To analyze the CT findings and clinical features of lung large cell neuroendocrine carcinoma (LCNEC) in order to improve the understanding, diagnosis and treatment of the disease.

The clinical data and CT signs of 80 LCNEC patients who were admitted to our hospital and pathologically confirmed were retrospectively reviewed, and the relevant literature was reviewed.

The most common clinical symptoms were cough and expectoration, about 71.25%. CT showed that the average diameter of the tumor was (58.23±33.58)mm, including 5 cases of mediastinal type, 23 cases of central type and 52 cases of peripheral type; Calcification occurred in 16 cases, lobulation sign in 78 cases, burr sign in 63 cases, irregular shape in 72 cases, pleural adhesion in 71 cases and lymphadenopathy in 60 cases; The plain CT value of the tumor was about (33.63±8.28)Hu, and the average enhancement amplitude in arterial phase was about (17.42±9.30)Hu; Single or multiple metastases were found in 34 cases at the first diagnosis, including 16 cases of bone metastasis, 14 cases of intracranial metastasis, 7 cases of adrenal metastasis, 6 cases of intrapulmonary metastasis, 5 cases of liver metastasis and 2 cases of spleen metastasis.

LCNEC tends to occur in elderly men with a long history of massive smoking. The clinical manifestations and laboratory indexes are lack of specificity. The diagnosis mainly depends on histopathological and immunohistochemical examination. The CT findings have certain characteristics. For elderly men with a history of severe smoking, the possibility of the disease should be considered when CT finds large nodules or irregular masses in the lung with lobulation, clear boundary, uneven enhancement and early metastasis. The standard treatment scheme is controversial, but it still advocates the early comprehensive treatment based on surgical treatment. Therefore, early diagnosis and early treatment are particularly important to improve the survival rate of LCNEC patients.