结节或肿块型不典型肺结核的CT 表现及误诊原因分析  

Analysis of CT appearances and misdiagnosis of nodule/mass atypical pulmonary tuberculosis

作　　者：田扬[1] 赵卫[1] 胡继红[1] 张丽芳[1] 张文斌[1] 

机构地区：[1]昆明医科大学第一附属医院医学影像科,云南昆明650032

出　　处：《实用放射学杂志》2014年第8期1298-1301,共4页Journal of Practical Radiology

摘　　要：目的：探讨结节或肿块型不典型肺结核病的 CT 征象,以提高对不典型肺结核 CT 表现认识。方法收集 CT 初诊误为肺癌经手术病理证实为肺结核的结节或肿块25例,观察病变的部位、形态、大小、边缘、密度、增强等征象,并分析误诊原因。同时收集经病理证实的肺癌35例。对结核及肺癌的结节或肿块的 CT 征象进行统计学分析。结果25例肺结核包括18例结节,7例肿块。边缘光滑3例,边缘欠整齐22例；浅分叶18例,深分叶4例；短毛刺2例,长毛刺4例；胸膜凹陷征3例；支气管充气征3例,空泡征1例,空洞3例；钙化2例；密度均匀12例,密度不均匀13例；轻度强化16例,中度强化7例,显著强化2例。25例结节或肿块型结核与35例肺癌比较,深分叶征、短毛刺征、空泡征、支气管征、胸膜凹陷征及血管集束征在2组间有统计学差异（P 〈0.05）,以上征象出现越多越提示肺癌。增强方面,轻度强化及显著强化2组有统计学差异（P 〈0.05）,轻度强化提示结核,显著强化更倾向于肺癌。经统计学分析多种不同征象（浅分叶、轻度增强、无短毛刺、无空泡征、无胸膜凹陷征、无血管集束征、无空气支气管征）联合诊断结节性或肿块型肺结核,征象出现越多,结核可能性越大。结论结节或肿块型肺结核少见深分叶征、短毛刺征、空泡征、支气管充气征、胸膜凹陷征、血管集束征等；浅分叶、长毛刺、轻度强化更多见于结核。Objective To investigate the CT appearances of nodule/mass atypical pulmonary tuberculosis,and to improve the recognition of atypical pulmonary tuberculosis.Methods The study involved 25 （18 nodules and 7 masses）patients of nodule/mass atypical pulmonary tuberculosis which were misdiagnosed of pulmonary cancer and 35 cases of pulmonary cancer proved by pathology.The CT appearances of all cases were analysed including location,size,shape,density,margin and enhancement.In addition, the causes of misdiagnosis of pulmonary cancer were analysed.Results The CT appearances of 18 nodules and 7 masses as follows：well-defined margin in 3 cases,irregular margin in 22 cases,deep lobular in 4 cases,shallow lobular in 18 cases,short specular in 2 cases,4 long specular sign in 4 cases,pleural indentation in 3 cases,air bronchogram in 3 cases,vacuole sign in 1 case,3 cavity in 3 cases,calcification in 2 cases,homogeneous density in 12 cases,13 inhomogeneous density in 13 cases,mild enhancement in 1 6 ca-ses,moderate enhancement in 7 cases,significant enhancement in 2 cases.There were significant differences in deep lobulation sign, short specular sign,air bronchogram sign,pleural indentation and convergence of vessels sign between tuberculosis and pulmonary cancer （P 〈0.05）.The more signs of above,the higher risk of pulmonary cancer.There were also significant differences in mild enhancement and significant enhancement between the two groups （P 〈0.05）.The mild enhancement was more common in tuberculosis and the significant enhancement was more common in pulmonary cancer.Conclusion The deep lobulation signs,short specular, air bronchogram,vacuole sign,pleural indentation and convergence of vessels sign usually indicate pulmonary cancer.The appearance of short lobulation,long specular sign and mild enhancement may be helpful to diagnose of pulmonary tuberculosis.

关 键 词：肺结核 计算机体层成像 肺癌 

分 类 号：R521[医药卫生—内科学] R814.42[医药卫生—临床医学]