肺硬化性血管瘤的CT表现及其误诊分析  

Analysis of Misdiagnosis and CT Features of Pulmonary Sclerosing Hemangioma

作　　者：李海军[1] 彭德昌[1] 龚洪翰[1] 何玉麟[1] 曾献军[1] 聂晓[1] 聂思 叶成龙[1] 

机构地区：[1]南昌大学第一附属医院影像科,330006

出　　处：《临床放射学杂志》2016年第9期1372-1375,共4页Journal of Clinical Radiology

摘　　要：目的探讨肺硬化性血管瘤(PSH)的CT表现,分析其误诊原因。方法回顾性分析25例经手术病理证实的PSH患者临床及CT资料,总结其CT特征,并对术前诊断错误病例进行分析总结。结果 25例PSH,术前CT正确诊断10例,误诊为肺癌6例、结核球1例、炎性假瘤1例、孤立性纤维瘤2例、炎性肌纤维母细胞瘤1例,另4例考虑良性病变,性质不明。肿瘤位于左肺17例,其中上叶9例、下叶8例;右肺8例,其中上叶3例、中叶5例;中央型8例,周围型17例。病灶大小0.8 cm×0.8 cm^4.8 cm×3.7 cm,平均约2.7 cm×2.3 cm。24例CT表现为圆形或类圆形结节或肿块,边界清楚,11例浅分叶;1例为不规则肿块,边界尚清。CT平扫密度均匀18例,7例密度不均匀;增强扫描7例不均匀强化,中央轻度强化区,边缘明显强化;18例均匀明显强化,净强化值30~80HU,平均52.3 HU。9例病灶内或边缘可见钙化。血管贴边征10例,空气新月征2例,尾征4例,肺动脉为主征3例,血管集中征2例,胸膜牵拉凹陷1例,长毛刺1例,棘状突起1例。结论 PSH表现具有一定CT特征(血管贴边征,空气新月征,尾征等),仔细多平面观察及增强扫描可以提高术前正确诊断率。Objective To explore the CT features and analysis of misdiagnosis of pulmonary sclerosing hemangioma（ PSH）. Methods Clinical and CT data of 25 cases of PSH confirmed by surgery and pathology were analyzed retrospectively. We carefully set out to find the CT features of PSH of preoperative misdiagnosis and summary analysis. Results Preoperative CT diagnoses of 10 cases were considered to be PSH. There were lesions that were misdiagnosed as lung cancer（ n = 6）,tuberculoma（ n = 1）,inflammatory pseudotumor（ n = 1）,solitary fibrous tumor（ n = 2）,inflammatory myofibroblastic tumor（ n = 1） and the remaining 4 cases were considered to be benign lesions. Tumors were located in the left lung in 17 cases（ upper lobes 9 cases,lower lobe 8 cases）,right lung in 8 cases（ 3 cases in the upper lobe and 5 cases in the middle lobe）. Eight cases were central and 17 cases were peripheral. The sizes ranged from 0. 8 cm × 0. 8 cm to4. 8 cm × 3. 7 cm（ mean： 2. 7 cm × 2. 3 cm）. CT showed round or oval nodules or masses with smooth edge in 24 cases,irregular mass with a well-defined margin in 1 case and visible slight superficial lobulation in 11 cases. CT scan showed homogeneous density in 18 cases,heterogeneity in 7 cases,and calcification in 9 cases of lesions or edges. The enhanced-CT showed non-uniform strong enhancement in 7 cases with the central mildly enhancing region,whereas the periphery was significantly enhancing. The were 18 cases with significant uniform enhancement. There were welt vessel signs in 10 cases,air meniscus sign in 2 cases,tail signs in 4 cases,prominent pulmonary artery sign in 3 cases,vessel convergence signs in 2 cases,pleural retraction signs in 1 case,long burr in 1 case,and spinous process in 1 case. Conclusion PSH have some specific CT features（ welt vessel signs,air meniscus sign,tail signs,etc.）. The accuracy of correct diagnosis preoperative can be improved with careful multi-planar reconstruction observation and enhancement scanning.

关 键 词：硬化性血管瘤 肺 体层摄影术 X线计算机 误诊 

分 类 号：R734.2[医药卫生—肿瘤]