肺Wegener's肉芽肿病的CT诊断与鉴别诊断

CT diagnosis and differential diagnosis of pulmonary Wegener's granulomatosis

目的探讨肺Wegener's肉芽肿病的CT表现,提高对该病的诊断水平。方法总结分析经病理证实的韦格纳肉芽肿17例,男10例,女7例,年龄11-72岁,平均年龄37.5岁。所有的患者均行胸部CT平扫加增强扫描。结果CT表现有:大片状浸润病灶4例,小片状浸润病灶5例,多发结节影(直径小于3cm)9例,肿块(直径大于3cm)2例,空洞11例,条状阴影4例,磨玻璃影3例,肺不张2例,支气管狭窄阻塞2例。部分病例多种病灶混合存在,并互相转化,病灶增多或减少。结论肺Wegener's肉芽肿病的表现呈多样性,以片状浸润、结节和空洞病变最常见,薄壁空洞和环形空洞具特征性。此病要与肺癌,结核、肺炎与脓肿等疾病相鉴别。

Objective To characterize CT features of pulmonary Wegener＇s granulomatosis so as to improve the diagnostic accuracy. Methods Seventeen patients, 10 males and 7 females, aged 11-72 （mean 37.5） with histopathologically and clinically proved Wegener＇s granulomatosis were included. All the patients underwent CT plain scan and enhanced scan. Results CT manifestation of pulmonary Wegener＇s granulomatosis included massive infiltration with blurred margins （n = 4）, small patchy infiltration （n = 5）, multiple nodules（less than 3cm in diameter） （n = 9）, mass （more than 3cm in diameter） （n = 2）, cavitation （n = 11）, strip shadow （n = 4）, groundglass like shadow（n = 3）, pulmonary atelectasis （n = 2）, bronchus narrowing or obstruction （n = 2）. Some patients presented with varied kinds of lesions, which could transform each other and become more or less. Conclusions Imaging manifestation pulmonary Wegener＇s granulomatosis is varied. The main manifestation is patchy infilitration, nodules and cavitation. Thin walled cavity and ring-shade cavity are diagnostic. This disease should be differentiated to pulmonary carcinoma, tuberculosis, pneumonia and abscess.