胸壁肿瘤、肿瘤样病变的CT分析

CT diagnosis of tumors or tumor-like lesions of chest wall

目的分析胸壁肿瘤和肿瘤样病变的CT表现,提高对胸壁肿物的诊断水平。方法回顾性分析29例经手术或穿刺病理证实的胸壁肿瘤和肿瘤样病变的CT表现,全部病例均行螺旋CT平扫,其中15例加增强扫描。结果根据胸壁肿瘤及肿瘤样病变的CT表现分型:位于肋骨内侧突向肺野的软组织肿块(Ⅰ型):胸膜转移瘤7例,恶性胸膜间皮瘤3例,胸膜结核2例;以肋骨、胸骨骨质破坏为主要表现的病变(Ⅱa型):肋骨、胸骨转移瘤共6例,肋骨多发性骨髓瘤、嗜酸性肉芽肿、骨纤维异常增殖症各2例;发生于肋间隙的软组织肿块(Ⅱb型):肋间神经鞘瘤2例,脂肪瘤1例;发生于肋骨、胸骨外侧胸壁软组织肿块(Ⅲ型):腋窝淋巴结转移瘤、乳腺癌各1例。结论对于胸壁肿瘤或肿瘤样病变的CT诊断,应先将其分型,再细致观察其影像学特征,从常见病变入手,逐一排除,以提高其诊断正确率。

Objective To study the imaging features of tumors or tumor-like lesions of chest wail so as to improve diagnosis accuracy of the disease. Methods The CT materials of 27 patients with tumors or tumor-like lesions of chest wail which were proved by surgery or histopathology were analyzed retrospectively. CT plain scan were performed in all the cases, 15 cases of them were received both CT plain scan and contrast CT scan. Results According to their CT features, the lesions were divided into 4 types. Itype： the mass protruded from chest wall into lung field, including pleural metastasis 7 cases, malignant pleurai mesothelioma 3 cases and pleural tuberculosis 2 cases. Ⅱa type： the lesions principally presented destruction of the ribs and sternum, including costal or sternal metastasis 6 cases, costal multiple myeloma 2 cases, costal eosinophilic granuloma 2 cases, fibrous dysplasia of rib 2 case. Ⅱb type： the soft tissue mass located in intercostal space, including neurilemmoma of intercostal nerves 2 cases and lipoma 1 case. Ⅲ type： the chest wail mass was located outside the ribs and sternum, including breast carcinoma 1 case and metastatic tumor of axillary nodes 1 case. Conclusion When diagnosing the tumors or tumor-like lesions of the chest wail, the first step is to decide which type the lesion belongs to. The second step is to analyze the CT feathers carefully, then eliminate the impossible diagnosis step by step from the common lesions and get the most possible diagnosis.