以蜂窝肺改变为主的继发性肺结核高分辨率CT征象分析  

Honeycomb-like secondary pulmonary tuberculosis on high resolution CT

作　　者：余辉山 李靖 李宝学 李政旻 

机构地区：[1]武汉市肺科医院武汉市结核病防治所影像科,430030

出　　处：《中国防痨杂志》2016年第5期364-368,共5页Chinese Journal of Antituberculosis

摘　　要：目的分析以蜂窝肺改变为主的继发性肺结核高分辨率CT（high resolution CT，HRCT）征象，提高以蜂窝肺改变为主的间质性肺结核的CT诊断水平。方法回顾性分析53例以蜂窝肺改变为主的继发性肺结核患者HRCT表现，其中，经痰涂片和痰培养发现结核分枝杆菌阳性29例（54．7％），经皮肺穿刺病理诊断15例（28．3％），经纤维支气管支镜病理诊断9例（17．O％）。结果（1）发病部位：46例（86．8％）患者病灶发生于两肺上下叶，病灶HRCT表现虽然是蜂窝状影，但仍然是肺结核常发生的部位。（2）病灶分布范围：43例（81．1％）患者病灶分布在1～3个肺叶中，绝大部分病灶是随机性和不对称性分布。（3）蜂窝肺的形态：肺结核引起的蜂窝肺改变多以厚壁性、薄壁张力性这两种混合性蜂窝状阴影为主，共41例（77．3％）。（4）伴随病灶：继发性肺结核引起的蜂窝肺改变的HRCT表现中，呈多发片状融合灶40例（75．4％），支气管播散灶及树芽征27例（50．9％），斑点微结节灶53例（100．0％），支气管血管束牵拉扭曲18例（33．9％），肺叶容积缩小30例（56．6％），代偿性肺气肿30例（56．6％），纤维薄壁空洞14例（26．4％），胸膜增厚粘连38例（71．6％）。结论了解上述相关CT征象，有利于提高以蜂窝肺改变为主的继发性肺结核HRCT的正确诊断率。Objective To analyze the features of honeycomb-like secondary pulmonary tuberculosis on high resolution CT （HRCT）, and improve the level of diagnose interstitial pulmonary tuberculosis （IPTB）. Methods The characteristics on HRCT of 53 patients with honeycomb-like secondary pulmonary tuberculosis were retrospectively analyzed. In 53 cases, 54.7% cases were checked as Mycobacterium tuberculosis positive by sputum smear and culture, 28.3% were diagnosed by percutaneous biopsy, 17.0% were diagnosed by fiheroptic bronchos copy. Results （1） Focal location： 86.8% were upper lobes and dorsal segment on bilateral lung, although the fo cals appeared honeycomb Iike on HRCT, the distribution was usually the features of CT of pulmonary tuberculosis. （2） Focal distribution： 81.1% were distributed on 1--3 lung lobes, the distribution of the most locals was random and asymmetry. （3） Morphological trait of honeycomb-like lung： the cyst wall of honeycomb-like tuberculosis appeared thick or thin and tensive, which were about 77.3%. （4） Complicated locals： in the features on HRCT of honeycomb-like tuberculosis, 75.4% were multiple fused patchy locals. 50. 9% were bronchogenic disseminated and tree-in-bud locals, 100.0% were spot or micro-nodule, 33.9% were bronchia vascular bundle twisted, 56.6% had lung volume decreased, 56.6% were pulmonary emphysema, 26.4% were cavity, 76.6% were thicken and adhesive pleura. Conchtsion According to above HRCT traits, that was useful to improve the accuracy of diagnosing honey- comb-like Secondary pulmonary tuberculosis.

关 键 词：肺结核 继发性 蜂窝肺 诊断 显像 体层摄影术 x线计算机/高分辨率 

分 类 号：R816.4[医药卫生—放射医学]