的:探讨CT扫描对支气管囊肿的诊断价值。方法:回顾性分析13例经手术和病理证实的成人支气管囊肿患者的CT表现。结果:纵隔型支气管囊肿3例,直径4～13cm,1例呈囊性,2例为软组织密度肿块,增强后其囊内容物及囊壁均未见强化,显示为高密度囊肿。肺内型支气管囊肿10例,直径0.5～6.0cm,含气和含液囊肿分别为2例和3例,均为边界清楚的圆形或卵圆形病灶,囊壁有强化,囊内容物未见强化;软组织肿块5例,1例合并肺段隔离症,1例边缘有环形钙化,3例为边缘模糊的不规则肿块。结论:CT平扫和增强对含气和含液支气管囊肿的诊断有特异性,对软组织密度支气管囊肿的鉴别诊断较困难,增强CT扫描有助于高密度囊肿的诊断。     

肺癌误诊为纵隔囊肿一例

患者　男 ,46岁 ,因“胸闷气促 40多天 ,加重 2 0多天”入院。查体发现气管略右偏 ,左侧胸廓呼吸动度减弱 ,左侧语颤消失 ,叩诊实音 ,左肺呼吸音较右肺明显减弱 ,无干、湿鸣。胸部X线片示左侧胸腔内有一个 10cm× 10cm× 15cm的囊状阴影 ,壁光滑 ,左膈升高。胸部CT扫描示左侧胸腔前紧邻纵隔区囊状类圆形囊性病变 ,左侧有少量胸水 ,左肺萎缩 ,诊断为作者单位 :6460 0 0　四川省泸州医学院附属医院胸心外科纵隔囊肿。2 0 0 2年 2月 2 7日行左侧剖胸探查术 ,行左胸腔内巨大囊肿加左全肺、胸膜切除及肺门淋巴结清扫术。术中发现囊腔大小 11cm× 11cm× 15cm ,囊壁与胸膜、左肺不能分开 ,囊壁厚 0 .4～ 1.0cm ,囊内无分隔 ,并引流出黑褐色液体约2 30 0ml,左肺完全不张 ,质地较硬 ,肺门处 4枚淋巴结肿大。病理报告为左肺中分化腺癌 ,伴坏死囊性变 ,肺门 4枚淋巴结中 2枚有癌转移。术后恢复良好 ,3月后出现第 3腰椎椎体成骨性转移 ,给予放疗和化疗 ,随访术后 8月仍存活。讨论　由于肺癌可出现各种不典型表现 ,容易引起误诊 ,临床上近 40 %的肺癌病例被误诊为其它疾病 ,其中以误诊为肺结核、肺炎、肺部炎性假瘤等为主。而本例表现为巨大囊性病变 ,术中仍表现为囊性病变 ,却未见确切肺部实质肿瘤 ,实属少见。     

肺癌纵隔淋巴结转移核素断层显像的病理学基础

目的研究评价99mTc-MIBI SPECT术前诊断肺癌及纵隔转移淋巴结的价值.方法随机选取本院胸外科1997年3月～2000年12月间初诊"肺部阴影待查"患者100例,术前常规检查并加行99mTc-MIBI SPECT检查.男80例,女20例,平均年龄57.61±10.99岁.肺癌手术中规范清扫纵隔各组淋巴结,光学显微镜观察.计算核素断层显像之诊断敏感性,特异性,准确性,阳性预测值,阴性预测值,阳性拟然比、阴性拟然比等指标.对转移淋巴结假阴性显像,配对进行淋巴结图像分析,获取各切片转移癌细胞的面积值(μm2)及其面积百分比.结果 (1)99mTc-MIBI SPECT对支气管肺癌的诊断评价敏感性(93.67%),特异性(61.90%),准确性(87.00%),阳性预测值(90.24%),阴性预测值(72.22%),阳性拟然比(2.47)及阴性拟然比(0.10).(2)99mTc-MIBI SPECT对纵隔转移淋巴结的诊断评价敏感性(85 19%),特异性(93.62%),准确性(90.54%),阳性预测值(85.19%),阴性预测值(93.62%),阳性拟然比(13.28)及阴性拟然比(13.28)及阴性拟然比(0.16).(3)淋巴结图像分析显示淋巴结中转移癌细胞的数量同显像与否既有一定联系又非密切相关,淋巴结癌细胞数量(面积)并不是其显像与否的唯一因素.结论本组显示了SPECT在肺癌诊断鉴别和纵隔转移淋巴结预测上的独特价值,为外科手术中定向摘除淋巴结提供了定性和定量的方法.     

