球形肺炎的CT诊断与鉴别诊断

CT Differentiation Diagnosis of Spherical Pneumonia

目的探讨球形肺炎的CT表现及其诊断价值。资料与方法回顾性分析经CT扫描、临床观察，手术、穿刺活检证实的28例球形肺炎，采用螺旋CT薄层扫描及部分HRCT扫描，3名医师共同阅片，分析其CT表现。结果球形肺炎CT表现：大多位于肺的背部，靠近或紧贴胸膜，均单发，球形，少数为楔形、方形，胸膜肥厚明显，直径约2～5cm，病灶多为中低密度，较均匀，周围密度较淡，可见“晕征”、“局部充血征”、“刀切征”，少数有透亮影及钙化，增强扫描可见明显强化，抗生素治疗后复查，大多数较快吸收，吸收期病灶位置、形态可发生变化。结论球形肺炎的CT征象具有一定的特征性，吸收期病灶位置、形态发生变化可视为本病的一个特征。CT多征象综合分析，并结合临床，多能做出正确诊断，不易鉴别者应活检以尽早确诊。

Objective To discuss the CT features of spherical pneumonia and its diagnostic value. Materials and Methods CT features of 28 cases with spherical pneumonia proved by CT scan （conventional scan, HRCT, contrast enhanced scan）, operation, biopsy and clinical information, were analyzed retrospectively. Results The CT features included ： the site of spherical pneumonia most located in the back of the lung and near the pleura, single in number, about 2 ～ 5 cm in diameter, middle or lower homogeneous in density, and faint in periphery, ＂localized plethora＂, ＂halo＂, ＂sharpen rim perpendicular to pleura＂ signs, markedly enhanced by contrast media; There were empty space, calcification and radiolucent shadow in few cases. After antibiotics were administrated for a short time, the lesion was resolved quickly in most cases. Conclusion Spherical pneumonia has some CT features. The change in location and shape of focus with resolution may be one of the manifestations. Correct diagnosis depends on CT features and clinical data, biopsy is necessary when it is difficult to differentiate diagnosis.