1、 早早 会会 诊诊 10.1210.12）喉癌的影像学诊断1 患者患者 男男 71Y71Y 患者于患者于1 1年前无明显诱因出现声音嘶哑，无咽喉部疼年前无明显诱因出现声音嘶哑，无咽喉部疼痛，病来无咽喉部异物感。患者于辽渔医院取病理痛，病来无咽喉部异物感。患者于辽渔医院取病理回报（回报（2012.9.262012.9.26）：左声带高）：左声带高-中分化鳞状细胞癌中分化鳞状细胞癌喉癌的影像学诊断2 既往史：既往史：1.1.高血压病史高血压病史5-65-6年，心率失常病史，规律用药，血年，心率失常病史，规律用药，血压正常；压正常；2.22.2型糖尿病病史；型糖尿病病史；3.19643.1964年肝
2、炎病史，分型不详，治愈年肝炎病史，分型不详，治愈喉癌的影像学诊断3 患者患者 男男 55Y55Y 患者患者4 4个月前因声门型喉癌，于大连医科大学附属第个月前因声门型喉癌，于大连医科大学附属第一医院（一医院（2012.6.182012.6.18）行喉裂开及气管切开术，术后）行喉裂开及气管切开术，术后因颈部切口感染，于我科门诊持续换药，因颈部切口感染，于我科门诊持续换药，2020天前出天前出现气短，复查喉镜示：右侧声带肉芽样新生物，现气短，复查喉镜示：右侧声带肉芽样新生物，1010天前，动态喉镜下取病理回报：高分化鳞状细胞癌天前，动态喉镜下取病理回报：高分化鳞状细胞癌喉癌的影像学诊断4喉喉：在颈
3、前正中，在颈前正中，舌骨下舌骨下 第第3 3颈椎至第颈椎至第5 5颈椎平面颈椎平面上通喉咽上通喉咽 下接气管（气道门户）下接气管（气道门户）喉的位置喉的位置喉癌的影像学诊断5喉癌的影像学诊断6喉癌的影像学诊断7 声门上区层面（舌骨层面）声门上区层面（舌骨层面）正常的喉部正常的喉部CTCT解剖解剖喉癌的影像学诊断8 声门上区层面（喉前庭层面）声门上区层面（喉前庭层面）喉癌的影像学诊断9 声门区层面（真声带层面）声门区层面（真声带层面）喉癌的影像学诊断10 声门下区层面声门下区层面喉癌的影像学诊断11 患者，男性，患者，男性，5252岁，声嘶岁，声嘶2020日左右日左右病例一病例一喉癌的影像学诊断
4、12喉癌的影像学诊断13喉癌的影像学诊断14喉癌的影像学诊断15 声门上型喉癌，鳞状细胞癌声门上型喉癌，鳞状细胞癌病理诊断病理诊断喉癌的影像学诊断16 患者，男性，患者，男性，5050岁，渐进性声嘶岁，渐进性声嘶8 8月月病例二病例二喉癌的影像学诊断17喉癌的影像学诊断18喉癌的影像学诊断19喉癌的影像学诊断20 左侧声门癌，鳞状细胞癌左侧声门癌，鳞状细胞癌病理诊断病理诊断喉癌的影像学诊断21 喉癌是喉部最常见的恶性肿瘤，发生率男性多于女喉癌是喉部最常见的恶性肿瘤，发生率男性多于女性，男性，男:女约女约8 8：1 1，认为与吸烟、饮酒及病毒感染有，认为与吸烟、饮酒及病毒感染有关。其病理类型关。
5、其病理类型97%97%为鳞状上皮细胞癌，腺瘤。为鳞状上皮细胞癌，腺瘤。喉癌的喉癌的CTCT诊断诊断喉癌的影像学诊断22 指发生于声门上区的癌，主要好发生于会厌喉面、指发生于声门上区的癌，主要好发生于会厌喉面、杓状软骨皱襞、梨状窝、喉室及室带。通常分化程杓状软骨皱襞、梨状窝、喉室及室带。通常分化程度较低，由于血供及淋巴组织丰富，癌细胞生长迅度较低，由于血供及淋巴组织丰富，癌细胞生长迅速，肿瘤的体积常明显大于其他部位的肿瘤。速，肿瘤的体积常明显大于其他部位的肿瘤。一、声门上型喉癌一、声门上型喉癌喉癌的影像学诊断23 该处因距离声带较远，早期常不容易发现，一旦发该处因距离声带较远，早期常不容易发现，
6、一旦发现大多数已是晚期，该处的癌易侵犯会厌前间隙及现大多数已是晚期，该处的癌易侵犯会厌前间隙及喉旁间隙，易发生颈淋巴转移喉旁间隙，易发生颈淋巴转移 。CTCT上常表现为喉前上常表现为喉前庭肿块或结节，部分病例可侵及会厌致会厌增厚或庭肿块或结节，部分病例可侵及会厌致会厌增厚或呈结节状，杓会厌皱襞肿胀。呈结节状，杓会厌皱襞肿胀。喉癌的影像学诊断24 声门区癌最为常见，它好发于声带的前中声门区癌最为常见，它好发于声带的前中1/31/3，可向，可向各个方向发展，癌细胞分化较好，故癌灶常较小，各个方向发展，癌细胞分化较好，故癌灶常较小，CT CT 表现为声带增厚，外形不规则，可见结节状或菜表现为声带增厚
7、，外形不规则，可见结节状或菜花状肿块，声带固定在内收位。容易侵犯前联合，花状肿块，声带固定在内收位。容易侵犯前联合，前联合受累意味着对侧声带受侵犯。前联合受累意味着对侧声带受侵犯。二、声门型喉癌二、声门型喉癌喉癌的影像学诊断25 声门下癌未累及声带前不出现临床症状，声门下癌未累及声带前不出现临床症状，所以早期所以早期就诊者少，就诊者少，CT CT 的横断面连续扫描能清晰显示声门下的横断面连续扫描能清晰显示声门下区各壁和肿瘤的上下边界、大小范围，使得侵及声区各壁和肿瘤的上下边界、大小范围，使得侵及声门下区的肿瘤可准确显示。门下区的肿瘤可准确显示。CT CT 表现为声门下区偏心表现为声门下区偏心性
8、结节或肿块性结节或肿块三、声门下型喉癌三、声门下型喉癌喉癌的影像学诊断26 喉癌在喉癌在CTCT影像上都有一定的共性：影像上都有一定的共性：1 1、喉内占位肿块；、喉内占位肿块；2 2、受累处喉襞组织增厚，两侧不对称；、受累处喉襞组织增厚，两侧不对称；3 3、喉腔气道变形或狭窄；、喉腔气道变形或狭窄；4 4、喉旁或会厌前脂肪间隙消失；、喉旁或会厌前脂肪间隙消失；总结总结喉癌的影像学诊断27 5 5、声带固定，声门裂矢状线偏转；、声带固定，声门裂矢状线偏转；6 6、喉软骨破坏，颈部淋巴结肿大。、喉软骨破坏，颈部淋巴结肿大。喉癌的影像学诊断28 Most laryngeal cancers are
9、 Most laryngeal cancers are squamous cell squamous cell carcinomascarcinomas,reflecting their origin from the,reflecting their origin from the squamous cellssquamous cells which form the majority of the which form the majority of the laryngeal laryngeal epitheliumepithelium.Laryngeal cancerLaryngeal
