先天性肺囊性腺瘤样畸形的CT表现

目的 探讨小儿先天性肺囊性腺瘤样畸形的影像学表现,提高对该病的认识.方法 11例小儿先天性肺囊性腺瘤样畸形均经手术、病理证实,术前胸部CT平扫,7例病变区加做高分辨率CT扫描.结果 双肺受累3例,右肺受累5例,左肺受累3例,CT表现单个或多个含气囊腔(直径>2 cm)6例,多发蜂窝样囊腔(直径<1 cm)5例,囊内含气9例,2例囊内含少量液体,7例伴有不同程度肺气肿.5例合并纵隔疝,1例合并先天性肺隔离症.所有病变有一定的占位效应.结论 先天性肺囊性腺瘤样畸形的CT表现有一定特征可为该病诊断提供可靠信息.     

婴儿先天性肺部囊肿性病变的X线征象

作者报告3例婴儿的先天性肺部囊肿性病变,包括孤立性支气管肺囊肿、腺瘤样囊肿性畸形及先天性大叶性肺气肿各1例,并讨论了其X 线征象及鉴别诊断。婴儿先天性肺部囊肿性病变常呈急性发作,而临床症状大多呈非特异性,故X 线诊断具有重要意义。其X 线表现如下:     

先天性肺囊性腺瘤样畸形的CT表现

目的:探讨先天性肺囊性腺瘤样畸形的CT表现。方法:回顾性分析15例先天性肺囊性腺瘤样畸形的CT表现,并与手术、病理结果对照。结果:15例先天性肺囊性腺瘤样畸形CT表现为大囊型10例、小囊型5例。病理检查见囊腔为异常增生的管腔或腺样结构,壁内被覆假复层纤毛柱状上皮8例,纤毛柱状及立方上皮7例;囊周可见平滑肌及弹性纤维环绕,15例囊壁内均未见软骨成分及腺体。结论:CT检查是诊断先天性肺囊性腺瘤样畸形的可靠方法,根据CT表现可推测其病理分型。     

先天性肺囊肿性病变60例临床病理观察

目的探讨先天性肺囊肿性病变临床病理特点以及与肺癌的关系。方法对60例外科手术切除先天性肺囊肿性病变进行临床病理学分析,并进行文献复习。结果支气管源性肺囊肿49例（81．7％）;先天性囊性腺瘤样畸形5例（8．3％）,其中1例伴发粘液性原位腺癌（国际肺癌研究协会／美国胸科学会／欧洲呼吸学会国际多学科肺腺癌分类2011年版,简称新版）,1例伴发鳞癌;肺隔离症6例（10．0％）。结论支气管源性囊肿是先天性肺囊肿性病变最常见的囊肿类型,先天性囊性腺瘤样畸形（CCAM）最少见。CCAMI型常伴有粘液细胞化生,粘液细胞增生可能属于浸润性粘液腺癌（新版分类．过去的粘液型细支气管肺泡癌）癌前病变。     

胎儿先天性肺囊性腺瘤样畸形的MRI诊断

目的:探讨MRI对胎儿先天性肺囊性腺瘤样畸形(CCAM)的诊断价值。方法:分析34例经产后病理证实的CCAM的MRI表现。结果:34例MRI扫描示,病灶位于左侧12例,右侧22例。出生后经胸部CT增强扫描比较,1例未发现病灶,2例误诊为先天性肺隔离症,1例误诊为先天性肺气肿。结论:MRI能很好显示胎儿CCAM的位置和形态,对该病的诊断具有较高价值。     

