Shepard J A, Moore E H, Templeton P A, McLoud T C
Department of Radiology, Massachusetts General Hospital, Boston.
Radiology. 1993 Jun;187(3):797-801. doi: 10.1148/radiology.187.3.8497633.
The diagnosis of pulmonary intravascular tumor emboli is difficult to establish both clinically and on conventional radiographic studies. Between 1985 and 1991, four cases of pulmonary intravascular metastases were demonstrated on computed tomographic (CT) scans from among 14,000 CT scans of the chest. A retrospective study of these cases was performed, including a review of chest radiographs. All four patients had invasive tumors, including an atrial myxoma, a renal cell carcinoma, an osteosarcoma, and a chondrosarcoma of the pelvis. Three cases had histopathologic documentation of pulmonary artery tumor emboli. At CT, all the patients demonstrated multifocal dilatation and beading of peripheral pulmonary arteries, primarily in a subsegmental distribution involving multiple lobes. Ossification of the pulmonary arteries occurred in one case of metastatic osteosarcoma. In two cases, small, peripheral wedge-shaped opacities distal to some abnormal pulmonary arteries suggested pulmonary infarcts. The finding of dilated and beaded peripheral pulmonary arteries at CT is highly suggestive of metastatic intravascular tumor emboli.
肺血管内肿瘤栓子的诊断在临床及传统影像学检查中均难以确立。1985年至1991年间，在14000例胸部计算机断层扫描（CT）中发现了4例肺血管内转移瘤。对这些病例进行了回顾性研究，包括复查胸部X光片。所有4例患者均患有侵袭性肿瘤，包括心房黏液瘤、肾细胞癌、骨肉瘤和骨盆软骨肉瘤。3例有肺动脉肿瘤栓子的组织病理学证据。在CT上，所有患者均表现为外周肺动脉的多灶性扩张和串珠样改变，主要呈亚段分布，累及多个肺叶。1例转移性骨肉瘤患者出现肺动脉骨化。2例患者在一些异常肺动脉远端出现小的外周楔形致密影，提示肺梗死。CT上发现外周肺动脉扩张和串珠样改变高度提示转移性血管内肿瘤栓子。
