肺结核患者的不典型CT表现

Atypical CT manifestations of pulmonary tuberculosis

目的探讨和分析肺结核患者的不典型CT表现特点。方法回顾性分析我院2010年1月至2012年9月CT表现不典型的肺结核患者73例,根据其图像特点进行分类并分析。结果所有患者按图像特点分为6型,其中多空洞型7例,表现为肺内多发空洞,无结核播散灶;肺间质型20例,表现为肺内大片细网织样密度增高影,与周围正常肺组织分界清晰,病变区内部分病灶融合实变,并可见多发垂直于胸膜的小叶间隔增厚影;雪花型16例,4例合并间质型,表现为多发腺泡样结节沿小支气管及其分支周围分布,受累各级支气管管腔充盈,内形成多发"小树芽征"及小叶性实变;肿块型29例,病灶边缘可见光滑、深分叶、长毛刺及胸膜凹陷征,未见短毛刺征,病灶平扫为等密度,其中3例肿块呈薄壁或厚环形强化,7例有不同程度的强化;肺门及纵隔淋巴结结核并假性动脉瘤型1例,表现为环形强化的淋巴结内出现假性动脉瘤;实变型4例,为多发段、叶实变,段、叶支气管腔内无异常改变。结论 6种肺结核的不典型CT表现中,肺间质型、雪花型和肺门及纵隔淋巴结结核并假性动脉瘤型有一定特异性,但所有类型需结合临床、化验检查等做出诊断。

Objective To investigate and analyze the features of atypical CT image of pulmonary tuberculo- sis. Methods A retrospective analysis of 73 cases of tuberculosis with atypical CT image of our hospital from Janua- ry 2010 to September 2012 was done to classify all cases into various types due to their image characteristics. Results According to the image characteristics, all cases were divided into 6 types including： type of multiple cavi- tates, 7 cases, showed multiple pulmonary cavitates without tuberculosis disseminated lesions; type of interstitial lesions, 20 cases, showed intrapulmonary large fine mesh weave-like higher density shadows with clear boundary, consolidation in it and multiple thickening interlobular septa perpendicular to the pleural were also seen; type of snowflake, 16 patients（4 with interstitial change）, showed that multiple acinar nodules distributed around the small bronchi and its branches, and formed feeding bronchus sign, multiple ＂tree-in-bud＂ and lobular consolidation in it; type of mass, 29 cases, showed that the edge was found smooth, lobulation, long burr, pleural indentation signs, no short glitches sign, intermediate density was seen in all masses on CT plain scan, 3 cases with rim enhancement, 7 with homogeneous enhancement; type of hilar and mediastinal lymphoid tuberculosis with pseudoaneurysm, 1 ca- ses, showed pseudoaneurysm in rim enhancement lymph node; type of consolidation, 4 cases, showed multiple seg- ment, lobe consolidation with normal endobronchial sign. Conclusion Type of interstitial lesions, snowflake, hi- lar and mediastinal lymphoid tuberculosis with pseudoaneurysm of these 6 types of atypical CT image of pulmonary tuberculosis have a certain degree of specificity to be diagnosed, but clinical and laboratory tests are still needed to be combined with in all types.