上期试题：淋巴瘤在纵隔中最常见的部位是 B
A．上纵隔
B．中纵隔
C．下纵隔
D．前纵隔
E．后纵隔
病史
女，57岁。咳嗽、咳痰1月余。无痰中带血、无发热、胸痛，查体右肺呼吸音减弱。
影像描述
胸片：右肺上下叶各见一肿块，占据胸腔大部分,肿块间无粘连，边缘光滑，无分叶，密度均匀，无钙化及空洞，邻近肋骨无破坏。
Chest film: the upper right lobe of the lung sees a lump, occupying a large part of the chest cavity. There is no adhesion between the lumps, the edges are smooth, without dividing leaves, the density is even, without calcification and cavity, the adjacent ribs are not damaged.
CT平扫：右上叶肿块占据了大部分上叶，紧贴纵隔及后胸壁，与气管分界不清，右主支气管后壁受压变形。右下叶肿块与侧胸壁相连，向下压迫肝脏。肿块边缘清楚，下叶者有浅分叶，密度大部较均匀，可见小片低密度影。肺门、纵隔未见淋巴肿大。增强扫描：注药后30秒肿块轻度不均匀强化；2分钟进一步增强，肿块内可见散在紊乱扭曲血管；平扫低密度区无明显强化。
CT scan: the upper lobe of the upper lobe is dominated by the upper lobe, which is close to the longitudinal and posterior chest wall, which is not clear with the trachea, and the posterior wall of the right main bronchus is subjected to compression and deformation. The lower lobe mass is attached to the lateral thoracic wall and compresses the liver. The edge of the mass was clear, the lower lobe had a shallow leaf, and the density was mostly uniform, and the low density shadow was seen. The lung door, mediastinum is not seen lymphatic enlargement. Enhanced scanning: 30 seconds after injection, mild inhomogeneous enhancement; 2 minutes further enhancement, the mass inside can be seen scattered in the disorder distorted blood vessels; Plain scan low density area without obvious reinforcement.
病例分析概述
胸膜孤立性纤维瘤（SFT）是一种较为少见的软组织肿瘤，其性质为纤维母细胞性，且组织往往有明显分支样血管。其可能发生在人体的各种部位，90%发生在胸膜，是除间皮瘤外胸膜肿瘤的第2位。患者多无特征性的临床症状，仅出现胸痛、胸闷和咳嗽等，可能与肿瘤对局部有占位和压迫有关。部分患者还会出现低血糖、关节病变等副肿瘤综合征。
Pleural isolated fibroma (SFT) is a relatively rare soft tissue tumor, which is characterized by fibroblast and often has obvious branched blood vessels. It may occur in various parts of the human body, 90% of which occurs in the pleura, and is the second place of the pleural tumor except mesothelioma. The patient has no special clinical symptoms, only chest pain, chest tightness and cough, may be related to the tumor on the local occupying and oppression. Some of the patients also suffer from hypoglycemia, joint lesions and other paraneoplastic syndromes.
1、胸腔内实质性肿块，与胸膜宽基底相连，肿块通常较大，孤立性、边缘清楚光整或浅分叶；
1. The substantial mass in the thoracic cavity is connected to the pleural broad base, and the mass is usually large, isolating and the edges are clear and light or shallow;
2、肿块向胸腔内突起，胸壁相应部位肋骨未见异常改变；
2. The mass was raised to the chest cavity, and the ribs in the corresponding part of the chest wall were not altered.
3、肿瘤在平扫时，其密度不均匀，可有不规则形的低密度影，其增强扫描有中高度的不均匀“地图样”强化出现，且延迟扫描会出现渐进性的强化。CT值平均增加12—25 HU，肿瘤内扭曲血管影及“假包膜征”等较具特征性；
3, tumor is in the scan, its density is uneven, can have irregular low-density shadow, the enhancement scanning has a highly non-uniform 'pattern' strengthening, and delay scan will be gradual strengthening. The CT value increased by 12 to 25 HU, and the tumor was characterized by the distortion of vascular shadow and 'fake envelope'.
4、CT提示恶性SFT的征象：肿瘤大片中央坏死，同侧胸膜侵犯。
4. CT suggested the symptoms of malignant SFT: large central necrosis of the tumor and invasion of the pleural membrane.
5、MR：肿瘤因含丰富的胶原纤维基质但细胞成分少而在T1WI、PDWI、T2WI均为低信号，T2WI上高信号为坏死、黏液变；增强扫描可强化；
5. MR: the tumor is low in T1WI, PDWI and T2WI due to its rich collagen fiber matrix but low cell content. The high signal on T2WI is necrotic and mucous. Enhanced scanning can be enhanced;
疾病的鉴别诊断
1、胸膜间皮瘤：几乎都表现为多发胸膜结节或弥漫肿瘤，极少表现为单发局限性病变，而且胸膜SFT的不均匀“地图”样明显强化的特征也可以与胸膜间皮瘤鉴别。
1, pleural mesothelioma: almost all the sound for multiple pleural nodule or tumor, a few limitations of single lesion, and pleural SFT uneven 'map' is obvious strengthening characteristics identification with pleural mesothelioma.
2、周围型肺癌：病变光滑不足，有毛刺征和分叶征等，并会出现胸膜凹陷；
2. Peripheral lung cancer: the lesion is smooth and insufficient, and there are burrs and leaves, and the pleural sag is present.
3、肺错构瘤：边界也较为清晰，也为类圆形的软组织结节影，无毛刺和分叶，但是，其内部有较多的脂肪成分，并多伴有钙化；
3. Pulmonary hamartoma: the boundary is also relatively clear, and it is a kind of circular soft tissue nodules, without burrs and leaves. However, there is a lot of fat content inside, and it is more calcified.
4、硬化性血管瘤：其结节的边缘清楚，但密度均匀，有钙化，增强扫描为花斑样；
4. Sclerosing hemangioma: the edge of the nodules is clear, but the density is uniform and calcified, and the enhanced scanning is a Mosaic;
5、肺肉瘤：发病多在40岁以下，在肺实质内呈膨胀性生长，很少侵犯或突破支气管黏膜，影像学表现为实质性肿块，直径多较大，肿块内可有钙化空洞形成；多为局限性胸膜侵犯。
5, sarcoma of the lung: in 40 years old the following, is swelling growth within the lung parenchyma, rarely invasion or break through the bronchial mucosa, imaging findings for substantial mass, diameter is larger, more mass can have calcification within the cavity formation; It is mostly limited pleural invasion.
本期试题：健康体检时，胸部X线片发现肺内靠近胸膜的孤立性小结节，此时应首先进行的检查是：？
A.定期复查胸部X线片
B.支气管镜
C.痰细胞学
D.胸部CT
E.经皮穿刺活检
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