胸膜间皮瘤影像学诊断(附19例报告及文献553例分析)

Image Diagnosis of Pleural Mesothelioma (Report of 19 Cases and Analysis of 553 Cases in the Literature)

目的：为提高对脑膜间皮瘤的认识，降低误诊率。材料与方法：报告经病理证实的19例，结合文献上553例进行分析。结果：恶性406例，良性78例，未分型88例。男368例，女204例。年龄4～86岁，平均39．6岁，其中30～45岁408例。胸痛337例，胸闷130例，咳嗽171例，发热85例。显示4×5×6cm～20×22×23cm大的肿块359例，胸膜不规则或弥漫性增厚71例，肋骨受侵106例，合并胸水279例，肺、骨、淋巴结转移73例。结论：（1）男多于女为4：2．2；（2）好发于30～45岁，占71．3％；（3）主要症状为胸痛（58．9％）、胸闷（22．7％）、咳嗽（30％）；（4）影像学表现：肿块（28％），弥漫性胸膜增厚（12．4％）、肋骨受侵（11．2％）。合并胸水（48．8％）；（5）恶性占71％；（6）误诊率高，占89．4％，其中误诊为结核性脑膜炎占37．5％。肺癌占25％、胸膜转移瘤占18．8％、纵隔原发性肿瘤占12．5％、肋骨原发性恶性肿瘤占6．2％。

Purpose: To increase the recognition of pleural mesothelioma and less the misdiagnosis rate. Materials and methods: 39 cases of pleural mesothelioma proved by pathological examination were reported and 553 cases in the literature were analysed. Results: 406 malignant, 78 benign, 88 undifferentcated; 368 males and 204 females, the age ranged from 4～86 years,the average of 39. 6 years. 30～45 years of 406 cases. 337 pain and 130 tightness in the chest , 171 cough, 85 fever, 359 cases 4 × 5 ×6cm ～20× 22 ×23cm of the masses, 71 pleural thickening, 106 rib destruction, 73 cases metastases in the pulmonary, bone and lymphaden , 279 pleural effusions. Conclusion: (1) Males more than females (4: 2. 2); (2) 30～45years was 71. 3%: (3) Chest pain (58. 9% ) Chest tightnes (22. 7 % ) cough (30% ); (4) Image finging was masses (28%) , pleural thickening (12. 4%),rib destruction (11. 2 % ), pieural effusions (48. 8 % ); (5 ) malignant was 71 %; (6) misdiagnosis rate was 89. 4 %