儿童腹部脏器外囊性病变的的CT诊断

目的:探讨CT对儿童腹部脏器外囊性病变的诊断价值。方法:回顾性分析35例经手术病理证实的儿童腹部脏器外囊性病变的CT表现。结果:淋巴管瘤11例,其中肠系膜淋巴管瘤7例,腹膜后淋巴管瘤4例,肿块形态不规则,囊壁菲薄,张力低,边缘清楚,其中8例可见线条状分隔,8例行增强扫描均未见强化。肠系膜囊肿8例,均为先天性肠系膜囊肿,形态较规则,边缘清晰锐利,囊壁薄而均匀,6例为单房,2例为多房,2例囊壁呈线状强化,6例囊壁无强化。大网膜囊肿4例,长径均大于6cm,病灶位于腹腔前方,紧贴前腹壁,形态不规则。肠重复畸形6例,均与肠管关系密切,4例呈管状,2例呈类圆形,4例囊壁可见强化。囊性畸胎瘤4例,3例位于腹膜后,1例位于骶尾部,2例囊壁可见线条状钙化。腹部脓肿2例,呈不规则液性密度区,囊壁较厚且厚薄不均,增强时明显强化。结论:CT对腹部脏器外囊性病变的形态特征、大小范围及与周围组织结构的关系显示清晰,能对大多数病变作出准确诊断。     

儿童先天性肺囊性腺瘤样畸形的影像学诊断

目的探讨儿童先天性肺囊性腺瘤样畸形的影像学表现,提高对本病的认识。方法搜集23例经病理证实的儿童先天性肺囊性腺瘤样畸形患者的X线和CT资料,分析影像学特点,并与组织病理学资料作对照分析。结果 18例患儿胸片表现异常,其中气胸样改变9例,多囊状改变7例,肿块样实变1例,肺炎样改变1例,其中合并肺纵隔疝9例,出现患侧肺气肿16例;5例患儿胸片表现正常。CT表现为巨大囊腔7例,类圆形薄壁囊腔7例,蜂窝样小囊8例,肿块样改变1例,其中,3例可见液平面,右肺受累11例,左肺受累12例;Stocker分型I型15例,II型7例,III型I例。结论CT检查可作为诊断儿童先天性肺囊性腺瘤样畸形的可靠方法。     

先天性肺囊性腺瘤样畸形CT表现

目的分析先天性肺囊性腺瘤样畸形的CT表现及病理分型,以提高对该病诊断水平。方法回顾性分析9例经手术病理证实为先天性肺囊性腺瘤样畸形的临床资料及CT表现,并与病理结果对照。结果 9例患者均为单侧肺单叶受累,其中右肺5例(上叶2例、下叶3例),左肺4例(上、下叶各2例)。根据CT分型标准,大囊型6例,小囊型3例;大囊型表现为单或多个含气大囊及周围不规则小囊,其中至少有一个囊腔直径3.0cm;小囊型表现为数目众多、大小相近的蜂窝样小囊腔,最大囊直径约为0.3~1.9cm。6例大囊型对应病理表现为Stocker I型,3例小囊型为Stocker II型。结论先天性肺囊性腺瘤样畸形CT表现具有一定的特征性,CT检查能准确反应病变分布范围及其形态特征,还可根据CT特征推测其病理类型。     

儿童先天性肺囊性腺瘤样畸形Ⅲ型的CT表现及鉴别诊断

目的探讨CT在儿童先天性肺囊性腺瘤样畸形(CCAM)Ⅲ型诊断与鉴别诊断中的应用价值。方法回顾性分析经手术切除、病理证实为CCAMⅢ型5例患儿的胸部CT影像学特点,并与病理结果进行对照,术前5例均行胸部CT平扫及增强扫描。结果 5例先天性肺囊性腺瘤样畸形的CT表现为囊实型3例,实质型2例,均为单发;右肺受累4例,左肺受累1例;病理检查为异常增生的管腔或腺瘤样结构。结论 CT检查能够清晰的显示CCAMⅢ型的病变、范围及周围关系,对其临床治疗及鉴别诊断起到积极作用,是诊断CCAMⅢ型的重要手段。     

