误诊为肺癌的肺结核CT、病理表现及误诊分析

CT Findings,Pathology and Cause Analysis of Tuberculosis Nodules or Masses Misdiagnosed as Lung Cancer

目的探讨误诊为肺癌的肺结核CT、病理表现并分析误诊原因。方法收集CT误诊为肺癌的40例肺结核及40例周围型肺癌,病灶直径≥1cm。回顾性分析病灶的形状、内部特征、强化特点、边缘、邻近肺组织改变及淋巴结并分析误诊原因。结果①病灶形状及部位:类圆形22例,分叶状10例,不规则8例。上叶18例,下叶12例,中叶10例。②内部特征:密度均匀28例,空洞3例,钙化7例,空洞伴钙化2例。③病灶强化特点:中度欠均匀强化18例,中度均匀强化5例,轻度欠均匀强化6例,无明显强化11例。④边缘特征及邻近组织改变:边缘不光整40例,边界模糊12例,毛刺征18例,卫星灶40例,胸膜增厚及粘连11例,胸膜凹陷征3例,引流支气管管壁增厚5例。⑤肺门及纵膈淋巴结:淋巴结肿大31例。肿大淋巴结均匀强化21例,环形强化4例,无明显强化6例。40例病理均可见到结核肉芽组织及干酪样坏死组织。结论误诊为肺癌的肺结核CT表现与病理类型密切相关,病灶周围的卫星灶提示肺结核的可能,但需要组织活检才能明确诊断。

Objective To investigate CT and pathologic findings of tuberculosis nodules or masses misdiagnosed as lung cancer and analyze their causes.Methods Forty patients with tuberculosis lesions ≥ 1cm in diameter were misdiagnosed as lung cancer on CT.The shape,internal features,enhanced features,margin,adjacent lymph nodes and lung tissue changes were analyzed retrospectively.The causes of misdiagnosis were also analyzed.Results（1） The shape and location of the lesion：oval in 22 cases,lobulated in 10 cases,irregular in 8 cases.18 cases were in upper lobe,12 cases in lower lobe,and 10 cases in middle lobe.（2） Internal features：inhomogeneous density were in 28 cases,cavitation in 3 cases,calcification in 7 cases,and cavitation with calcification in 2 cases.（3） Lesion enhancement characteristics：Moderate inhomogeneous enhancements were in 18 cases,moderate homogeneous enhancement in 5 cases,slightly inhomogeneous enhancement in 6 cases,and no enhancement in 11 cases.（4） Marginal features and adjacent tissue changes：irregular margin were in 40 cases,12 cases of ill-defined margin,spicule sign in 18 cases,satellite lesions in 40 cases,pleural thickening and adhesions in 11 cases,pleural indentation in 3 cases,and drainage of the bronchial wall by thickness in 5 cases.（5） Hilar and mediastinal lymph nodes：Lymph nodes enlargement in 31 cases.Lymph nodes homogeneous enhancement were in 21 cases,ring enhancement in 4 cases,and no enhancement in 6 cases.Conclusion CT findings of tuberculosis nodules or masses misdiagnosed as lung cancer are correlative with their pathology.Nodules or masses with satellite lesions may be suggestive of tuberculosis,but biopsy to confirm the diagnosis was necessary.