摘要
目的探讨不典型肺结核的多层CT影像表现及CT诊断要点。方法回顾性分析30例术前误诊为肺癌的不典型肺结核多层CT影像学资料并分析其误诊原因。结果本组30例不典型肺结核中，发病年龄在45～73岁之间。发生于两肺上叶21例、下叶6例，右肺中叶3例；依病灶表现的形态为球形病变12例（占40％），楔形病变18例（占60％），平扫无一例发现钙化灶。18例楔形病灶均伴有邻近胸膜增厚，球形病灶中6例（占20％）伴有邻近胸膜局限性肥厚。30例不典型肺结核中，12例病灶（占40％）直径〉4cm，12例病灶（占40％）周围伴有明显纤维瘢痕，6例病灶（占20％）内部空洞形成。21例不典型肺结核行CT增强扫描，其中18例病灶不均匀强化，9例于动脉期可见“血管穿透现象”，3例不典型肺结核伴有纵隔内环形强化的肿大淋巴结，并呈环形强化表现，内部可见明显的液化坏死区。结论中老年不典型肺结核较容易误诊为肺癌，其CT表现多变，在充分应用多层CT图像后处理技术的基础上仔细分析其影像学特点有助于不典型肺结核的诊断。
Objective To explore the CT features of atypical pulmonary tuberculosis. Methods Thirty middle-aged and elderly pa- tients （45 -73 years of age） with atypical pulmonary tuberculosis misdiagnosed as lung cancer were reviewed. Results The le- sions were in upper lobes of both lungs in 21, lower lobe in 6, and right middle lobe in 3 cases. The morphology included spherical lesions in 12 （40%）, and wedge-shaped lesions in 18 （60%）. Adjacent pleural thickening was founded in 18 cases with wedge- shaped lesions, but only in 6 （20%） eases were spherical lesions found. In the 30 cases, the lesions larger than 4 cm in diameter were found in 12 （40%） , obvious fibrous scar around the lesions in 12 （40%） , and cavitary changes in the lesions in 6 cases （20%）. Calcification was not found in plain scan. Moreover, 21 cases of atypical pulmonary tuberculosis underwent enhanced CT scan. Contrast-enhanced CT characters included inhomogeneous enhancement in 18, visible ＂vascular penetration phenomenon＂ at arterial phase in 9, and ring-shaped enhancement of enlarged lymph nodes in 3 cases. Conclusion The imaging findings of atypical pulmonary tuberculosis in the elderly vary. So they are more easily misdiagnosed as lung cancer. The postprocessing technique of CT is helpful for diagnosing atypical pulmonary tuberculosis.
出处
《临床军医杂志》
CAS
2013年第7期730-732,735,共4页
Clinical Journal of Medical Officers
关键词
不典型肺结核
X线
计算机体层摄影术
误诊
atypical pulmonary tuberculosis
X-ray
computerized tomography
misdiagnosis