原发性纵隔肿瘤及囊肿的外科治疗：附54例分析

1968年4月～1987年4月,我院手术治疗原发性纵隔肿瘤及囊肿54例,均经病理证实,现报告分析如下。临床资料分析1、性别及年龄:54例中男36例,女18例男女比例为3:2。患者年龄为10～70岁,其中21～50岁的青壮年38例,占70％,10岁以下儿童3例。2、肿瘤性质及部位:54例中,良性肿瘤44例(81.48％),恶性肿瘤10例(18.52％)。     

超声支气管镜引导下经支气管针吸活检对纵隔恶性肿瘤的病理诊断

目的探讨超声支气管镜引导下的经支气管针吸活检（endobronchial ultrasound—guided transbronchial needle aspiration，EBUS—TBNA）在纵隔恶性肿瘤诊断中的价值。方法对2011年8月1日至2013年2月28日期间胸部cT诊断的148例纵隔肿瘤患者，病理诊断证实为恶性肿瘤的129例阳性患者的EBUS—TBNA检查资料总结，探讨其穿刺成功率及诊断敏感性。结果获得EBUS．TBNA阳性诊断的129例患者纵隔恶性肿瘤在扫查和活检中均能清晰显示，准确引导，118例取得阳性诊断，11例假阴性，穿刺成功率100％，诊断敏感性91．47％；无并发症发生。结论EBUS．TBNA是纵隔肿瘤确诊和新辅助化疗疗效评价的安全、实用性技术。     

纵隔胃源性囊肿1例报告

患者 ,女 ,４３岁 ,１７年前查体发现右肺门肿物 ,未作治疗。无诱因出现刺激性干咳 ,渐加重 ,夜间尤甚３个月。有时 ,吐少量白色粘稠痰液。无咳血。抗炎治疗后效果欠佳 ,渐加重且胸闷。ＰＥ :心肺（ -）。实验室检查 :ＷＢＣ :４．６×１０９／Ｌ,Ｎ :０．５２２,Ｌ:０．４７８。３次痰检阴性。Ｂ超表现 :肝、胆、胰、脾、双肾均未见异常回声像。腹膜后未见异常回声像。Ｘ线表现 :右肺中野内带心缘旁可见一５ｃｍ×５ｃｍ肿块阴影 ,其密度较均 ,中等 ,边缘尚清 ,余未见异常。ＣＴ表现 :右肺野内带与右心房前外方可见一边缘清晰 ,密度均质 ,…     

异位支气管囊肿4例临床分析

总结既往诊治4例异位支气管囊肿，分析其病因、病理及预后．探讨异位支气管囊肿的病理和临床表现。异位支气管囊肿外科手术治疗效果良好，电视胸腔镜(VATS)技术适合推广。     

先天性支气管肺囊肿的X线诊断(附16例)

目的探讨X线检查在先天性支气管肺囊肿诊断中的应用价值。方法收集资料完整的先天性肺囊肿16例,分析其发病部位和X线表现等。结果先天性支气管肺囊肿主要X线征象可分型为①单发含气囊腔,多呈薄壁圆形或卵圆形空腔,本组1例;②单发圆形或椭圆形含气液囊腔影1例,囊壁多较厚,空腔内有气液平面;③单发含液囊肿,表现为圆形椭圆形密度增高阴影,密度均匀,边缘光滑,可随呼吸而变形,本组1例。④一侧局限多发含气或含气液囊肿表现为多发大小不等的含气囊腔,囊壁光滑而薄,个别有液面,本组4例,部分极似囊状支气管扩张并发感染。⑤广泛多发含气或气液囊肿,病变广泛分布,呈蜂窝状改变,亦称为“蜂窝肺”,本组9例。其发病部位右肺6例(上叶2例,下叶2例,右侧广泛多发病灶2例),左肺7例(下叶3例,左侧广泛多发病灶4例),双肺广泛多发病灶3例。结论胸部动态X线检查和追踪观察简便易行,是诊断本病的首要检查方法,对支气管肺囊肿诊断和分型均有重要参考价值。     

颈部支气管囊肿误诊为鳃裂囊肿1例

1临床资料 患者,女,20岁,因“颈左侧肿物10年”人院。患者10年前元明显诱因发现颈左侧上部出现一无痛性包块,元明显不适症状,未在意及治疗。2年前包块缓慢增大,曾在当地医院行B超检查提示囊性肿物。现为进一步诊治,人住我科治疗。人院查体：颈左侧上段胸锁乳突肌前缘深面包块,大小约4．Ocm×3．Ocm×3．Ocm,类圆形,囊性质地,表面光滑,     

Neurenteric cyst of the posterior mediastinum

We report a case of a large posterior mediastinal neurenteric cyst in a neonate demonstrated by chest radiographs, barium swallow examination, ultrasonography and CT of the thorax. All the investigations revealed a large posterior mediastinal cystic mass with vertebral anomalies in the form of scoliosis and hemivertebra. The cyst was completely excised by a right posterolateral thoracotomy and biopsy showed the features of a neurenteric cyst. The rarity of the lesion prompted us to report this case.     

