隐源性机化性肺炎的HRCT表现  

HRCT findings of cryptogenic organizing pneumonia

作　　者：吴晓华[1] 马大庆[1] 靳二虎[1] 岳云龙[2] 侯新萌[1] 张淑红[3] 

机构地区：[1]首都医科大学附属北京友谊医院放射科,北京100050 [2]首都医科大学附属北京世纪坛医院核磁室,北京100038 [3]首都医科大学附属北京友谊医院病理科,北京100050

出　　处：《医学影像学杂志》2016年第7期1217-1221,共5页Journal of Medical Imaging

摘　　要：目的 探讨隐源性机化性肺炎（COP）的影像学特点及其鉴别诊断。方法 对20例经开胸、电视胸腔镜或经皮肺穿刺活检或支气管镜活检诊断为COP的高分辨CT（HRCT）进行影像分析,并和病理学对照,追踪临床及治疗后结果。结果 COP主要发生于40岁以上的女性,临床主要表现为咳嗽和咳痰、活动后气促和喘憋。HRCT表现为双肺病变（14例,70%）,多灶性（19例,95%）,实变（17例,85%）,磨玻璃密度影（7例,35%）,结节（8例,40%）,对抗生素治疗无效,激素治疗有效。对糖皮质激素的反应率为100%。随访2~130个月不等,所有病例病情稳定。结论 COP影像学上表现具有一定的特点,实变,结节和GGO的多灶性,双肺的分布,胸膜下及支气管血管束旁分布是隐源性机化性肺炎的典型CT表现,反晕征是隐源性机化性肺炎的较为特异性表现。典型影像表现结合临床、经皮肺活检及经支气管镜肺活检多数病例可以确诊,少数须开胸肺活检。Objective To study the HRCT findings of cryptogenic organizing pneumonia （COP）. Methods The clinical,radiologic and pathologic features of 20 patients with COP confirmed by open or video-assisted thoracoscopic （VATS） lung biopsy, trans bronchial lung biopsy （TBLB） or percutaneous lung biopsy were analyzed. Treatment information and follow-up data were also obtained. Results COP usually affected female patients over 40 years of age. Clinical presentations included cough, sputum and exertional dyspnea. HRCT findings included bilaterial （ 14/20,70% ） distributed consolidation （ 17/20,85% ） and ground glass opacity （GGO） （7/20, 35% ）, nodules （8/20, 40% ）. The lesions were unresponsive to antibiotic, while good responsive to corticosteroid. Honeycomb changes were not found. The overall percentage of response to glucocorticoid was 100%. The duration of follow up ranged from 2 to 130 months. All patients were in stable clinical course. Conclusion In general, multiple consolidation, GGO and nodules in bilaterial lungs, subpleural or peribronchialvascular predominant distribution were typical HRCT findings of COP. Reverse halo sign was relative specific CT finding. With clinical data and typtical HRCT findings, trans bronchial lung biopsy （TBLB） or percutaneous lung biopsy most COP could be diagnosed. Some cases need open or video-assisted thoracoscopic （VATS） lung biopsy to make a definitive diagnosis.

关 键 词：闭塞性细支气管炎机化性肺炎 肺疾病 间质性 病理学 临床 体层摄影术 X线计算机 

分 类 号：R561[医药卫生—呼吸系统] R814.42[医药卫生—内科学]