纵隔淋巴结病变CT诊断及鉴别

目的探讨纵隔常见的淋巴结病变的CT表现及特征。方法总结经手术、淋巴结活检或临床治疗证实的纵隔淋巴结病变42例,所有患者均行CT平扫及增强扫描。分析其临床及CT表现与相互鉴别要点。结果 44例最终结果分别为:淋巴结结核6例,淋巴结转移癌16例,结节病5例,淋巴瘤9例,巨淋巴结增生4例,艾滋病淋巴结肿大2例。淋巴结结核是最常见的淋巴结炎性病变,以形态多样、钙化、增强扫描边缘环形强化为典型特点。淋巴结转移瘤是最常见的纵隔淋巴结恶性病变,原发灶淋巴引流区优势分布、液化坏死明显、增强呈薄壁环形强化是其重要特征。淋巴瘤CT表现以累及范围广,病变淋巴结密度均匀,增强呈轻度均匀强化为主。结节病以肺门淋巴结对称性肿大、病灶多数不融合且境界清晰、密度均匀、均匀强化为鉴别要点。巨淋巴结增生具有血供丰富、常累及单个淋巴结、呈肿块样增生等特点。结论胸部CT检查是诊断纵隔淋巴结病变的首选方法,病灶形态特点、分布、强化及临床表现对诊断及鉴别有重要意义。

Objective To investigate the mediastinal lymph node disease common CT manifestations and features.Methods Menstrual surgery,lymph node biopsy or clinical treatment of mediastinal lymphadenopathy confirmed 42 cases of normal in all patients underwent CT,35 patients and enhanced scan.The clinical and CT findings and differential diagnosis of each other.Results 42 cases the final results were：lymph node tuberculosis in 6 patients,lymph node metastasis in 16 cases,5 cases of sarcoidosis,9 cases of lymphoma,4 cases of Castleman’s d disease,2 cases of AIDS lymph nodes.Lymph node tuberculosis is the most common inflammatory disease,with varied shapes,calcification,enhanced scan is typical of the edge of ring enhancement.Lymph node metastases is the most common malignant mediastinal lymph nodes,primary tumor lymphatic drainage area edge distribution,liquefaction necrosis apparent increase was thin ring enhancement is an important feature.CT manifestations of lymphoma involving a wide range of pathological lymph node density,the main increase was mild homogeneous enhancement.Sarcoidosis with hilar lymph node enlargement symmetry,lesions,and most do not integrate the realm of clear,uniform density,homogeneous enhancement of differential diagnosis.Giant lymph node hyperplasia with a rich blood supply,often involving a single lymph node,showing tumor-like proliferation and so on.Conclusion Thorax CT diagnosis of mediastinal lymphadenopathy is the preferred method,lesion morphological characteristics,distribution,and strengthen the diagnosis and identification of clinical significance.