胸壁肿块的CT诊断

CT diagnosis of chest wall masses

目的分析胸壁肿块的CT表现,提高其诊断水平。方法 30例临床证实的胸壁肿块患者均经CT平扫,10例又经增强扫描。对所有患者的CT表现进行了回顾性分析。结果在CT像上,胸壁结核(5例)表现为胸壁内软组织密度肿块影;细菌性脓肿(4例),表现为局限性软组织肿块影,密度不均匀;脂肪瘤(4例)表现为胸壁内局限性脂肪密度肿块影;神经源性肿瘤(5例)表现为胸壁内密度均匀、边界清楚的软组织肿块影;血管瘤(1例)表现为左侧胸壁散在条状迂曲的软组织密度肿块影,增强后明显强化;胸膜间皮瘤(3例),其中良性者(2例)表现为局限性胸膜增厚,恶性者(1例)表现为弥漫性胸膜增厚伴胸腔积液;胸膜转移瘤(3例)表现为胸膜结节状增厚;肋骨转移瘤(4例)表现为胸膜结节状增厚;Askin瘤(1例)表现为右侧胸壁内及胸膜处软组织肿块影伴邻近肋骨骨质破坏。结论 CT对胸壁肿块的定位及良、恶性鉴别具有重要价值,尤其64排螺旋CT及其后处理技术更有利于其诊断与鉴别诊断。

Objective To analyze the CT findings of chest wall masses and to elevate the diagnostic level.Methods Thirty patients with clinically proved chest wall masses underwent conventional CT scans.10 patients underwent contrast-enhanced CT scans.CT findings of all patients were analyzed retrospectively.Results On CT images,chest wall tuberculosis（n=5） appeared as mass shadows with soft tissue density;bacterial abscess（n=4） appeared as localized soft tissue mass shadows with nonhomogeneous density;lipoma（n=4） appeared as localized mass shadows with fatty density;neurogenic tumor（n=5） appeared as soft tissue mass shadows with homogeneous density and well-defined margin;hemangioma（n=1） appeared as scattered-stripe-like mass shadows with soft tissue density and obvious enhancement after contrast-enhanced scan;pleural mesothelioma（n=3） in which benign tumor（n=2） appeared as localized pleural thickening,while other one malignant tumor appeared as diffused pleural thickening associated with hydrothorax;pleural metastasis（n=3） appeared as nodular pleural thickening;rib metastasis（n=4） appeared as single or multiple soft tissue mass shadows with osteolytic destruction;and Askin tumor（n=1） appeared as soft tissue mass shadow associated with bony destruction of neighbor ribs.Conclusion CT plays important role in the localization,diagnosis and differential diagnosis of chest wall masses,especially 64-detector row helical CT with postprocessing techniques is helpful to differentiate benign from malignant lesions.