10、 cancer喉癌的影像学诊断29 Smoking is the most important risk factor for Smoking is the most important risk factor for laryngeal cancer.Death from laryngeal cancer laryngeal cancer.Death from laryngeal cancer is 20 times more likely for heaviest smokers is 20 times more likely for heaviest smokers than for n
11、onsmokersthan for nonsmokers.喉癌的影像学诊断30,An irregular mass was ,An irregular mass was found in thefound in the laryngeal After contrast injection,the mass showed After contrast injection,the mass showed heterogeneous obvious enhancementheterogeneous obvious enhancement There are some enlarged lymph n
12、odes in the There are some enlarged lymph nodes in the neck.neck.喉癌的影像学诊断31 physical examphysical exam includes a systematic includes a systematic examination of the whole patient to assess examination of the whole patient to assess general health and to look for signs of general health and to look
13、for signs of associated conditions and metastatic disease.associated conditions and metastatic disease.DiagnosisDiagnosis喉癌的影像学诊断32 That is all,thank youThat is all,thank you喉癌的影像学诊断33喉癌的影像学诊断34喉癌的影像学诊断35喉癌的影像学诊断36喉癌的影像学诊断37喉癌的影像学诊断38喉癌的影像学诊断39喉癌的影像学诊断40喉癌的影像学诊断41喉癌的影像学诊断42喉癌的影像学诊断43喉癌的影像学诊断44喉癌的影像学
14、诊断45喉癌的影像学诊断46喉癌的影像学诊断47喉癌的影像学诊断48喉癌的影像学诊断49喉癌的影像学诊断50喉癌的影像学诊断51喉癌的影像学诊断52喉癌的影像学诊断53喉癌的影像学诊断54喉癌的影像学诊断55喉癌的影像学诊断56喉癌的影像学诊断57喉癌的影像学诊断58喉癌的影像学诊断59喉癌的影像学诊断60喉癌的影像学诊断61喉癌的影像学诊断62喉癌的影像学诊断63喉癌的影像学诊断64喉癌的影像学诊断65CT manifestationCT manifestation The lesion is located in the lower lobe of The lesion is locate
15、d in the lower lobe of the right lung without a clear margin.There the right lung without a clear margin.There are cystic low density areas in the lesion.are cystic low density areas in the lesion.In the peripheral partIn the peripheral part of the lesion,there of the lesion,there are irregular low
16、density areas,and air-are irregular low density areas,and air-fluid level in it.fluid level in it.喉癌的影像学诊断66Possible diagnosis:Possible diagnosis:pulmonary bulla infectionpulmonary bulla infection 喉癌的影像学诊断67Differential diagnosisDifferential diagnosisPulmonary hypoplasia:Pulmonary hypoplasia:There a
17、re some cystic like lesions at the end There are some cystic like lesions at the end of the bronchi.of the bronchi.Lung abscessLung abscess The wall of the abscess is always thick,and The wall of the abscess is always thick,and the inner wall is irregular.the inner wall is irregular.喉癌的影像学诊断68Differ
18、ential diagnosisDifferential diagnosisPulmonary sequestration:Pulmonary sequestration:It is commonly seen in young adults.There It is commonly seen in young adults.There is no clear boundary between the normal lung is no clear boundary between the normal lung tissue and sequestration lung tissue.There tissue and sequestration lung tissue.There is an arterial supply to the sequestration is an arterial supply to the sequestration tissue arising from the abdominal aorta.tissue arising from the abdominal aorta.喉癌的影像学诊断69Thats all,thank you!Thats all,thank you!喉癌的影像学诊断70
