Case 9-（2）CT, 肺占位-肺癌
肺癌是癌症第一大杀手，肺癌的影像表现如何以及英文影像报告该怎么写呢？
CT CHEST WITHOUT CONTRAST
HISTORY: New mass seen on chest x-ray.
TECHNIQUE: High resolution contiguous axial tomographic images of thechest were acquired from the thoracic inlet to the lung bases. Advanced radiation dose reduction techniques were employed includingX- and Z-axis tube current modulation, weight-based tube voltagereduction, iterative reconstruction, and/or model-based iterativereconstruction. 3D reconstructions including Maximum IntensityProjection, Sagittal, and Coronal reformations were acquired andreviewed on an independent 3D workstation.
COMPARISON EXAM: Chest x-ray X/X/XXXX
Radiation dose estimate (DLP): XX.X mGy-cm.
FINDINGS:
Neck base: No focal lesion. The visualized portions of the thyroidappear symmetric.
Lymph nodes: No axillary, mediastinal, or hilar lymphadenopathy by CTsize criteria although hilar lymph node evaluation is suboptimal inthe absence of intravenous contrast.
Cardiovascular: Normal heart size. No pericardial effusion. There isatherosclerotic calcification seen in the LAD. The thoracic aorta andpulmonary arteries are normal in caliber.
Pleura and pleural space: No pleural effusion.
Lungs: The trachea and central airways are patent. There are milddiffuse centrilobular emphysematous changes. There is a X.X x X.X x X.X cm peripheral rounded mass with mildly irregular borders seen inthe left lower lobe abutting the pleura, however does not appear tobe arising from the pleura (series X, image XXX; series X, imageXX). There is biapical scarring. There is bibasilar atelectasis.
Musculoskeletal: No aggressive osseous lesion. There is sclerosisseen in the lateral left fifth rib (series X, image XX).
Upper abdomen: The partially imaged upper abdomen demonstratesscattered subcentimeter hypodensities in the liver with largestmeasuring up to X.X cm in the hepatic dome (series X, image XXX) andnonobstructing kidney stones in bilateral kidneys with largestmeasuring up to X mm in the right kidney. The remainder of the upperabdomen is unremarkable although abdominal organs are incompletelyevaluated on chest CT. No adrenal masses are seen.
IMPRESSION:
1.X.X x X.X x X.X cm peripheral rounded left lower lobe mass withmildly irregular borders, with portions abutting the pleura. This ishighly concerning for a primary lung malignancy. CT-guided biopsy isadvised for histologic analysis
2.Sclerotic focus in the anterior fifth left rib may represent a boneisland however metastatic disease cannot be excluded. PET/CT ornuclear medicine bone scan is advised.
3.Scattered subcentimeter hypodensities in the liver with largestmeasuring up to X.X cm in the hepatic dome. These may represent cystsbut would be better assessed with a PET/CT.
4.Mild to moderate upper lobe predominant emphysema.
Key words:
CT CHEST WITHOUT CONTRAST：CT平扫
tube current modulation: 管电流调制
iterative reconstruction: 迭代重建
atherosclerotic：动脉粥样硬化
caliber：管径
The trachea and central airways are patent：气管支气管通畅
abutting the pleura：贴邻胸膜
centrilobular emphysematous changes：小叶中心型肺气肿
irregular borders：不规则边界
Scattered subcentimeter hypodensities：散在小低密度灶
Sclerotic focus：致密灶
bone island：骨岛
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