螺旋CT扫描对肺泡蛋白沉着症的诊断价值

The value of spiral CT scans in diagnosing pulmonary alveolar proteinosis

目的通过观察临床症状与CT表现的相关性评价螺旋CT扫描对肺泡蛋白沉着症(PAP)的诊断价值。方法对10例由支气管肺泡灌洗确诊的PAP患者的胸部常规与高分辨率CT扫描结果进行了回顾性分析,并与临床症状相对照。结果 10例患者中,8例起病隐匿且病程进展缓慢,2例未见明显临床症状;胸部CT扫描显示所有患者双侧肺野中散在性或弥漫性分布的磨玻璃样密度影和典型的"铺路石"征。轻微的临床症状与明显异常的CT表现之间的不对称性是PAP的重要特征。结论胸部螺旋CT是诊断PAP的重要依据,但确诊仍需借助于支气管肺泡灌洗。

Objective To assess the value of spiral CT scans in diagnosing pulmonary alveolar proteinosis（PAP） through observing the relativities between clinical symptoms and CT findings.Methods 10 patients with PAP confirmed by bronchoalveolar lavage underwent conventional and high-resolution spiral CT scans of the chest.The CT findings of all patients were retrospectively analyzed and compared with clinical symptoms.Results Among 10 PAP patients,8 cases were obscurely pathogenetic and slowly progressed,the other 2 cases had no obvious clinical symptoms.The chest CT scanning showed that there were scattered or diffuse shadows with ground-glass density and typical ＂paving stone＂ signs in the lung fields.The unsymmetry between mild clinical symptoms and obvious abnormal CT findings was an important feature of PAP.Conclusion The intrapulmonary ＂ paving stone＂ signs visualized on CT images and unsymmetry between clinical manifestations and imaging abnormalities are essential evidence for diagnosing PAP,while the definite diagnosis depends necessarily on bronchoalveolar lavage.