肺非结核分支杆菌病的CT影像表现

CT appearance of pulmonary nontuberculous mycobacterial infection

目的:提高对肺非结核分支杆菌病CT影像学表现的认识。方法:回顾性分析1995～2003年经确诊的46例肺非结核分支杆菌病的胸部CT表现,分析病变形态和累及范围。结果:结节影和小斑片影全部病例都有。空洞、支气管扩张是本病的常见表现。本组病例合并空洞者26例,占56.52%,其中8例为发生于2个肺叶以上的多发空洞;有支气管扩张者22例,占47.83%。病变多为双侧多叶分布,累及双肺或2叶以上者39例,1叶者7例。结论:肺非结核分支杆菌病的主要CT表现是结节影、小斑片影、空洞、实变和支气管扩张,CT影像学表现较难与继发型肺结核鉴别。当影像学表现为累及多个肺叶、多种病变形态同时存在,或伴有多发空洞者,而临床规则抗痨治疗疗效不佳或同步性差时,应考虑到肺非结核分支杆菌病的可能。

Objective To raise the recognition of CT appearance of pulmonary nontuberculous mycobacteriaNTM disease. Methods Chest CT findings of 46 cases during 1995 to 2003 with cultures positive for pulmonary NTM were reviewed the form and extent of lesion were analyzed. Results All cases had nodules and patchy shadows. The cavities and bronchiectasis were frequently seen. Twenty-six cases56.52% showed cavities in 8 cases there were multi-cavities in more than two lobes. Twenty-two cases47.83% had bronchiectasis. The lesion involved bilateral multiple lobes were frequently seen bilateral more than two lobes were seen in 39 cases. Only one lobe involved were seen in 7 cases. Conclusion The nodule and patchy shadows and cavity and air space consolidation and bronchiectasis are the CT main appearances of pulmonary NTM but are indistinguishable from those of secondary pulmonary TB. The possibility of pulmonary nontuberculous mycobacterial infection should be taken into consideration when involvement of multiple lobes multi-form of lesion co-existed on CT or associated with multi-cavities and anti-tuberculous treatment were ineffective.