胎儿肺囊性病变的磁共振表现

【摘要】目的：探讨产前MRI在诊断胎儿肺囊性病变中的应用价值。方法：回顾性分析30例产前诊断为胎儿肺囊性病变（主要为先天性肺气道畸形、肺隔离症、支气管源性囊肿、先天性支气管闭锁）的MRI表现，并与超声、随访结果进行对照分析。结果：30例病变MRI定位于左肺18例，右肺12例；诊断为先天性肺气道畸形23例，肺隔离症5例，左侧胸腔积液伴左肺信号不均1例，先天性肺气道畸形合并肺隔离症1例；均表现为快速稳态场回波序列或单次激发快速自旋回波序列高信号、快速翻转恢复运动抑制序列低信号。出生后手术病理证实的16例病灶中，7例先天性肺气道畸形，边缘多呈分叶状，内部多为大小不一的囊；4例肺隔离症均位于左肺下叶，3例可见体循环血管分支进入病灶；3例支气管源性囊肿中部分病变与气管或支气管关系密切；1例纵隔淋巴管畸形，向纵隔内胸腺前后间隙延伸，呈爬行性生长；1例先天性支气管闭锁，呈团状，边缘光整，内部信号均匀；以病理结果为标准，MRI产前定位准确率为87.50%，定性准确率为62.50%，而超声产前定位准确率为87.50%，定性准确率为43.75%。3例在产前超声随访中病灶自行消退；11例在随访中的病灶未自行消退且未行手术治疗。结论：产前MRI是胎儿超声有效的补充手段，能多方位地显示胎儿肺囊性病变，有助于鉴别诊断。     

先天性支气管囊肿的影像诊断

目的：探讨先天性支气管囊肿的影像学表现特征。方法：回顾性分析24例经手术病理证实的先天性支气管囊肿的 CT 和 MRI 图像。18例行 CT 增强扫描,6例行 CT 平扫,其中5例加行 MRI 平扫,2例行 PET-CT 扫描。结果：24例先天性支气管囊肿包括肺内型5例和纵隔型19例。病灶呈圆形、椭圆形、“D”字形或分叶形;11例病变位于典型部位,包括右侧气管7例和隆突下4例;13例病变位于不典型部位,包括前纵隔4例、食管旁2例、脊柱旁1例、心包旁1例和两下肺5例。以 CT 值20 HU 为囊、实性病变分界值,5例为囊性（CT 值＜20 HU）,19例为实性（CT 值＞20 HU）;边缘钙化3例;内部分层4例。病变 T1 WI 呈低、等或高信号,T2 WI 均呈显著高信号,3例显示分层。24例中误诊10例,术前诊断符合率为58．3％。结论：先天性支气管囊肿的 CT 和 MRI 表现特征有助于其诊断和鉴别诊断,并指导进一步的治疗。     

CT and histopathological correlation of congenital cystic pulmonary lesions: a common pathogenesis?

AIM: To determine whether similarities exist in both the imaging and histopathological features of congenital cystic lung lesions and whether a more appropriate classification would be to adopt the theory of "malinosculation". MATERIAL AND METHODS: From the histopathology and computed tomography (CT) database, 24 patients (16 male, median age 3 years) with congenital cystic lung lesions were identified. CT studies were reviewed for site and characteristics of the lesions, parenchymal features, bronchial anatomy, and the presence of a feeding systemic vessel. Individual histopathological parameters were also correlated with CT data. RESULTS: There were five type 1 congenital cystic adenomatoid malformations (CCAMs), six type 2 CCAMs, one type 4 CCAM, one bronchial atresia, four pleuropulmonary blastomas (PPBs), and seven sequestrations. CCAMs (types 1, 2 and 4), sequestrations and PPBs appeared as cystic lesions, with cyst size less than 2cm in type 2 CCAMs. Sequestrations were distinguished radiologically from CCAMs by systemic vessels. Reduced pulmonary attenuation was seen in bronchial atresia, type 2 CCAMs and in sequestrations. Histopathology showed an overlap in entities with sequestrations demonstrating CCAM type 2 histology and segmental atresia noted in both type 2 CCAMs and sequestrations. PPBs showed histological and imaging overlap with type 4 CCAMs and were distinguished on histology by the presence of blastematous proliferation. CONCLUSIONS: This study demonstrates overlap in the CT appearances of congenital cystic lesions. The similarity in CT and histopathology findings across the spectrum of developmental lesions supports the hypothesis of a common aetiology.     

