巨大淋巴结增生症的CT表现

CT study of giant lymph node hyperplasia

目的：探讨巨大淋巴结增生症（CD）的CT表现特点。方法：结合临床与手术病理资料，回顾性分析12例CD的CT表现特点。结果：12例中，局限型CD9例，表现为颈部、肺内、纵隔、腋窝、左侧后腹膜单发或毗邻2个肿块，共12个肿块，呈类圆形或椭圆形，直径在18～150mm间，平均50mm，其中2个肿块见钙化，1个巨大肿块内见裂隙状低密度灶，其余肿块均呈均质密度伴显著持续性强化，平扫CT值42～50HH，增强后CT值在108～145HU间，且腹部3例肿块周边可见更高密度环形强化影及粗大血管影。弥漫型CD3例，CT上均见有全身多处淋巴结多发肿大，肿大淋巴结直径在8～30mm间．呈均质软组织密度伴轻度强化，其中1例出现肺部病变，表现为两肺弥漫性分布的多发气囊腔及沿肺纹理分布斑点、小片状密度增高影。结论：均质软组织密度肿块伴显著持续性强化及钙化是局限型CD的主要CT表现，具有一定特征性；而弥漫性CD的CT表现类似淋巴瘤，常难以诊断，若合并淋巴细胞性间质性肺炎或副肿瘤性天疱疹等可具有一定的提示诊断价值。

Objective：To assess the OF findings of the Castleman disease（CD）. Methods：The study comprised 12 patients with two types of CD： localized CD（n = 9）and disseminated CD（n = 3）. The OF findings of the 12 cases with the surgical and pathological records were analyzed retrospectively. Results：The 9 patients with localized CD, 12 masses in total, had single or two-adjacent mass in the neck, lung, mediastinum, axillary fossa and retroperitoneal space. On CT scan, the 12 masses appeared as large as 18 - 150mm in diameter （mean 50mm）, round or elliptical, homogeneous soft-tissue density masses with marked persistent enhancement （from 42 - 50HU to 108 - 145HU） excluding 2 relatively large masses with calcification and I mass with flawed nonenhanced region. The 3 patients with multicentric CD had multi-systemic lymph node enlargement. They appeared as homogeneous soft-tissue density masses with slightly enhancement. Pulmonary abnormalities were seen in 1 of the 3 patients which presenting distributed thin-walled cysts and small flaked shadows follow the way of bronchus. Conclusion： Homogeneous soft-tissue density masses with marked persistent enhancement and calcification in large mass were the relatively characteristic OF findings of localized CD. The CT findings of disseminated CD were similar to lymphoma, combining with lymphocytic interstitial pneumonitis and/or paraneoplastic pemphigus （PNP） may be valuable to the diagnosis of disseminated CD.