胸壁结核的CT诊断  

CT features of thoracic tuberculosis

作　　者：全昌斌[1] 敖国昆[1] 李红[1] 袁小东[1] 李利佳[1] 

机构地区：[1]解放军第309医院放射科,北京100091

出　　处：《中华临床医师杂志（电子版）》2011年第20期5925-5929,共5页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的分析胸壁结核的CT影像特征,以提高对其的认识和诊断能力。方法回顾性分析经手术切除、穿刺活检及临床综合确诊的胸壁结核52例,其中男25例,女27例,年龄16～76岁,平均31岁,全部病例均行胸部CT平扫检查,39例加做CT增强扫描。结果 52例平扫CT均清楚显示胸壁肿块影,其中单发肿块39例,多发肿块13例;其中胸壁肿块以软组织包块或寒性脓肿为主要表现者49例,以肋骨破坏为主者3例;肿块最小1.5cm×1.5cm×1.0cm,最大8.1cm×12.2cm×16.6cm;上述软组织包块可呈梭形、不规则形或类圆形,内部密度相对较低,其CT值6～37HU,部分累及邻近肋骨,导致溶骨性破坏者9例,导致骨膜增生硬化者8例;39例行增强CT扫描,其中35例肿块可见周边囊壁环形线样强化,边缘较光滑连续,而内部低密度区呈不强化的囊腔,2例包块内无液化者及2例以肋骨破坏为主者均未见明显强化;本组胸部CT同时发现肺实质和(或)胸膜以及纵隔内伴有结核灶者47例。结论 CT尤其是增强CT能很好地显示出胸壁结核的影像学特征,反映其病理基础,同时能发现肺部、胸膜及纵隔内的结核感染证据,故CT检查对胸壁结核的诊断及治疗有十分重要的临床价值。Objective To improve the awareness and diagnostic accuracy of thoracic tuberculosis by reviewing relevant CT documents.Methods 52 cases of thoracic tuberculosis [25 male,27 female; mean age 31 years (16-76)] were reviewed.All cases had final clinical diagnoses as thoracic tuberculosis and plain CT data.39 of the 52 had enhancement CT data.Results Thoracic mass lesions (39 single,13 multiple) were revealed on plain CT in all cases,among which soft tissue mass or cold abscess were demonstrated in 49 cases and osteoclasia of ribs in 3 cases.The minimum and maximum volume of the lesions was 1.5 cm×1.5 cm×1.0 cm and 8.1 cm×12.2 cm×16.6 cm respectively.Fusiform or round like or irregular shape of soft tissue masses were showed with hypodense central zone (6-37 HU) and partially involvement of adjacent ribs (9 osteolytic,8 periosteal proliferation).Of the 39 cases of enhancement CT,35 displayed smooth ring enhancement with unenhanced central zone.2 cases without necrosis and 2 osteoclasia of ribs all revealed no obvious enhancement.47 cases revealed concomitant pulmonary tuberculosis and/or pleural tuberculosis and mediastinal tuberculosis.Conclusions CT,especially enhancement CT can demonstrate radiologic features of thoracic tuberculosis which is associated with its pathology,meanwhile detect concomitant tuberculosis lesions in lung,pleural,and mediastinum.Therefore CT is of significant value in the management of thoracic tuberculosis.

关 键 词：结核 胸壁 体层摄影术 X线计算机 诊断 

分 类 号：R521.7[医药卫生—内科学]