Neoplastic disease:

Carcinoma of the bronchus

• Squamous carcinoma
• Adenocarcinoma
 1.Carcinoma of the bronchus is one of the most
common primary malignant tumours.
2.It has a clear association with cigarette smoking.
3.The majority of bronchial carcinomas arise in
larger bronchi at, or close to, the hilum.
4. It is convenient to consider the radiological
features of central and peripheral tumours
separately.
Signs of a central
tumor:
The tumour itself may present as
hilar mass (fig.2.106) and/or
narrowing of a major bronchus.
The narrowing may be irregular
or smooth.
左上叶中央型腺癌，左上叶支气管狭
窄（左图），肿块已包饶左肺动脉
（右图，箭）
The effect of obstruction by the
tumour (Fig.2.107) is usually a
combination of collapse and
consolidation.
The alveoli collapse because air is
absorbed beyond the obstructed
bronchus and cannot be replaced,
whereas consolidation is the
consequence of retained secretions
and secondary infection .
中心型肺癌的 MRI 表现
Signs of a peripheral
tumour:
A peripheral tumour
(Fig.2.108) usually present as
a solitary pulmonary mass.
The signs of a peripheral
primary carcinoma are :
1.A rounded shadow with an
irregular border. Lobulation,
notching and infiltrating edges
are the common patterns.
(fig.2.33,p40)
Cavitation within the mass.
Peripheral squamous cell carcinomas show
a particular tendency for cavitation.
The walls of the cavity are classically thick
and irregular, but thin-walled smooth
cavities due to carcinoma do occur.
• Age/Sex:
• 57/M
Chief complaints: cough, sputum, and
mild fever for 6 months
• Squamous cell lung cancer (with cystic
lung to lung metastasis)
Spread of bronchial
carcinoma :
Evidence of spread on bronchial
carcinoma may be visible on plain chest
radiography,
but CT and, in highly selected cases,
MRI have made a major contribution
to the staging of lung cancer.
Both(CT and MRI) may show enlarged
mediastinal lymph mode suggesting
involvement by tumour or direct invasion
of the mediastinum that is either not visible
or is questionable on the plain chest film
information,
So that may save the patient unnecessary
thoracotomy.
Hilar and mediastinal
lymph node enlargement
due to lymphatic spread of
tumor.
Only greatly enlarged
lymph node can be
recognized on plain chest
radiograph.
CT, on the other hand, has the
ability to show even mildly
enlarged nodes, nodes that are
not identifiable on plain film.
右肺上叶中央型肺癌并纵隔、肺
门淋巴结转移
In practice, the role of CT is to
decide which patients need
preoperative lymph node
biopsy, and to tell the surgeon
which nodes to biopsy.
• Pleural effusion in a patient with
lung cancer is usually due to
malignant involvement of the pleura,
• but it may be secondary to
associated infection of the lung or
coincidental, as in heart failure.
lnvasion of the
midiastinum ：
On plain films, the signs are widening of
the mediastinal shadow and elevation of a
hemideaphragm suggesting involvement
of the phrenic nerve by tumour (Fig.2.107).
Mediastinal widening can be a difficult
sign to evaluate, particularly in older
people with aortic unfolding.
CT and MRI are much more
sensitive and accurate methods
of assessing mediastinal invasion
by tumour ,
because the neoplasm can be
directly visualized (Figs2.111, 2.112).
MRI 显示肿瘤已侵犯了主动脉
（箭）
Invasion of the chest wall (Fig.2.113).
Destruction of a rib immediately
adjacent to a pulmonary shadow is
virtually diagnostic of bronchial
carcinoma with chest wall invasion.
Recognizing the rib destruction can
be difficult sometimes.
It is important therefore to make a
conscious effort to look at the ribs
directly.
Oblique views may be helpful in
detecting bone destruction.
CT and MRI can demonstrate rib
and soft tissue invasion when the bone
is not visibly eroded on plain films.
Useful for MRI is particularly
showing invasion of the apex of
the chest, the so-called
Pancoast’s tumour (Fig.2.114).
Rib metastases:
Carcinoma of the lung frequently
metastasizes to the ribs where it
produces bone destruction.
 Pulmonary metastases:
Primary lung carcinoma
sometimes metastasizes to other
parts of the lungs.
The rounded shadows that result
are similar to secondary deposits
from other primary tumours .
Metastatic neoplasms
1.Pulmonary metastases.
Typically, mesastases are spherical and
well defined (Fig.2.117, 2.118),
although irregular borders are
occasionally seen. Usually, they are
multiple and vary in size.
CT scanning can demonsrate metastases as
small as 3-6mm.
There is, however, a disadvantage attached
to the excellent sensitivity of CT.
2.Pleural metatases.
These usually give rise to pleural
effusion. The individual pleural
metastases are rarely seen.
3.Metastases to ribs.
these are common with those primary
tumours that metastasize to bone, namely
bronchus, breast, kidney, thyroid and prostate.
All except prostatic and breast cancers produce
mainly or exclusively lytic metastases.
.
The common manifestations of
intrathoracic malignant lymphoma are
mediastial and hilar adenopathy and
pleural effusion.
神
经
源
性
肿
瘤
心包囊肿（ MRI ）
支气管囊肿