糖尿病合并干酪性肺炎影像学表现

Imaging Manifestations of Tuberculosis Caseous Pneumonia in Diabetic Patients

目的:探讨糖尿病合并肺结核干酪性肺炎的影像学表现特点。方法:18例确诊2型糖尿病合并干酪性肺炎患者,男14例,女4例,年龄47-72岁。临床症状为发热、咳嗽(干咳为主)。均行胸部X线检查及胸部CT扫描。结果:13例表现为大叶性肺炎(72.2%),CT检查发现实变病变中有小空洞存在,5例右下肺可见播散病灶;3例表现为肺不张(16.7%);2例表现为小叶性干酪性肺炎(11.1%)。病变部位:右上肺11例,左上肺4例,右中下肺3例。7例(38.9%)经痰检及纤支镜检查确诊,2例(11.1%)误诊为肺癌,9例(50.0%)在多种治疗无效后1月后确诊。结论:糖尿病合并结核干酪性肺炎主要表现为大叶实变及虫蚀状空洞,一般无肺门及纵隔淋巴结肿大,支气管腔通畅,具有一定特征性,熟悉这些表现特点,对糖尿病合并结核干酪性肺炎影像学诊断有极大帮助。

Objective：To discuss the imaging features of diabetic patients with caseous pneumonia.Methods：Eighteen cases（14males,47-72 years old）of type 2 diabetes mellitus had been per-formed chest X-ray examination and chest CT scan.Their main clinical symptoms were fever and cough.Results：Thirteen cases showed lobar pneumonia（72.2%）,and CT examination revealed small hollows in the lesions.Five cases of patients showed right lower lung lesions disseminated; three cases had atelectasis（16.7%）;two cases displayed lobular caseous pneumonia（11.1%）.Lesions distribution were：11cases in the right upper lung,4cases in the left lung,and 3 cases in the lower right lung.Seven cases（38.9%） were confirmed after sputum examination and bron-choscopy,2cases（11.1%）were misdiagnosed as lung cancer,and 9cases（50.0%）were confirmed one month later with a variety of ineffective treatment.Conclusion：The imaging manifestations of diabetic patients with caseous pneumonia show large-leaved substantive lung lesions and worm-eaten-like hollows,generally without swelling of the hilar and mediastinal lymph nodes.The wall of bronchial cavity is very smooth.These manifestations are helpful for radiological diagnosis of diabetic patients with tuberculosis caseous pneumonia.