【病例】巨大胸腺囊肿1例CT影像表现

病史

A 50-year-old asymptomatic man with incidental finding.

50岁男性,无明显症状,偶然发现胸部异常。

【病例】巨大胸腺囊肿1例CT影像表现

【病例】巨大胸腺囊肿1例CT影像表现

【病例】巨大胸腺囊肿1例CT影像表现

【病例】巨大胸腺囊肿1例CT影像表现

1.Which of the following is the most common patient presentation of this finding?

该病患者最可能出现的症状是下列哪项?

Asymptomatic 无症状

Chest pain 胸痛

Gastroesophageal reflux 胃食管返流

Tamponade 心包压塞

2.No additional imaging is necessary to make the diagnosis.

诊断该病无需进一步影像学检查。

True

False

【病例】巨大胸腺囊肿1例CT影像表现

更多问题……

3.Which of the following features would suggest a benign nature to a finding in this anatomic location?

该部位的病变如果出现哪些征象,可以提示为良性病变?

Thick walls, fluid-filled 厚壁、内含液体

Solid components, enhancing 实性成分、增强扫描强化

Thin walls, fluid-filled 薄壁、内含液体

4.Typical management of this finding includes needle biopsy.

该病一般需要进行穿刺活检定性。

True

False

【病例】巨大胸腺囊肿1例CT影像表现

【病例】巨大胸腺囊肿1例CT影像表现

答案:

  1. AsymptomaticThe most common presentation of this finding is asymptomatic, and it is usually discovered incidentally. Rarely does it present as chest pain. The most severe presentation is cardiac tamponade. It almost never presents as reflux.

    该病的患者通常无明显临床症状,为偶然发现。胸痛很少出现。重症患者可能出现心包压塞。而胃食管返流症状几乎不会出现。

  2. FalseThere is a cystic anterior mediastinal mass without substantial mass effect upon adjacent structures, but further characterization with gadolinium-enhanced MRI is necessary, especially with such a large cyst, to definitively rule out malignancy.

    该病灶为上纵膈囊性肿块,无明显实性部分,对邻近器官无侵犯。但仍需进行MRI增强扫描,以排除恶性可能,特别是较大的囊性病灶。

  3. Thin walls, fluid-filled
  4. FalseFurther characterization with MR imaging is performed. Current imaging suggest a benign etiology, and biopsy is not recommended.

    现有的影像学检查提示病灶为良性,MRI进一步检查可以提供更多的特征性表现,而无需进行穿刺活检。

【病例】巨大胸腺囊肿1例CT影像表现

影像表现及诊断

影像表现There is a cystic anterior mediastinal mass without substantial mass effect upon adjacent structures.

上纵膈可见囊性占位,无实性部分,对邻近器官无侵犯。

鉴别诊断

  • Pericardial cyst 心包囊肿
  • Thymic cyst 胸腺囊肿
  • Morgagni hernia Margagni疝
  • Fat pad 脂肪垫
  • Cystic teratoma 囊性畸胎瘤
诊断Large thymic cyst

巨大胸腺囊肿

【病例】巨大胸腺囊肿1例CT影像表现

讨论

Thymic cysts are benign and almost always incidentally discovered well-defined cystic mass located in the cardiophrenic angle and anterior mediastinum. Large cysts may rarely cause chest pain or tamponade.

胸腺囊肿为良性。通常为偶然发现的心膈角处或上纵膈的囊性包块,边界清楚。较大的囊肿可能引起胸痛或心包压塞。

影像学表现

  • Appears as a well-defined cardiophrenic angle mass, usually seen on the right.影像学表现为心隔角处囊性肿块,边界清楚,常见于右侧。
  • Cystic with water density core on CT and bright on T2-weighted imaging.CT示囊内呈液性密度,MRI T2WI呈高信号。
  • Important to obtain an MR study with contrast to ensure lack of pathologic enhancement.MR增强扫描有重要的临床意义,可以判断是否有异常的强化。
  • Echocardiography can be a useful adjuvant in further characterizing the cyst and adjacent pericardium.超声心动图有助于进一步判断囊肿的影像特征,判断与临近心包的关系。
随访

  • Usually no follow-up is needed in asymptomatic individuals with incidentally discovered cysts.偶然发现胸腺囊肿、且无明显临床症状的患者,一般无需随访复查。
  • Extremely large cysts or symptomatic cysts will benefit from scheduled follow-up and/or intervention, although no controlled trials have evaluated the management of thymic cysts.目前仍没有关于胸腺囊肿处理的对照试验,但通常认为,较大的、或有临床症状的胸腺囊肿,需要定期随访复查,或介入治疗。

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