胸部放线菌病的影像学特征

Imaging features of thoracic actinomycosis

目的观察胸部放线菌的X线平片及CT特征。方法回顾性分析5例胸部放线菌病患者的影像学资料。结果5例患者中,3例经支气管纤维镜活检、1例经CT穿刺、1例经手术病理确诊。5例X线正、侧位胸片显示团块和大片密实影,未见空洞、气体和液化灶;CT示病变共累及9个肺叶,26个肺段。4例以团块为主要病灶(其中2例见2个肿块),周围肺见多发斑点、斑片及条索状模糊影;5个团块内均见空洞,薄壁,内壁光滑;空洞内充满低密度液化灶和散在悬浮的气体影,但未见气-液平面,是本组病例较典型的CT表现。5例均见邻近胸膜增厚,4例肺门和(或)纵隔淋巴结增大;1例右肺斑片状影合并纵隔脓肿。结论以团块内出现空洞为主要表现的胸部放线菌CT表现具有特征性:空洞壁薄、内壁光滑、空洞内充满液化灶和散在悬浮的气体影且不形成气-液平面,可显示病灶的细节征象。X线平片诊断此病价值有限。

Objective To observe X-ray and CT features of thoracic actinomycosis. Methods Image data of 5 cases with thoracic actinomycosis were retrospectively analyzed. Results Three cases were diagnosed with bronchoscopy, 1 case with CT-guided biopsy and the other with operation. All the cases showed clump and plaque density, but no cavity, air or hquation was found on chest X-ray film. CT showed foci distributed in 9 lobes and 26 segments. Lump was the main abnormality in 4 cases （2 cases with 2 lumps respectively）. Multiple blurred spots, patchies and stripes were found around the lumps. Cavity was found inside 6 lumps, and thin wall, smooth inner, low density liquation and suspended air bubbles, but no airfluid levels in the cavity were characteristic signs. Vicinity pleural thickening was found in 5 cases, lymphadenovarix in hilar and/or mediastinum in 4 cases and blurred patches in right lung incorporated mediastinal abscess in 1 case. Conclusion CT characteristics of thoracic actinomyeosis contributes to display the details of thoracic actinomycosis, including cavity in the lump with thick wall, smooth inner, low density liquation and suspended air bubbles, but no air-fluid level, whereas chest X-ray film has limited diagnostic value for thoracic actinomycosis.