Asymptomatic adults with isolated, unilateral right pulmonary vein atresia: multidetector CT findings

We report two cases of a very rare congenital anomaly, i.e. isolated unilateral pulmonary vein atresia. The patients were asymptomatic and the diagnosis was made using multidetector CT (MDCT), which also showed cyst formation in the right lung. Asymptomatic adult cases or association with cystic lung lesions have never been reported in this condition before.     

纵隔囊性病变的CT诊断及鉴别诊断

目的探讨纵隔囊性病变的CT诊断及鉴别诊断.方法本组共12例,均经手术及病理证实,男9例,女3例,年龄17～55岁.12例均行CT平扫,其中5例行CT增强扫描.回顾性分析其CT表现.结果纵隔囊性病变中,胸腺囊肿3例,淋巴管瘤2例,支气管囊肿7例.3例胸腺囊肿中,2例位于前纵隔,1例位于左颈及前纵隔;2例淋巴管瘤,1例位于中纵隔,1例位于左颈及前、中纵隔.7例支气管囊肿,均位于中纵隔气管及支气管右旁区域.结论CT平扫结合增强扫描,不仅准确显示纵隔囊性病变的位置和形态,而且清楚显示其与邻近结构的关系,因此结合临床资料及发病部位,对于纵隔囊性病变一般能够达到术前定性诊断.     

Cystic Lung Disease: a Comparison of Cystic Size, as Seen on Expiratory and Inspiratory HRCT Scans

Objective

To determine the effects of respiration on the size of lung cysts by comparing inspiratory and expiratory high-resolution CT (HRCT) scans.

Materials and Methods

The authors evaluated the size of cystic lesions, as seen on paired inspiratory and expiratory HRCT scans, in 54 patients with Langerhans cell histiocytosis (n = 3), pulmonary lymphangiomyomatosis (n = 4), confluent centrilobular emphysema (n = 9), paraseptal emphysema and bullae (n = 16), cystic bronchiectasis (n = 13), and honeycombing (n = 9). Using paired inspiratory and expiratory HRCT scans obtained at the corresponding anatomic level, a total of 270 cystic lesions were selected simultaneously on the basis of five lesions per lung disease. Changes in lung cyst size observed during respiration were assessed by two radiologists. In a limited number of cases (n = 11), pathologic specimens were obtained by open lung biopsy or lobectomy.

Results

All cystic lesions in patients with Langerhans cell histiocytosis, lymphangiomyomatosis, cystic bronchiectasis, honeycombing, and confluent centrilobular emphysema became smaller on expiration, but in two cases of paraseptal emphysema and bullae there was no change.

Conclusion

In cases in which expiratory CT scans indicate that cysts have become smaller, cystic lesions may communicate with the airways. To determine whether, for cysts and cystic lesions, this connection does in fact exist, paired inspiratory and expiratory HRCT scans are necessary.     

腹部巨大囊性病变的CT分析

目的探讨腹部巨大囊性病变的CT表现及其诊断价值。方法搜集经手术病理证实的腹部巨大囊性病变28例,回顾性分析其CT。结果28例中,卵巢囊肿4例,卵巢浆液性和黏液性囊腺瘤各1例,肾重度积水3例,肾囊肿2例,输尿管囊肿2例,胰腺假性囊肿3例,脾脏囊肿3例,先天性胆总管囊肿2例,肝脏囊肿1例,肠系膜囊肿和肠系膜淋巴管囊肿各1例,脐尿管囊肿1例,腹膜后脂肪肉瘤囊性变1例,腹膜不成熟畸胎瘤1例,囊性转移癌1例。腹部囊性病变92.9%为良性,各种囊性病变有其一定的发病部位和其特征性的CT表现。结论CT是腹部囊性病变定位、定性诊断的重要影像学手段。     

