肺泡蛋白沉积症影像学诊断

Image diagnosis of pulmonary alveolar proteinosis

目的:探讨肺泡蛋白沉积症的影像学表现及诊断价值。方法:回顾性分析经病理证实的29例PAP患者的临床和X线胸片、常规CT和HRCT资料。结果:X线表现:双肺云絮状密度增高阴影(29例);以下同常规CT表现:弥漫性、地图样、片状磨玻璃影(29例);HRCT表现:"碎石路征"(21例),"地图样"病变(29例),"空气支气管征"(18例)。结论:①X线胸片能发现PAP病变,但缺乏特征性。②常规胸部CT扫描对于诊断PAP有帮助,是胸片的重要补充检查方法。③"碎石路征"、实变区细小而少的"空气支气管征"和"地图样"病变,是PAP在HRCT上的典型表现。④肺泡灌洗:是最关键的诊断和治疗手段。

Objective： To study the imaging manifestation and diagnostic value in pulmonary alveolar proteinosis （PAP）. Methods：The clinical record,chest X ray,conventional CT and HRCT of 29 patients with PAP confirmed by pathology were retrospectively analyzed. Results：Findings on X-ray： floccule dense shadow in both lungs（29 cases）. Findings same as conventional CT： diffuse disposition, map-like, and patchy ground-glass（29 cases）. Findings on HRCT ： crazy paving appearance （21 cases）, map-like pathological change （29 cases）, bronchiogram sign（18 cases）. Conclusion： Firstly, the PAP can be found on chest X- ray, but the findings are lack of characteristic. Secondly, conventional CT scanning of chest contributes for the diagnosis of PAP and it is an important supplementary inspection method to X-ray. Thirdly, crazy paving appearance, small and less bronchiogram sign,map-like pathological change, in the lung consolidation area, are the typical features of PAP on HRCT. Fourthly, bronchoalveolar lavage is the key diagnostic and therapic method of PAP.