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病变定位：纵隔还是肺内？

2018-06-07 佚名 影像园

纵膈肺内
关注

患者，男，77岁，咳嗽咳痰30年，加重伴喘憋、胸痛1月

【所属科室】

呼吸科

【基本资料】

患者，男，77岁

【主诉】

咳嗽咳痰30年，加重伴喘憋、胸痛1月

【现病史】

患者30年前开始出现间断咳嗽咳痰，为白色黏痰，量中等，常于着凉感冒后出现，无发热，无胸闷憋气及呼吸困难。此次1月前无明显诱因开始出现间断胸闷憋气，咳嗽咳痰，痰为黄白色黏痰，伴前胸及后背部偶有疼痛，与活动无关，持续时间10分钟以上，可自行缓解，胸部CT提示肺部阴影，门诊给予化痰对症治疗，患者仍自觉间断咳痰及胸闷症状。

【影像图片】

















【讨论问题】


【医学影像APP用户讨论】

评论：右肺下叶主支气管背侧见欠规则软组织密度肿块影，边界欠清，病变大部分位于肺内，联通纵隔，肺动脉分支被包绕。右主支气管变窄，纵膈内可见淋巴结影。增强扫描病变呈轻度强化。
 
【结果】

（右下肺肿物）肺非小细胞肺癌，结合免疫组化结果考虑鳞状细胞癌。
 
【病例小结】

肺癌为目前全世界最常见的导致死亡的恶性肿瘤性病变之一，其中非小细胞肺癌(NSCLC)约占全部肺癌的80％- 85％。评估非小细胞肺癌患者的局部病变情况或远处淋巴结转移以及远道器官转移主要依靠TNM分期和临床分期，即通过原发肿瘤(T)的部位和大小、区域淋巴结(N)受累及范围和有无远处转移(M)来描述肺癌的解剖学分期。CT扫描是目前术前评估肺癌T分期较常用的方法，通过CT测量肿瘤最大径可以做出较为准确的T分期。CT是常用的无创性评价纵隔淋巴结转移情况的检查方法。淋巴结转移的CT标准包含大小、形态、位置、密度和边缘及强化方式等的改变，目前认为大小是评估术前分期最重要的标准，以淋巴结短轴≥l cm作为转移性淋巴结的阈值。新版M分期分为胸腔内转移与胸腔外转移，胸腔内转移包括胸膜转移、心包转移及对侧肺内出现转移性结节，常见的胸外转移部位有肾上腺、骨、脑、肝等。目前CT检查可以较好的评估肺癌胸腔内外侵犯程度及范围，但不能发现早期的肾上腺转移，因为在非小细胞肺癌的肿块中约2／3都是良性腺瘤。

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  1. [GetPortalCommentsPageByObjectIdResponse(id=322277, encodeId=75a73222e760, content=典型病例分析.学习了., beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=60791943465, createdName=1e0f8808m18(暂无匿称), createdTime=Thu Jun 07 16:55:18 CST 2018, time=2018-06-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=322270, encodeId=f9793222e01c, content=了解一下.谢谢分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=35998606, createdName=bapan0434, createdTime=Thu Jun 07 15:27:25 CST 2018, time=2018-06-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=322264, encodeId=7656322264a3, content=学习学习了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKibA62IFMeUJEmSyIe8DvYFeERuOsfrRd8iano7nENqQU1dRR3tqeQOUL3eqgYgEZRT2t2iaEsib0JEw/132, createdBy=66771693911, createdName=易水河, createdTime=Thu Jun 07 15:20:51 CST 2018, time=2018-06-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=322256, encodeId=637d32225660, content=了解一下.谢谢分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2019/12/23/2f51002e1349ccda5be11c1eea1e1e60.jpg, createdBy=a22097948, createdName=天地飞扬, createdTime=Thu Jun 07 14:45:36 CST 2018, time=2018-06-07, status=1, ipAttribution=)]
    2018-06-07 1e0f8808m18(暂无匿称)

    典型病例分析.学习了.

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=322277, encodeId=75a73222e760, content=典型病例分析.学习了., beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=60791943465, createdName=1e0f8808m18(暂无匿称), createdTime=Thu Jun 07 16:55:18 CST 2018, time=2018-06-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=322270, encodeId=f9793222e01c, content=了解一下.谢谢分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=35998606, createdName=bapan0434, createdTime=Thu Jun 07 15:27:25 CST 2018, time=2018-06-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=322264, encodeId=7656322264a3, content=学习学习了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKibA62IFMeUJEmSyIe8DvYFeERuOsfrRd8iano7nENqQU1dRR3tqeQOUL3eqgYgEZRT2t2iaEsib0JEw/132, createdBy=66771693911, createdName=易水河, createdTime=Thu Jun 07 15:20:51 CST 2018, time=2018-06-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=322256, encodeId=637d32225660, content=了解一下.谢谢分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2019/12/23/2f51002e1349ccda5be11c1eea1e1e60.jpg, createdBy=a22097948, createdName=天地飞扬, createdTime=Thu Jun 07 14:45:36 CST 2018, time=2018-06-07, status=1, ipAttribution=)]
    2018-06-07 bapan0434

    了解一下.谢谢分享!

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=322277, encodeId=75a73222e760, content=典型病例分析.学习了., beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=60791943465, createdName=1e0f8808m18(暂无匿称), createdTime=Thu Jun 07 16:55:18 CST 2018, time=2018-06-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=322270, encodeId=f9793222e01c, content=了解一下.谢谢分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=35998606, createdName=bapan0434, createdTime=Thu Jun 07 15:27:25 CST 2018, time=2018-06-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=322264, encodeId=7656322264a3, content=学习学习了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKibA62IFMeUJEmSyIe8DvYFeERuOsfrRd8iano7nENqQU1dRR3tqeQOUL3eqgYgEZRT2t2iaEsib0JEw/132, createdBy=66771693911, createdName=易水河, createdTime=Thu Jun 07 15:20:51 CST 2018, time=2018-06-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=322256, encodeId=637d32225660, content=了解一下.谢谢分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2019/12/23/2f51002e1349ccda5be11c1eea1e1e60.jpg, createdBy=a22097948, createdName=天地飞扬, createdTime=Thu Jun 07 14:45:36 CST 2018, time=2018-06-07, status=1, ipAttribution=)]
    2018-06-07 易水河

    学习学习了!

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=322277, encodeId=75a73222e760, content=典型病例分析.学习了., beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=60791943465, createdName=1e0f8808m18(暂无匿称), createdTime=Thu Jun 07 16:55:18 CST 2018, time=2018-06-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=322270, encodeId=f9793222e01c, content=了解一下.谢谢分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=35998606, createdName=bapan0434, createdTime=Thu Jun 07 15:27:25 CST 2018, time=2018-06-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=322264, encodeId=7656322264a3, content=学习学习了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKibA62IFMeUJEmSyIe8DvYFeERuOsfrRd8iano7nENqQU1dRR3tqeQOUL3eqgYgEZRT2t2iaEsib0JEw/132, createdBy=66771693911, createdName=易水河, createdTime=Thu Jun 07 15:20:51 CST 2018, time=2018-06-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=322256, encodeId=637d32225660, content=了解一下.谢谢分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2019/12/23/2f51002e1349ccda5be11c1eea1e1e60.jpg, createdBy=a22097948, createdName=天地飞扬, createdTime=Thu Jun 07 14:45:36 CST 2018, time=2018-06-07, status=1, ipAttribution=)]
    2018-06-07 天地飞扬

    了解一下.谢谢分享!

    0

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