周围型肺错构瘤CT特征及鉴别诊断

CT features and differential diagnosis in peripheral pulmonary hamartoma

目的分析周围型肺错构瘤的CT影像特征及鉴别诊断,以期提高诊断准确率。方法 21例经临床病理证实的肺错构瘤,CT平扫+增强8例,平扫13例。主要观察病灶的密度、病灶边缘、瘤周肺野及CT增强特征。结果全部病例病灶边缘光滑、清楚,不规则浅分叶7例,深分叶2例;边缘细长毛刺及胸膜凹陷征伴血管集束征1例;病灶内爆米花样钙化2例,伴瘤内低密度脂肪影;14例病灶内无脂肪、无钙化;8例增强扫描瘤内软组织轻度强化,平均CT值小于20HU。结论周围型肺错构瘤有一定的CT特征,包括光滑清楚的边缘,内含钙化、脂脉成份。病灶随访复查及动态CT增强扫描有助于周围型肺错构瘤与其他孤立性肺结节的鉴别诊断。

Objective To discuss the CT features and differential diagnosis in peripheral pulmonary hamartoma （PPH）, in order to improve the diagnostic accuracy. Methods Twenty-one patients of PPH confirmed by pathology and clinic. Eight patients performed the plain CT and enhanced CT scanning, thirteen patients only with the plain CT scanning. CT finding of PPH were observed lesion densi- ty,edge, peritumoral lung field and enhanced CT features. Results All cases were smooth and clear margins, and shallow lobulated or irregular shape in 7 cases, deep lobulated in 2 cases, elongated burr and pleural indentation with vascular convergence in one case, popcorn calcification with fat inside in 2 cases, none of the fat and calcification in 14 cases. Eight cases had slight enhancement （CT valued 20HU）. Conclusions There are some specific CT features of PPH,including smooth and regular edge, calcification and fat inside. Follow-up review and dynamic enhanced CT scanning is useful to differenti- ate between PPH and other solitary pulmonary nodule.