胆固醇性肺炎的CT诊断  

CT Diagnosis of Cholesterol Pneumonia

作　　者：邝健谊[1] 李子平[1] 贺李[1] 孟悛非[1] 王连唐[2] 

机构地区：[1]中山大学附属第一医院放射科,广东广州510080 [2]中山大学附属第一医院病理科,广东广州510080

出　　处：《中山大学学报（医学科学版）》2011年第4期515-520,共6页Journal of Sun Yat-Sen University:Medical Sciences

摘　　要：【目的】通过分析胆固醇性肺炎的CT表现,探讨其CT诊断的可能性。【方法】搜集18例经手术、纤维支气管镜活检后病理证实的胆固醇性肺炎,其中男13例,女5例;年龄11～71岁,平均52.9岁。所有病例均行螺旋CT扫描,平扫1例,平扫加增强扫描17例。CT征象分析包括病变数目、大小、形态、边缘、密度及强化后的强化程度进行分析。【结果】CT表现为结节肿块型10例,斑片型3例,混合型5例。结节肿块型多见分叶,周围毛刺或"晕"征,中心可见低密度,增强后全瘤或环状不均匀强化。斑片型为边缘清晰或磨砂玻璃样大小不一片状影,其中1例双肺多发片状影,可见中度均匀强化。混合型为囊肿、结节、空洞病灶旁实变或磨砂玻璃影。软组织肿块或片状病灶内可见支气管充气、充液征象。肺门及纵隔淋巴结肿大13例,术后证实为炎症反应性改变;胸腔少量积液3例;病灶内见到少量圆点状或不规则钙化灶3例。18例中8例合并其他病变,除并发的脂肪瘤、畸胎瘤各1例包膜内见到脂肪外,CT未见胆固醇肺炎病灶范围内脂肪密度影;病理检查亦未见脂肪组织。另合并恶性肿瘤及脓肿各2例,支气管囊肿及陈旧性肺结核、矽肺各1例。【结论】病灶内支气管气像、充液征,周围大范围磨砂玻璃样渗出,或双肺多发斑片状病灶,可诊断炎症;肿块或混合型大病灶内中心区超过半径的规则类圆形或多房的低密度灶,并周围"环靶征"强化的CT征象,对诊断胆固醇性肺炎具有一定的诊断意义。[Objective] To discuss the possibility of the CT diagnosis by analyzing the CT features of cholesterol pneumonia.[Methods] A total of 18 patients with cholesterol pneumonia confirmed by pathological examination after surgery or fibrobronchoscope biopsy were collected to undergo spiral CT scan.13 men,5 women;age,11-71 years;mean age,52.9 years.1 patient only with plain scan and the other 17 patients underwent additional contrast enhancement scan.CT signs of the disease and the number,size,shape,margin,density,and the enhanced degree were analyzed.[Results] CT showed 10 patients belong to nodule-tumor pattern,3 patients belongs to sheet pattern,5 patients belongs to mixed pattern.Lobulated,spicula or ＂halo＂ sign were more common in nodule-tumor pattern,and its center showed low-density,with the whole tumor or ring inhomogeneous enhancement.The different size of patches with clear or ground-glass edge were sheet pattern,including 1 case with multiple patchy and moderate homogeneous enhancement.The mixed pattern included cyst,nodule,cavitary lesion with adjacent consolidation or ground-glass opacity.The bronchi filled with gas or fluid were soft tissue mass or sheet lesion.Hilar and mediastinal lymph nodes swelling showed in 13 cases,which were confirmed with inflammatory response;A small amount of pleural effusion in 3 cases;and a little dot-like or irregular calcification were seen in 3 cases.8 were combined with other diseases.In addition to the concurrent lipomas（1 patient） and teratoma（1 patient）.CT showed no fat density in other cholesterol pneumonia;and pathological examination had no adipose tissue.Both 2 patients complicated with malignant tumors or abscesses.Each 1 patient complicated with bronchial cyst,old pulmonary tuberculosis and silicosis.[Conclusions] Inflammation can be diagnosed as follows：larger lesions,with air and fluid bronchogram,surrounded by a wide range of ground-glass opacity effusion,or multiple patchy lesions.For the nodule-tumor and mixed pattern,with low-density of regula

关 键 词：电子计算机断层扫描 胆固醇性肺炎 CT诊断 

分 类 号：R541.4[医药卫生—心血管疾病]