非结核分枝杆菌肺病的CT特点及分析

Non Tuberculosis CT Appearance and Analysis

目的:分析非结核分枝杆菌的CT表现特点及其与肺结核病的鉴别要点。材料与方法:20例非结核分枝杆菌肺病患者进行胸片和病灶CT检查,同时收集临床资料,对非结核分枝杆菌肺病进行动态观察,并与20例肺结核病例进行影像学对照,分析病变形态和累及范围。结果:20例非结核分枝杆菌肺病的病灶累及右肺的12例(60%),累及左肺的6例(30%),双肺累及的2例(10%),其中病灶分布于右上肺尖的9例(45%);肺内出现空洞16例(80%),其中5例为发生于2个肺叶以上的多发空洞,空洞周围浸润的2例;肺内出现支气管扩张15例(75%);支气管播散少见(1例(5%))。结论:非结核分枝杆菌肺病的影像学表现在病灶的分布、形态及病灶内外的情况具有一定特点,对诊断及鉴别诊断有一定意义,但与继发型肺结核较难鉴别,当影像学表现为结节影、小斑片影、空同、实变和支气管扩张等多种病变形态同时存在或多发空洞、空洞周围浸润较少,而临床规则抗痨治疗疗效不佳或同步性差时,应考虑到肺非结核分支杆菌病的可能。

Purpose：To study the chest CT appearance of pulmonary nontuberculosis mycobacterial infection.Materials and Methods：The chest X-ray findings of 20 cases with cultures positive for pulmonary nontuberculosis mycobacterium were reviewed,20 cases had CT scans simultaneously.All abnormalities and predominant lober involvement were recorded.The findings of chest X-ray and CT were compared.Results：The chest X-ray showed that the right lung was more frequently involved than left,and upper lobe was involved more than lower ones.Multiple manifestation were often co-exsiting.In addition,bronchiectasis,＂tree in bud＂ sign,and mediastinal lymphadenopathy were also seen on CT but not on chest X-ray.Conclusion：space consolidation,cavity,nodule,fibrosis,bronchiectasis,and＂tree in bud＂sign are major abnormalities of pulmonary NTMB are indistinguishable from those of secondary pulmonary TB.Multiple co-existing manifestations may be the characteristic findings of pulmonary NTMB infection.