胸部结节分叶状边界清晰（胸部影像学鉴别诊断）

胸部结节分叶状边界清晰（胸部影像学鉴别诊断）肺曲霉菌病、包虫囊肿破裂、Rasmussen动脉瘤、肺癌、肺转移、畸胎瘤其鉴别诊断包括：This CT feature is non-specific and can be simulated by several other entities.这种CT特征是非特异性的，并且可以由其他疾病引起。

说到空气新月征，大家想到第一诊断肯定是肺曲霉菌病

The typical computed tomography (CT) aspeCT of an aspergilloma is a mass separated from the wall of the cavity by an airspace of variable size and shape resulting in the air crescent sign also known as the meniscus sign.

曲霉菌病的典型CT表现是由不同大小和形状的空腔使腔壁与肿块分开，形成空气新月征，也称为弯月征。

This CT feature is non-specific and can be simulated by several other entities.

这种CT特征是非特异性的，并且可以由其他疾病引起。

其鉴别诊断包括：

肺曲霉菌病、包虫囊肿破裂、Rasmussen动脉瘤、肺癌、肺转移、畸胎瘤

肺曲霉菌病

Aspergilloma. A 62-year-old woman with a previous history of tuberculosis.

曲菌球。62岁男性，结核病史。

Axial CT image obtained with mediastinal window settings show a thick-walled cavity containing an ovoid mass in the left upper lobe of the lung.

横断面CT纵隔窗显示左肺上叶一厚壁空洞，内含卵圆形肿块。

An image obtained with the patient in the prone position demonstrates the change in the aspergilloma location.

俯卧位图像显示曲菌球位置改变。

包虫囊肿破裂

Ruptured hydatid cyst.A 30-year-old man with cough and dyspnea.

包虫囊肿破裂。30岁男性咳嗽、呼吸困难。

Coronal (a) and sagittal (b) CT images obtained with pulmonary window settings show a large cavitated lesion in the left upper lobe containing multiple curvilinear hyperattenuating membranes in the dependent part representing the detached crumpled endocyst。

冠状窗（A）和矢状面（B）CT肺窗图像显示左肺上叶一巨大的空洞状病灶，下部见曲线状高密度隔膜，内囊分离、皱缩。

Rasmussen动脉瘤

Rasmussen aneurysm. A 40-year-old man presented with a 3-month history of cough fever and weight loss. He also presented sudden hemoptysis.Rasmussen动脉瘤。40岁男性，咳嗽、发烧和体重减轻3个月。突然咯血。 Axial CT images obtained with lung window settings in the supine (a) and prone (b) positions show a nodule with no mobility inside a cavity and air interposed between the nodule and the cavity wall (the air crescent sign) located in the left lower lobe.仰卧位（A）和俯卧位（B）横断面CT肺窗显示左肺下叶一空腔病灶，内部结节不移动，气体将结节和腔壁分离（空气半月征）。

An axial contrast-enhanced CT image shows intense enhancement of the intracavitary nodule. Note also small nodules in both lungs and a lingular cavitated consolidation

横断面增强CT图像显示腔内结节显著强化。需注意双肺内小结节和条状腔隙实变。

肺癌

Lung cancer. A 74-year-old man with a history of pulmonary TB 50 years previously.

肺癌。 74岁男性，50年前患肺结核病史。

An axial CT image (a) shows two bullae in the right lower lobe with a small nodule inside the smaller bulla (arrow).

横断面CT图像显示右肺下叶两个肺大疱，内见小结节（箭头）。

A follow-up image obtained 2 years later (b) demonstrates a mass with spiculated borders in the posterior aspect of the largest bulla corresponding to the growth of the small nodule seen previously inside the smaller bulla.

2年后随访图像显示于大肺大疱后部见实性肿块，边缘毛刺，小肥大疱内小结节增大所致。

Also note the parenchymal interstitial thickening suggestive of carcinomatous lymphangitis and bilateral pleural effusion.

需注意肺实质间质增厚，提示癌性淋巴管炎；双侧胸腔积液。

肺转移

Metastases. A 37-year-old woman with uterine metastases.肺转移。 37岁女性，子宫转移。Axial CT images obtained with lung window settings (a b) showseveral cavitated nodules some with intracavitary nodules (arrows) in both lungs横断面CT图像肺窗显示两肺部多发空腔结节，部分见腔内结节（箭头）

肺畸胎瘤

Teratoma. A 22-year-old woman presented with a history ofcough and hemoptysis.

畸胎瘤。 22岁女性，有咳嗽和咯血病史。

Axial chest CT images obtained with the lung(a) and mediastinal (b) window settings reveal a thick-walled cavity in the left upper lobe adjacent to the mediastinum with an intracavitary mass (asterisk) and the air crescent sign.

横断面胸部CT肺窗（a）和纵隔窗（b）显示在左肺上叶邻近纵隔见厚壁空腔，腔内见肿块和空气新月征。

Note that the solid content presents focal areas of fat density (arrows in b)

需注意实性成分局部呈现脂肪密度（b中的箭头）

来源： 影像医学与核医学

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