Orbital hydatid cysts: Sonographic and CT appearance

Two cases of unilateral proptosis due to orbital hydatid cysts were evaluated by ultrasound and computed tomography. Image morphology of this rare disease is presented.     

Leiomyosarcoma of the rectum: Report of three cases

Leiomyosarcoma is a malignant tumor which rarely occurs in the rectum. Three patients with leiomyosarcoma of the rectum are presented. Treatment should include wide surgical excision followed by adjuvant chemotherapy. Emphasis is placed upon computerized tomography as the method of choice for the diagnosis of recurrent disease. Recurrent tumor should be resected whenever possible.     

Treatment of Non-Small Cell Lung Cancer （NSCLC） Using CT in Combination with a PET Examination to Minimize the Clinical Target Volume of the Mediastinum

OBJECTIVE To decrease radiation injury of the esophagus and lungs by utilizing a CT scan in combination with PET tumor imaging in order to minimize the clinical target area of locally advanced non-small cell lung can-cer, without preventive radiation on the lymphatic drainage area. METHODS Of 76 patients with locally advanced non-small cell lung cancer (NSCLC), 32 received a PET examination before radiotherapy. Preventive radiation was not conducted in the mediastinum area without lymphatic metastasis, which was confirmed by CT and PET. For the other 44 patients, preventive radiation was performed in the lymphatic drainage area. PET examinations showed that the clinical target volume of the patients was decreased on average to about one third. The radiation therapy for patients of the two groups was the same, i.e. the dose for accelerated fractionated irradiation was 3 Gy/time and 5 time/week. The preventive dose was 42 to 45 Gy/time, 14 to 15 time/week, with 3-week treatment, and the therapeu- tic dose was 60 to 63 Gy/time, 20 to 21 time/week, with a period of 4 to 5 weeks. RESULTS The rate of missed lymph nodes beyond the irradiation field was 6.3% and 4.5% respectively in the group with and without PET exami- nation (P = 0.831). The incidence of acute radioactive esophagitis was 15.6 % and 45.5% in the two groups respectively (P = 0.006). The incidence of acute radiation pneumonia and long-term pulmonary fibrosis in the two groups was 6.3% and 9.1%, and 68.8% and 75.0%, respectively (P = 0.982 and P = 0.547). CONCLUSION The recurrence rate in the lymph nodes beyond the tar-get area was not increased after minimizing the clinical target volume (CTV), whereas radioactive injury to the lungs and esophageal injury was reduced, and especially with a significant decrease in the rate of acute radioactive esophagitis. The method of CT in combination with PET for minimizing the mediastinal CTV is superior to the conventional preventive radiation of the mediastinum.     

Bronchogenic Carcinoma in a Scleroderma Patient with Multiple Metastases: One Case Report

Introduction The association between pulmonary interstitial fibrosis and the development of bronchogenic carcinoma in a patient with scleroderma has been reported rarely[1]. It is hypothesized that intense epithelial proliferation that is accompanied by the .brotic process increases the occurrence of carcinomatous changes[2]. We report the case of a pa-tient who presented with 3-year history of Raynaud's phenomenon, gradual tightening of the skin which was ignored by the patient and her family members, and a 2-week history of severe respiratory dis-tress with left shoulder and upper back pain followed by the develop-ment of paraparesis. After a series of examinations, the patient was diagnosed with scleroderma and simultaneously with bronchogenic carcinoma and multiple distant metastases.     

23例细支气管肺泡癌胸部CT和HRCT分析

目的：分析细支气管肺泡癌的胸部CT和HRCT的影像学特征，提高肺泡癌的诊断水平。方法：对经病理组织学确诊的23例肺泡细胞癌的临床症状、胸部CT和HRCT的影像学特征进行回顾性分析。结果：在23例肺泡癌中，女性15例占65％，最常见症状是咳嗽。按CT和HRCT特征将病变分为局限型（10例）和弥漫型（13例）。局限型呈胸膜下分布，含磨玻璃密度结节和实性结节，有分叶、毛刺、胸膜凹陷征、空泡征和细支气管充气征等。弥漫型可见肺实变征或多发性结节改变。实变区内可见枯树枝征、蜂窝征、磨玻璃密度影，腺泡结节分布于实变影的边缘和／或非实变区的肺叶。结论：胸部CT和HRCT的特征性表现有助于肺泡癌的早期诊断。     

老年人原发性支气管肺癌86例临床分析

本文报道老年人肺癌86例,占同期收治的426例肺癌的20.19％。其中男性77例,女性9例。年龄在60～78岁之间。有吸烟史者73例,占84.88％。误诊率为67.44％。咳嗽75例(87.21％),痰血43例(50.00％),胸闷41例(47.67％),胸痛31例(36.05％)。分型中心型67例(77.91％),周围型19例(22.09％)。所有病例均经病理细胞学确诊,鳞癌57例(66.28％),未分化癌17例(19.77％),腺癌12例(13.95％)。老年人肺癌单纯化疗疗效欠佳。