胸部结节病的CT诊断与分析

Analysis on the diagnosis of thoracic sarcoidosis with CT

【目的】分析结节病的CT表现,以提高对本病的认识和诊断水平。【方法】回顾性分析经活检证实52例胸部结节病的CT表现。【结果】52例结节病中,肺门、纵隔淋巴结肿大46例(88.5%),其中仅见肺门或/和纵隔淋巴结肿大16例(30.7%),肺门或/和纵隔淋巴结肿大伴有肺内改变30例(57.5%),仅见肺部侵润性改变而无淋巴结肿大2例(3.8%),肺纤维性改变4例(7.7%)。肺内主要表现为结节影(30例),支气管血管束增粗(14例),小叶间隔增厚(8例),实变影(2例),磨玻璃影(2例)。【结论】双侧肺门对称性淋巴结肿大和/或纵隔淋巴结肿大以及沿支气管血管束分布的结节影是胸部结节病的特征性表现;不典型者需密切结合临床检查及治疗后随访。

[Objective] To analyze the CT appearances of thoracic sarcoidosis, and to obtain a higher accurate rate of diagnosis. [Methods] The chest CT findings of 52 patients with proven sarcoidosis were reviewed. [ Results] In 52 sarcoidosis cases on CT scan, 46 cases （88.5%） had lymph node enlargement in bilateral hili and mediastinum, among them 16 cases （30.7%） just had lymph node enlargement in bilateral hill and/or mediastinum, 30 cases （57.5%） had lymph node enlargement in bilateral hili and/or mediastinum combined with pulmonary parenchymal abnormality, 2 case （3.8 % ） had only abnormal findings in the lung but without lymph node enlargement, 4 cases （7.7 % ） had fibrous changes in lung. The most frequent findings of pulmonary parenchymal abnormality were nodules （30 cases）, thickening of bronchovasular bundles （ 14 cases）, interlobular septal thickening （8 cases）, consolidation opacities （2 cases）, ground-glass opacities （2 cases）. [Conclusions] The main feature of sarcoidosis in HRCT findings are symmetric lymph node enlargement in bilateral hili and/or mediastinum, nodules located along bronchovascular bundles. Diagnosis of the atypical cases is difficult and should combinedn with clinical findings and follow-up.