肺炎性假瘤的CT影像表现与误诊原因

CT Imaging Findings and Misdiagnosis Causes of Pulmonary Inflammatory Pseudotumor

目的探讨肺炎性假瘤的CT影像表现及误诊原因,提高诊断水平。方法对35例经手术病理证实的肺部炎性假瘤的CT影像表现进行系统回顾性分析。结果肺炎性假瘤多位于肺野外周,局限于一叶,形态多不规则,病灶常呈广基底贴于胸膜并且邻近胸膜增厚,可见"桃尖征"、"平直征"、"晕征"等特征性表现,增强扫描多为高度均匀性强化,病灶经抗炎治疗后可缩小或无变化。术前诊断正确11例,误诊为周围型肺癌17例,结核球4例,肺错构瘤2例,肺脓肿1例,误诊率71.4%。结论全面综合地分析肺炎性假瘤CT表现特征并结合临床资料可提高肺炎性假瘤影像诊断的正确率,减少误诊。

[Objective]To investigate the CT imaging findings and misdiagnosis causes of pulmonary inflammatory pseudotumor,so as to improve the diagnosis level. [Methods]CT imaging findings of 35 cases of pulmonary inflammatory pseudotumor which were confirmed by operation and pathology were analyzed retrospectively. [Results]The pulmonary inflammatory pseudotumor mainly located in peripheral lung field,and was limited in one pulmonary lobe with irregular shape.Broad-base lesions often affixed to the pleura with adjacent pleural thickening,there were characteristic performances of ＂peach sharp sign＂,＂flat sign＂ and ＂halo sign＂.The enhanced scan showed high homogeneous enhancement.After anti-inflammatory treatment,the lesions can be reduced or no change.11 cases of preoperative diagnosis were accurate,the misdiagnosis included peripheral lung cancer in 17 cases,tuberculoma in 4 cases,pulmonary hamartoma in 2 cases and lung abscess in 1 case,the misdiagnosis rate was 71.4%. [Conclusion]The comprehensive and integrated analysis of CT imaging findings combined with clinical data can improve the accurate rate of imaging diagnosis in pulmonary inflammatory pseudotumor,and reduce misdiagnosis.