成人不典型肺结核58例影像表现及误诊分析

Imaging manifestation and misdiagnosis analysis of 58 cases of adult atypical pulmonary tuberculosi

目的探讨不典型肺结核影像学特点,以便与其他肿块性病变特别是周围型肺癌鉴别。方法回顾性分析58例均经手术和/或病理组织学证实的不典型肺结核的X线和CT影像学表现及误诊情况。结果根据CT征象,将58例不典型肺结核分为结节或肿块型31例(53.4%),节段或肺叶实变型12例(20.7%),空洞型6例(10.3%),支气管内膜结核、肺底结核及粟粒结节型各3例(5.2%)。不典型肺结核首诊误诊率26例,占44.83%,其中15例被误诊为肺癌,超过一半。结论不典型肺结核主要误诊原因是过分依赖影像学征象的诊断价值;对各种影像征象进行综合分析,并对病灶进行动态观察有助于提高不典型肺结核的诊断率。

Objective To investigate the imaging features of atypical pulmonary tuberculosis, and to identify peripheral lung cancer from other mass lesions Methods The X-ray and CT imaging manifestations and misdiagno- sis of 58 cases of atypical pulmonary tuberculosis were analyzed retrospectively. All the cases were confirmed by oper- ation and or pathology. Results The clinical symptoms, X-ray and CT imaging manifestations of atypical pulmonary tuberculosis were non-specific, with the positive rate for tuberculosis bacteria of 10.3%. X-ray could only detect some abnormal shadow in lung, while CT could show certain characteristic signs. According to CT manifestations, the 58 cases of tuberculosis were divided into 31 cases ofnodus or tumour type （53.4%）. 12 cases of segmental or lobar con- solidation-type （20.7%）, 6 cases of empty-type （10.3%）, 3 cases of endobronchial tuberculosis （5.2%）, 3 cases of basal tuberculosis （5.2%） and 3 cases of miliary pulmonary tuberculosis （5.2%）. Twenty-six patients were misdiagnosed in the first diagnosis, with the first misdiagnosis rate of 44.8%, including 15 cases of lung cancer. Conclusion The main cause of misdiagnosis is over-dependence on radiological signs. Comprehensive analysis of diagnostic signs and dynamic observation of lesions could help improve the rate of diagnosis of atypical tuberculosis.