肺结核空洞伴曲菌球形成的X线诊断

CT and Chest Radiographic Manifestations of Pulmonary Tuberculosis Complicated by Aspergilloma

目的探讨肺结核空洞内继发曲菌球形成的X线诊断要点及价值。方法收集我院1997-2008年经外科手术后病理证实的肺结核空洞伴曲菌球形成的临床资料,共41例,进行回顾性分析,探讨其临床症状及X线特征。结果肺结核空洞伴曲菌球行成的临床症状以大量咯血为最常见。X线平片上多表现为肺结核病灶背景下的空洞内结节状或球形病灶,其周围可见新月形气腔;CT上多表现为结核病灶所形成的空洞内的结节状影,周围可见新月形气体密度影,由仰卧位转为俯卧位后,结节影可移动至空洞的较低部位。结论经正规抗结核治疗后的肺结核病人,出现咯血或者咯血很难止住,X线胸片或者CT片上出现空洞内的结节影及周围的新月形气腔时,高度提示肺结核空洞伴曲菌球形成的诊断,正确的诊断对外科手术治疗有很大的帮助。

Objective To explore CT and chest radiographic manifestations and diagnosis value of pulmonary tuberculosis complicated by aspergilloma. Methods cases of patients with pulmonary tuberculosis complicated by aspergilloma that were confired by surgery were analyzed retrospectively. The clinical symptom and image character were also evaluated. Results Hemoptysis is a common clinical symptom in the patients with aspergilloma. Thoracic X-ray of patients shows typical image, with low density tuberous and globular nidus in the cavity surrounded with semicircle or crescent vacuoles. During CT scans, the fungus ball could move with the change of patient,s body position. Conclusion It is important to analyze clinical symptom and X-ray character for the diagnosis of secondary pulmonary aspergilloma when pulmonary tuberculosis patients with hemoptysis which is hard to cure or typical CT and chest radiographic manifestations. The right diagnosis is helpful for cure of sugery.