以声音嘶哑为主诉的胸部病变的MDCT评价

MDCT evaluation in patients complaining of hoarseness with thoracic diseases

目的:分析以声音嘶哑为主诉的胸部病变的多层CT(MDCT)表现特点,用来指导临床诊治。方法:回顾性分析37例以声音嘶哑为主诉患者的胸部CT,由两位放射科医师采用盲法对胸部病变类型、发生部位、良恶性与喉返神经走行区的关系进行评价。所有患者均行电子喉镜检查或支气管镜检查、CT平扫和增强检查,排除喉部原发病变。其中经手术或支气管镜活检及纵隔镜活检病理证实18例,19例临床综合诊断证实。结果:37例胸部病变中,恶性33例,包括肺癌23例、恶性纵隔肿瘤6例和肺外肿瘤纵隔淋巴结转移4例;良性4例,包括肺纵隔淋巴结结核1例;左气管食管沟神经鞘瘤1例和主动脉弓前下壁假性动脉瘤2例。33例恶性肿瘤中,肿瘤直接侵犯喉返神经走行区6例,淋巴结转移侵犯或压迫27例。12例声带麻痹记录者显示左侧声带麻痹10例侧,全部有左喉返神经走行区明显病变存在,右侧声带麻痹4例侧,均无对应右喉返神经胸内走行区明显病变。结论:多种胸部病变可以引起声音嘶哑,肺癌伴淋巴结转移是最常见的原因,MDCT可以很好地显示其相关性,帮助确认病因。

Objective：To analyze the CT imaging characteristics of the thoracic diseases with hoarseness as the chief complaint.Methods：CT findings in 37 patients with pathologically or synthesized clinical methods conformed were reviewed retrospectively and jointly by two observers blinded to the pathological results.All patients underwent precontrast and postcontrast helical CT.The types of thoracic diseases,location,differentiation of tumor were observed,along with correlations between lesions and recurrent laryngeal nerve.Results：All of 37 cases were classified into two groups,33 malignant and 3 benign in each group,respectively. The malignant included 23 cases of bronchiogenic carcinomas,6 cases of mediastinal tumors,and 4 cases of mediastinal lymph nodes metastasis from other cancers rather than puemary origin.One case of myoschwannoma located in tracheo-asophageal canal,one case of tuberculosis and two cases of aortic arch pseudoaneurysm composed of benign group.Six cases appeared invasive correlations between laryngeal nerve and neoplasms,and 27 cases were compressed by the metastasis of enlarged lymph nodes in malignant cases.Twelve cases were confirmed by laryngoscope,10 cases displayed left vocal cords paralysis and lesions could be found in the area of left recurrent laryngeal nerve transited.Four cases in right could not displayed obvious lesion.Conclusion：Hoarseness can be caused by various thoracic diseases,of which lung cancer with lymph node metastasis is the most common reason.CT can detect and evaluate the involvements of recurrent laryngeal nerve resulting from the thoracic diseases,the characteristic imaging can provide information that aids the diagnosis,staging,and follow-up of the diseases.