45例结核性支气管狭窄肺不张的CT征象

CT Manifestations of 45 Cases with Tuberculous Bronchostenotic Atelectasis

目的探讨结核性支气管狭窄肺不张的CT征象,提高诊断与鉴别诊断水平。资料与方法回顾性分析经纤维支气管镜检查和/或痰检证实的45例结核性支气管狭窄肺不张患者的CT征象。结果45例中,左或右上叶肺不张19例;中度及重度肺不张37例;多支支气管狭窄28例;多叶肺不张5例。不张肺叶的外缘常较平直或凹入,内缘与纵隔界面清楚;肺门区无块影;不张肺叶内常出现迂曲、变形的支气管气相8例,支气管扩张14例,钙点或钙斑12例;不张肺叶的同侧和/或对侧肺野显示新旧兼存的多形性结核病灶和支气管播散病灶25例。结论除观察不张肺叶及其内部的CT征象外,仔细观察其余肺野、支气管、肺门及纵隔情况,有助于鉴别结核性支气管狭窄肺不张与中心型肺癌引起的肺不张。

Objective To discuss the CT manifestations of tuberculous bronchostenotic atelectasis. Materials and Methods The CT manifestations of tuberculous bronchostenotic atelectasis confirmed by fiberoptic bronchoscopy and/or sputum examination were analyzed retrospectively. Results There were left or right upper lobe collapse in 19 cases, moderate or severe collapse in 37 cases, multiple bronchostenosis in 28 cases, polylobar collapse in 5 cases, lateral margin of the collapsed lobe usually showed flat or concave but the inner or mediastinal border appeared clear; no mass shadow was found in the hilar region; within the collapsed lobe, there were convoluted and distorted air bronchograms frequently in 8 cases, brochiectasis in 14 cases, calcific flakes or patches in 12 cases, old or newly disseminated tuberculous lesions occurred in the same side of the collapsed lobe or its opposed lung in 25 cases. Conclusion Besides the collapsed lung lobe and its intralobar CT signs, the observation of the remaining lung field, bronchi, hilus and mediastinum is helpful to differentiate tuberculous bronchostenotic atelectasis from atelectasis caused by the central type lung cancer.