髂骨原发囊样骨肿瘤及瘤样病变的影像学诊断

目的:分析髂骨囊样骨肿瘤及肿瘤样病变的影像学表现。方法:回顾性分析经穿刺或/和手术病理证实的46例髂骨囊样骨肿瘤及肿瘤样病变影像学表现。46例全部行X线片检查,38例行CT检查,20例行MRI检查(增强16例)。结果:46例中骨肿瘤29例,其中良性肿瘤12例(骨巨细胞瘤4例,内生软骨瘤、软骨母细胞瘤各2例,血管瘤、骨母细胞瘤、骨样骨瘤、软骨黏液样纤维瘤各1例),恶性肿瘤17例(恶性巨细胞瘤、骨恶性纤维组织细胞瘤各1例,软骨肉瘤、淋巴瘤各4例,骨肉瘤7例),肿瘤样病变17例(单纯性骨囊肿1例,邻关节骨囊肿、动脉瘤样骨囊肿、嗜酸性肉芽肿各2例,骨纤维异常增生症10例)。发病部位为髂翼39例,髋臼7例。病变主要表现为髂骨囊样骨质破坏,呈膨胀性改变30例,硬化环形成24例,病变内见钙化灶14例,软组织肿块20例。结论:常见的髂骨囊样骨肿瘤和肿瘤样病变一般都具有某些特征性的CT表现,必要时综合X线、MRI表现,可提高定性诊断符合率。     

卵巢巨型囊性病变的CT诊断(附13例分析)

目的：评价卵巢巨型囊性病变的CT定位、定性诊断价值。方法：回顾性分析经手术、病理证实的卵巢巨型囊性病变13例，其中恶性囊性病变6例、良性囊性病变7例。结果：13例卵巢巨型囊性病变的良恶性CT表现和定位与文献报道有一定的差距，其中4例定位错误，3例良性病变误诊为恶性。2例恶性病变误诊为良性。定位、定性的准确率明显低于文献报道。文献报道囊壁内外结节是诊断良恶性的标志之一，但本文3例良性病变的囊壁及间隔出现结节，1例无结节囊性病变术后病理证实为恶性。结论：巨型囊性病变CT定位可出现误差。结合B超检查可提高定位诊断，当囊壁出现结节时，观察囊壁结节的多少是诊断良恶性的标志之一。     

Pulmonary lymphangioleiomyomatosis: high-resolution CT findings

Lymphangioleiomyomatosis (LAM) of the lung is a very rare disease. There are obvious discrepancies in the literature concerning the appearance of LAM on CT scans of the lung. This study adds the imaging findings of 11 patients and demonstrates how the imaging findings changed over time in four patients. Twenty-two CT examinations, and radiographs that had been obtained close to the CT examinations, of 11 patients with LAM confirmed by open lung biopsy were retrospectively evaluated with particular attention to the size of cystic lesions and wall thickness. Furthermore the CT scans were analysed for the type of pulmonary infiltration process and its distribution, presence or absence of pleural effusion, pneumothorax and lymph node enlargement. Clinical and CT follow-up studies were available in four patients. The CT scans revealed an increase in the interstitial pattern in all patients. Architectural distortion was seen in two patients and cystic lesions were present in all. The size of the cysts varied from small lesions to bullous emphysema. The cystic lesions revealed a wall thickness up to 2 mm but a wall was not perceptible in all. Pneumothorax was seen in only two patients; pleural effusion was seen in two patients. CT examination of patients with LAM reveals neither a uniform nor a pathognomonic appearance. In the early stages of LAM or in cases with interstitial changes the differential diagnosis of centrilobular emphysema or idiopathic pulmonary fibrosis seems to be more difficult than most authors believe. Received: 28 July 1997; Revision received: 20 October 1997; Accepted: 25 March 1998