肺炎性假瘤的影像诊断及误诊分析

Image diagnosis and misdiagnosis of pulmonary inflammatory pseudotumors

目的探讨肺炎性假瘤的影像学特点及鉴别诊断。方法回顾分析36例经手术病理证实的肺炎性假瘤的X线胸片表现、CT征象及误诊情况。结果 X线胸片一般只能查出异常结节或团块影,CT则可显示某些特征性征象。X线胸片误诊率72.2%(26例),CT检查误诊率53.1%。病灶多单发且位于胸膜下,<3cm病灶多呈边缘不光整的结节或斑块影,3cm以上病灶呈不规则团块状,密度均匀或不均匀,可见浅分叶征、周围晕圈样炎性浸润影、粗长毛刺或"核桃尖"样突起、广基底与胸膜相连,靠近肺门侧可见增粗、扭曲的肺纹理或引流支气管影。增强扫描病灶多呈不均匀明显强化。结论肺炎性假瘤影像表现多样化,充分认识和分析其CT表现特征,结合呼吸道感染病史,有助于提高诊断的准确率。

Objective To study the image features of pulmonary inflammatory pseudotumor.Methods The X-ray and CT signs of 36 cases with pulmonary inflammatory pseudotumor confirmed by pathology were analyzed retrospectively.Results Generally, X-ray film can only detect abnormal nodules shadow; CT may show some characteristic signs. The misdiagnosis rate of X-ray inspection is 72.2% （26 cases）, and misdiagnosis rate of CT examination is 53.1% （17 cases）. Lesions were more single, usually located under the lung pleura. 3 cm lesions showed irregular margin, but 3cm or more lesions showed irregular mass, with homogeneous or inhomogeneous density. Sometimes they had shallow lobulation, halo-like inflammatory infiltrations, long thick burr, ＂Walnut tip＂-like protuberances, square sign on the pleura, and pleural broad base attached to the side. Enlargement, distortion the drainage of bronchial lung markings or video can be seen near the hilar. Enhanced scan lesions often showed heterogeneous enhancement.Conclusion It is helpful for improving diagnostic accuracy and reducing the misdiagnosis to understand the diversity of image of pulmonary inflammatory pseudotumor and characteristics of CT-related inflammatory diseases, combined with a history of respiratory tract infections.