医学影像诊断学-胸膜病变.pptVIP

胸膜间皮瘤mesothelioma of pleuro 起源于胸膜间皮细胞、纤维细胞 分为上皮型、纤维型、混合型 局限型（良性为主）、弥漫性（恶性为主） 弥漫型与接触石棉有关 mesothelioma of pleuro-临床 良性可无症状 胸痛：持续性、剧烈、逐渐加重 呼吸困难、咳嗽、体重下降 肺性肺大性关节炎 mesothelioma of pleuro-影像 胸膜结节状影，与胸壁呈钝角相交 胸膜广泛结节状或不规则增厚 增强扫描均匀强化 T1略高信号、T2高信号 胸腔积液 纵隔淋巴结增大 胸膜肿块的鉴别 胸膜下肿瘤或结核瘤：锐角 胸膜间皮瘤：多发肿块 胸膜转移瘤：原发病灶、胸腔积液多 Which of the following clinical situations require chest tube placement? A : 20 year old college student presenting with acute chest pain which has now resolved and a 30% pneumothorax on CXRB : 35 year old woman with pneumococcal pneumonia on mechanical ventilation who has developed subcutaneous emphysema without evidence for pneumothorax on her CXRC : 68 year old man with COPD who has acute worsening of his dyspnea and has a 30% pneumothorax on his CXRD : 28 year old asthmatic with worsening wheezing and dyspnea and a pneumomediastinum on CXR A 56 year old man with COPD presents with worsening dyspnea. On CXR he has a pneumothorax on the right. The distance from the hilum to his chest wall is 11 cm and the distance from his hilum to the visceral pleura on the right is 8 cm. What % pneumothorax has he developed? A : 10%B : 25%C : 35%D : 60% All of the following are true about tension pneumothorax except: A : Can occur with a pneumothorax as small as 20%B : Is associated with contralateral displacement of mediastinal structuresC : Is potentially life threateningD : Requires radiologic confirmation before treating All of the following invasive procedures can be complicated by iatrogenic pneumothorax except: A : Bone marrow biopsyB : Placing a right heart catheter through a subclavian approachC : Transbronchial lung biopsyD : Thoracentesis Which of the following clinical situations is most likely to represent pneumothorax? A : Patient with COPD who has decreased breath sounds on the leftB : Young man with a 12-hour history of pleuritic left chest pain and dyspneaC : 45 year old patient with emphysema, recently worsened dyspnea, and decre