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纵隔淋巴结肿大（转移、结节病）丨影像表现

2022-10-23 熊猫放射 熊猫放射

关注

多系统慢性炎症性疾病，以非干酪性肉芽肿为特征最佳诊断线索：双肺门对称性及右侧气管旁肿大淋巴结CT：相应区域淋巴结肿大，可见钙化。

结节病丨影像表现

转移性疾病，淋巴结肿大

Metastatic Disease, Lymphadenopathy

影像表现：

最佳诊断线索：CT上胸部淋巴结≥10mm，PET/CT上FDG摄取增高

CT：淋巴结增大，短径≥10mm；低密度，有强化，有/无钙化；胸内/外恶性肿瘤的特异性淋巴引流通路

PET/CT：淋巴结内FDG摄取增高，容易发现肺癌淋巴结转移、食管癌局部淋巴结转移；假阳性：肉芽肿性疾病、感染/炎症

鉴别诊断

  • 淋巴瘤

  • 结节病

(左) 转移性黑色素瘤患者，PA胸片显示右上纵隔巨大软组织肿块。

(右) 同一患者的轴位CECT显示纵隔气管前区巨大软组织肿块，密度不均，气管明显受压，纵隔血管移位。这类肿块为广泛融合的转移性纵隔增大淋巴结。

(左) 原发性肺癌并纵隔淋巴结转移，PET/CT显示右肺结节和气管右旁淋巴结FDG代谢增高，分别对应原发性和转移性肺癌。

(右) 图示晚期恶性肿瘤的典型特征，表现为双肺多发转移，双侧恶性胸腔积液，肺门和纵隔淋巴结转移。

(左) 肺癌患者，左肺较大软组织肿块，密度较低，纵隔内左、右气管旁和主肺动脉窗区可见融合性的软组织密度灶。双侧胸腔少量积液。

(右) 同一患者，双侧锁骨上淋巴结肿大，为N3型，IIIB期，排除手术切除的可能。

(左) 骨肉瘤患者，气管右旁、右肺门和隆突下淋巴结增大并钙化。结肠和卵巢的粘液腺癌、甲状腺癌和骨肉瘤可导致钙化性淋巴结转移。

(右) 转移性乳腺癌患者，PET/CT显示隆突下淋巴结FDG摄取，胸膜转移灶FDG摄取增高。

(左) 转移性肝细胞癌患者，CECT显示纵隔淋巴结多发转移，密度不均。胸外恶性肿瘤的淋巴结转移远不如胸内恶性肿瘤的淋巴结转移常见。

(右) 原发性左肺上叶肺癌，并主肺动脉窗淋巴结转移。

结节病，淋巴结肿大

Sarcoidosis, Lymphadenopathy

概述：

  • 多系统慢性炎症性疾病，以非干酪性肉芽肿为特征

最佳诊断线索：双肺门对称性及右侧气管旁肿大淋巴结

CT：相应区域淋巴结肿大，可见钙化

鉴别诊断：

  • 淋巴瘤

  • 转移性疾病

  • 感染

  • 尘肺

(左) 结节病患者，PA胸片显示双肺门增大和气管右旁增厚，代表淋巴结增大。

(对) 同一患者，侧位片显示双肺门和隆突下淋巴结增大。约95%的结节病患者发生胸内淋巴结增大。大约90%的病例发生肺门/纵隔淋巴结增大和肺受累。

(左) 双肺门、气管右旁和隆突下淋巴结增大。

(对) 2期结节病患者，双肺门、气管右旁和隆突下多发肿大淋巴结，可见点状钙化。结节病的特征是增大淋巴结的对称性分布，可见双肺簇状分布的肺结节。

(左) 长期结节病患者，纵隔多发增大淋巴结并钙化。

(右) 结节病，多发纵隔及肺门增大淋巴结，外周壳状钙化在胸部CT上显示清晰。淋巴结钙化的发生率随疾病持续时间增加。

(左) 结节病，X线片显示双肺门淋巴结肿大。

(右) 结节病，CECT显示胸内广泛淋巴结增大，影响气管右旁、血管前、前纵隔和双侧内乳淋巴结。

(左) 轴位NECT显示左、右气管旁和血管前淋巴结无明显增大，内见钙化。

(右) 同一患者，PET/CT显示这些淋巴结FDG摄取增加。PET/CT不能区分结节病相关的淋巴结肿大与继发于淋巴瘤、转移性疾病、感染或尘肺的淋巴结肿大。然而，PET/CT可以用来监测治疗反应。

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    2022-10-23 delianjihui

    留存学习

    0

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    2022-10-23 delianjihui

    转发学习

    0

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    2022-10-23 delianjihui

    感谢分享

    0

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    2022-10-23 沙丁胺醇

    如果能注明分区可能会更好一点

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=2095662, encodeId=fb912095662c8, content=留存学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a5281475204, createdName=delianjihui, createdTime=Sun Oct 23 22:32:43 CST 2022, time=2022-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2095661, encodeId=ec8a20956617d, content=转发学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a5281475204, createdName=delianjihui, createdTime=Sun Oct 23 22:30:43 CST 2022, time=2022-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2095660, encodeId=16a02095660b6, content=感谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a5281475204, createdName=delianjihui, createdTime=Sun Oct 23 22:30:26 CST 2022, time=2022-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2095645, encodeId=be7720956456b, content=如果能注明分区可能会更好一点, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/01/06/2179198d1de3844a98c488d27acb08be.jpg, createdBy=fc172165616, createdName=沙丁胺醇, createdTime=Sun Oct 23 22:09:54 CST 2022, time=2022-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2095639, encodeId=9f5f209563965, content=学习了，谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7c592194322, createdName=1209e435m98(暂无昵称), createdTime=Sun Oct 23 21:30:34 CST 2022, time=2022-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2095579, encodeId=b8de20955e9ad, content=虽然还是有点懵（自身原因），但还是获得了许多知识。, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d1b68332029, createdName=ms3000000112897333, createdTime=Sun Oct 23 18:46:29 CST 2022, time=2022-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2095562, encodeId=b9ef20955620e, content=认真学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6EF3hKja8nER8RMzxQdria9eCYFhgLTLsDOeqnvIYdeLDz5eP6EnicLuE5gibiawgno4zUA0jAR7Nbtp2llQ9fs3Mk/0, createdBy=278f1986883, createdName=医鸣惊人, createdTime=Sun Oct 23 17:53:42 CST 2022, time=2022-10-23, status=1, ipAttribution=)]
    2022-10-23 1209e435m98(暂无昵称)

    学习了，谢谢分享

    0

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    2022-10-23 ms3000000112897333

    虽然还是有点懵（自身原因），但还是获得了许多知识。

    0

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    2022-10-23 医鸣惊人

    认真学习了

    0