菌阴肺结核影像诊断难点分析  

Analysis of diagnostic difficulties on imaging features in smear and culture negative pulmonary tuberculosis

作　　者：赵泽钢[1] 周新华[1] 

机构地区：[1]首都医科大学附属北京胸科医院影像科,101149

出　　处：《中国防痨杂志》2016年第5期342-345,共4页Chinese Journal of Antituberculosis

摘　　要：菌阴肺结核临床特征较少，有时仅表现为肺部阴影。其中孤立的肉芽肿结节、不规则肿块样影、段性及大叶性实变、多发性结节、弥漫的雪花状影，以及是否并发免疫功能低下等问题均是影像诊断的难点；此外，结节病Ⅲ期与粟粒性肺结核的鉴别、肺结核与肺癌等恶性病变并存等均为影像学鉴别诊断的棘手问题。分析与把握其基本影像学特征是确定肺结核诊断的前提，重视CT引导下经皮肺穿刺活检并结合临床症状与征象进行综合分析仍然是确定诊断的重要方法。Smear and culture pulmonary tuberculosis usually performed only the shadow of the lungs with less clinical manifestations. Some unusual imaging features such as solitary granuloma nodule, irregular mass, seg mental and lobar consolidation, multiple nodules, diffuse snowflake and immunocompromised complications were difficulties for imaging diagnosis. The differential diagnosis of miliary pulmonary tuberculosis from sarcoidosis of stage Ⅲ and the coexistent imaging of pulmonary tuberculosis with malignant lesions like lung cancer were also a thorny problem. To analyze and grasp the basic imaging features was the premise to determine diagnosis of pulmonary tuberculosis. Pay more attention to CT guided percutaneons puncture biopsy of lesions combined with clinical comprehensive analysis is still an important method to confirm the diagnosis of pulmonary tuberculosis.

关 键 词：结核 肺 菌阴 诊断 鉴别 体层摄影术 X线计算机 活组织检查 切割针 

分 类 号：R521[医药卫生—内科学]