前上纵隔巨大肿块的CT诊断（附46例分析）

Diagnosis of Huge Lumps Originated from Anterosuperior Mediastinum by Multi-slice CT

目的 分析发生于前上纵隔巨大肿块的多层螺旋CT表现,提高CT诊断水平.方法 回顾性分析经病理证实的46例前上纵隔巨大肿块（最大直径＞5.0cm）的多层螺旋CT表现.纵隔内肿块36例,其中良性胸腺瘤11例,恶性胸腺瘤8例,淋巴瘤10例,畸胎瘤5例,神经内分泌肿瘤1例,肠源性囊肿1例;纵隔旁肿块10例,其中纵隔型肺癌9例,炎性假瘤1例.结果 前上纵隔肿块定位诊断的CT征象有：肿块中心投影是否在纵隔结构内;肿块近纵隔侧边缘是否光整;肿块近肺侧边缘是否光整;纵隔内大血管是否受压移位;是否有支气管狭窄、胸膜增厚粘连、胸腔积液、炎症等肺内继发性改变表现.各类前上纵隔肿块的CT表现有一定特点.结论 依据CT征象,可以对发生于前上纵隔的巨大肿块作出定位及初步定性诊断.

Objective To analyse the multi-slice CT characters of huge lumps originated from anterosuperior mediastinum and improve diagnosis level. Methods 46 cases of pathologically proved huge lumps（maximum diameter 〉 5.0cm） from anterosuperior mediastinum were retrospectively analyzed.36 cases originated from mediastinum, including the benign thymoma（n=1 1）,malignant thymoma（n=8）,lymphoma（n=10）,teratoma（n=5）,neuroendocrine tumor（n= 1）,enterogenous cyst（n= 1）;10 cases originated from the lungs,including lung cancer（n=9）,inflammatory pseudotumor（n= 1）. Results The valuable signs of differential diagnosis by multi-slice CT included：location of the lump center;the inner lump with mediastinal interval;the lateral lump with pneumal interval;the change of the outline of blood vessel;signs of lung in secondary changes（bronchial stenosis,pleural thickening,pleural effusion, inflammation）.The lumps originated from anterosuperior mediastinum also have their specific CT characters of qualitation diagnosis. Conclusion Through the analysis in multi-slice CT characters of lumps from anterosuperior mediastinum,it would be possible to make the location and qualitation diagnosis of lumps originated from this region.