Male, physical examination found the right lung occupaic lesions 21 days, please diagnose!

Department ofThoracic Surgery"Basic Information"patients, male, 56-year-old"Main complaint"body found right lung occupaic lesions 21 days"past history"self-confessed physical fitness, no history of tuberculosis, smoking age 37 years, 18 per dayphysical examinationno cough, no cough, no blood, chest pain, chest tightness, no fever, no night sweatThe breathing tone is normal, unheard and dry, wetHow is theImage imageadiagnosisof theof thethe?Discussion"Comment 1: right lung inner part of the inner loin see nodules, less uniform density, clear boundary, the edge is shallow leaf, enhanced scanning slightly strengthened, the residual lung did not see significant abnormal changes, consider tumor lesions, low malignant possible, consider the dissocioma or hardeningangiomasyllemaComment 2: The patient is a middle-aged male, according to the morphological characteristics of the lesions and changes around, considered as benign or low malignant lesions, because the patient has no obvious positive characteristics, no fever, cough, etc., and is not a good place for tuberculosis, so do not consider tuberculosis balls, can improve the tuberculosisscreeninglaboratory indicators of the examinationComment 3: patients are male, older, can not rule out the possibility of peripheral lung cancer, you can ask the history of smoking, from the current imaging point of view, not quite in line with lung cancer, lung cancer lesions edge rough, visible leaves, can have short hairy shadow, often with chest dentsIf you want conservative treatment should be followed up closely, you can also do a puncture biopsyComment 4: For a case that lacks a typical sign and cannot be directly diagnosed, the exclusion method can be used to further clarify the diagnosisFirst of all, the lesions are small in volume, the edges are light, and they are shallow, which are not signs that malignant tumors should haveAt the same time, the enhancement of scanning lesions is very light, indicating that the blood supply of the lesions is not rich, inflammatory lesions and malignant tumors are not considered in the first place, so consider benign, hardened hemangiomas and dishemators can not be excludedcomment 5: patients without inflammatory signs, in addition to the lesions did not see clear calcification, there is no satellite stove around, the possibility of nodule ball is small, from the form of the lump to judge lung cancer is not large, benign tumors, the proportion of disheumoma as high as 75%, although we do not see a clear fatty composition, but the composition of the tumor itself is more complex, can contain cartilage, fiber, fat, etc Still close follow-up final result Pulmonary disheosome, cartilage component sydd pulmonary disheosome is the most common benign tumor in the lungs, the cause is not clear Most occur in adults between 40 and 50 years of age, but also visible in infants and young children, most of them for physical examination when accidentally found The dissoced tumor can be divided into cartilage type and fibrous type according to the pathological composition, with cartilage type, generally mainly cartilage component, which can contain adenosyries, fat, smooth muscle, fibrous tissue and epithelial tissue, sometimes visible calcification and osteopathy Growth is extremely slow, or does not grow, bad change is rare There are several types of CT performance depending on the composition and proportion of their tissues (1) The density of more uniform soft tissue lumps, no obvious calcification (2) The lump contains more low-density fat components (3) The lump contains calcification stove, typical of the popcorn-like (4) The chicken in the lump contains fat and calcified stove CT differential diagnosis of early peripheral type lung cancer: short fine burrs, leaf signs, near lung gate side vascular connection signs and fine bronchial signs, larger lumps may have eccentric hollow Tb ball: often in the upper leaf tip or the back section of the lower leaf to form a contoured lump, density is often uniform, the lump may be surrounded by arc calcification, the lesions are often scattered near the "satellite stove." Metastatic tumor: has a history of primary tumors, which is characterized by a lump with a more uniform density Source: Image Park