1、,早 會(huì) 診 張印（10.12）,1,患者 男 71Y 患者于1年前無(wú)明顯誘因出現(xiàn)聲音嘶啞，無(wú)咽喉部疼痛，病來(lái)無(wú)咽喉部異物感?；颊哂谶|漁醫(yī)院取病理回報(bào)（2012.9.26）：左聲帶高-中分化鱗狀細(xì)胞癌,2,既往史： 1.高血壓病史5-6年，心率失常病史，規(guī)律用藥，血壓正常； 2.2型糖尿病病史； 3.1964年肝炎病史，分型不詳，治愈,3,患者 男 55Y 患者4個(gè)月前因聲門(mén)型喉癌，于大連醫(yī)科大學(xué)附屬第一醫(yī)院（2012.6.18）行喉裂開(kāi)及氣管切開(kāi)術(shù)，術(shù)后因頸部切口感染，于我科門(mén)診持續(xù)換藥，20天前出現(xiàn)氣短，復(fù)查喉鏡示：右側(cè)聲帶肉芽樣新生物，10天前，動(dòng)態(tài)喉鏡下取病理回報(bào)：高分化鱗狀細(xì)胞癌,4

2、,喉： 在頸前正中， 舌骨下 第3頸椎至第5頸椎平面上通喉咽 下接氣管（氣道門(mén)戶）,喉的位置,5,6,7,聲門(mén)上區(qū)層面（舌骨層面）,正常的喉部CT解剖,8,聲門(mén)上區(qū)層面（喉前庭層面）,9,聲門(mén)區(qū)層面（真聲帶層面）,10,聲門(mén)下區(qū)層面,11,患者，男性，52歲，聲嘶20日左右,病例一,12,13,14,15,聲門(mén)上型喉癌，鱗狀細(xì)胞癌,病理診斷,16,患者，男性，50歲，漸進(jìn)性聲嘶8月,病例二,17,18,19,20,左側(cè)聲門(mén)癌，鱗狀細(xì)胞癌,病理診斷,21,喉癌是喉部最常見(jiàn)的惡性腫瘤，發(fā)生率男性多于女性，男:女約8：1，認(rèn)為與吸煙、飲酒及病毒感染有關(guān)。其病理類型97%為鱗狀上皮細(xì)胞癌，腺瘤。,喉癌

3、的CT診斷,22,指發(fā)生于聲門(mén)上區(qū)的癌，主要好發(fā)生于會(huì)厭喉面、杓狀軟骨皺襞、梨狀窩、喉室及室?guī)АＭǔ７只潭容^低，由于血供及淋巴組織豐富，癌細(xì)胞生長(zhǎng)迅速，腫瘤的體積常明顯大于其他部位的腫瘤。,一、聲門(mén)上型喉癌,23,該處因距離聲帶較遠(yuǎn)，早期常不容易發(fā)現(xiàn)，一旦發(fā)現(xiàn)大多數(shù)已是晚期，該處的癌易侵犯會(huì)厭前間隙及喉旁間隙，易發(fā)生頸淋巴轉(zhuǎn)移 。CT上常表現(xiàn)為喉前庭腫塊或結(jié)節(jié)，部分病例可侵及會(huì)厭致會(huì)厭增厚或呈結(jié)節(jié)狀，杓會(huì)厭皺襞腫脹。,24,聲門(mén)區(qū)癌最為常見(jiàn)，它好發(fā)于聲帶的前中1/3，可向各個(gè)方向發(fā)展，癌細(xì)胞分化較好，故癌灶常較小，CT 表現(xiàn)為聲帶增厚，外形不規(guī)則，可見(jiàn)結(jié)節(jié)狀或菜花狀腫塊，聲帶固定在內(nèi)收位。容

4、易侵犯前聯(lián)合，前聯(lián)合受累意味著對(duì)側(cè)聲帶受侵犯。,二、聲門(mén)型喉癌,25,聲門(mén)下癌未累及聲帶前不出現(xiàn)臨床癥狀， 所以早期就診者少，CT 的橫斷面連續(xù)掃描能清晰顯示聲門(mén)下區(qū)各壁和腫瘤的上下邊界、大小范圍，使得侵及聲門(mén)下區(qū)的腫瘤可準(zhǔn)確顯示。CT 表現(xiàn)為聲門(mén)下區(qū)偏心性結(jié)節(jié)或腫塊,三、聲門(mén)下型喉癌,26,喉癌在CT影像上都有一定的共性： 1、喉內(nèi)占位腫塊； 2、受累處喉襞組織增厚，兩側(cè)不對(duì)稱； 3、喉腔氣道變形或狹窄； 4、喉旁或會(huì)厭前脂肪間隙消失；,總結(jié),27,5、聲帶固定，聲門(mén)裂矢狀線偏轉(zhuǎn)； 6、喉軟骨破壞，頸部淋巴結(jié)腫大。,28,Most laryngeal cancers are squamous

5、 cell carcinomas, reflecting their origin from the squamous cells which form the majority of the laryngeal epithelium.,Laryngeal cancer,29,Smoking is the most important risk factor for laryngeal cancer. Death from laryngeal cancer is 20 times more likely for heaviest smokers than for nonsmokers.,30,

6、On plain CT scan , An irregular mass was found in the laryngeal which appears as a heterogenous soft tissue density. After contrast injection ,the mass showed heterogeneous obvious enhancement There are some enlarged lymph nodes in the neck.,CT Manifestations,31,physical exam includes a systematic e

7、xamination of the whole patient to assess general health and to look for signs of associated conditions and metastatic disease.,Diagnosis,32,That is all,thank you,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,CT manifestation,The lesion is located

8、 in the lower lobe of the right lung without a clear margin. There are cystic low density areas in the lesion. In the peripheral part of the lesion, there are irregular low density areas, and air-fluid level in it.,66,Possible diagnosis:pulmonary bulla infection,67,Differential diagnosis,Pulmonary h

9、ypoplasia: There are some cystic like lesions at the end of the bronchi. Lung abscess The wall of the abscess is always thick, and the inner wall is irregular.,68,Differential diagnosis,Pulmonary sequestration: It is commonly seen in young adults. There is no clear boundary between the normal lung tissue and seq