肺硬化性血管瘤的影像学表现及误诊分析  

Analysis of Misdiagnosis and Imaging Features of Pulmonary Sclerosing Hemangioma

作　　者：胡粟[1] 张妤[1] 诸伟[1] 黄瑾瑜[1] 叶爱华[1] 胡春洪[1] 

机构地区：[1]苏州大学附属第一医院影像中心,苏州215006

出　　处：《临床放射学杂志》2014年第1期46-49,共4页Journal of Clinical Radiology

摘　　要：目的探讨肺硬化性血管瘤的影像学表现及其误诊原因。方法分析经手术病理证实的20例肺硬化性血管瘤的x线及cT资料，观察病灶部位、形态、边界、最大径、强化程度及病灶内部特征等。对术前定性诊断错误者的影像学表现进行分析和总结。结果肿瘤发生于左上肺6例，左下肺4例，右上肺2例，右下肺5例，右中肺1例，同时发生于左上肺及右下肺、两上肺各1例。表现为圆形或类圆形16例，边界清楚锐利15例。最大径0．5—3．6cm不等，平均（2．14±0．93）em。平扫cT值平均约（35．45±10．55）HU；增强后均匀强化7例，边缘强化4例，CT值平均约（72．45±26．80）HU。贴边血管征4例，尾征2例，空气新月征1例，肺动脉为主征1例；胸膜凹陷征2例，血管集束征2例。x线发现病灶13例（81．25％），另有3例（18．75％）X线漏诊。cT术前定性诊断正确10例，误诊为错构瘤2例、肺癌4例、多发转移瘤2例、慢性感染1例、巨淋巴结增生1例，cT误诊率为50．0％（10／20）。结论肺硬化性血管瘤影像学上多表现为孤立、边界清、密度均匀、明显强化的结节，伴或不伴一些特征性征象（如贴边血管征、尾征等）。但少数表现不典型者（如境界不清、多发病灶等）易造成误诊，临床工作中需仔细观察病灶周围征象，尤其增强及多平面重组有助于提高诊断正确性。Objective To explore the imaging findings and reason of misdiagnosis in pulmonary sclerosing hemangio- ma. Methods The X-ray and CT data of 20 cases of pulmonary sclerosing hemangioma confirmed by pathology were ana- lyzed, including the location, shape, border, maximum diameter, enhanced and degree intratumaral features. The imaging findings of the misdiagnosed lesions were analyzed and summarized. Results Lesions located in the left upper lung in 6 cases, left lower lung in 4 cases, right upper lobe in 2 cases, right lower lobe in 5 cases, both the left upper lung and right lower lung in 1 case, and both the left and right upper lung in 1 case. 16 cases were round or oval in shape, 4 cases were irregular nodules. 15 cases were well margined and 5 cases with irregular edge. The maximum diameter ranged from 0.5 ~ 3.6 cm in an average of （2.14 _＋ 0.93） cm. The mean CT value was （35.45 ＋ 10.55 ） HU, and increased to （72.45 _＋ 26.80） HU with enhanced scan. There were welt vessel signs in 4 cases, tail signs in 2 cases, air meniscus sign in 1 ca- ses, prominent pulmonary artery sign in 1 case, pleural retraction signs in 2 cases and vessel convergence signs in 2 cases. There were 3 cases（ 18.75% ） misdiagnozed preoperatively with X-ray. The misdiagnosed rate of CT was 50.0% （ 10/20）, there were misdiagnosed as pulmonary hamartoma（ n = 2）, lung cancer（ n = 4）, metastatic tumors （ n = 2 ）, chronic infec- tion（ n = 1 ）, Castlemang disease（ n = 1 ）. Conclusion The imaging features of pulmonary sclerosing hemangioma is iso- lated, well-defined, homogeneously and significantely enhanced nodules, with or without certain characteristic signs （such as welt vessel signs）. Atypical imaging features may lead to misdiagnosis. The accuracy of correctly diagnosis preoperative can be improved with observing the image signs carefully, especially with enhanced scan and multi-planar reconstruction.

关 键 词：硬化性血管瘤 肺 误诊 体层摄影术 X线计算机 

分 类 号：R734.2[医药卫生—肿瘤]