胸壁结核的影像学评价

Evaluation of chest wall tuberculosis with imaging examination

目的:探讨胸壁结核(TB)的影像学表现,提高对此病的认识。方法:回顾性分析经手术病理证实的29例胸壁结核的CT、X线及US表现和相应的临床资料。采用多层(16、64层)螺旋CT机行胸部常规平扫及增强扫描,图像资料经薄层重建后多窗值观察。结果:主要临床表现为发热和局部肿痛。主要CT表现:骨质破坏15例,包括肋骨8例、胸骨3例、胸肋关节软骨3例及肩胛骨1例,呈虫蚀状(2例)或膨胀性(13例);胸壁寒性脓肿10例,为胸骨或肋骨前后缘或乳腺深面丘状或梭形囊性病变;胸壁全层软组织增厚4例,伴有钙化2例;壁层胸膜外局部肿块2例。其它伴随表现:肺内病变16例,纵隔钙化3例,肝内钙化1例,腹壁受累2例。胸壁病变大部分(15例)位于前胸壁,病变大小1.0cm×2.0cm～8.5cm×4.3cm,边界清楚或不清,增强后有环状强化,内界清晰;增厚胸壁呈轻度-中度不均匀强化。X线片上仅见骨质破坏;US可见囊性病变(7例)呈不均匀可移动低回声暗区,内部无血流信号。薄层CT重建及适时调窗可显示微小钙化或轻微骨质破坏。依据病变CT特征可分为4型:骨质破坏为主(n=13)、囊性病变(n=10)、胸壁软组织增厚(n=4)和壁层胸膜TB瘤(n=2)。结论:CT可明确胸壁TB的部位,显示骨质破坏、寒性脓肿、软组织肿块或增厚等病变特征以及胸壁外病变,增强CT可进一步明确病变范围、深度或性质,对指导临床制订治疗方案有重要价值。

Objective： To investigate the imaging findings of chest wall tuberculosis （TB）,in order to improve the knowledge of the disease. Methods：CT, uhrasonography and radiographic findings as well as the clinical manifestations of 29 patients with pathologically proved chest wall tuberculosis were retrospectively analyzed. Multi-slice （16-slice, 64-slice） CT without or with contrast enhanced scanning and post processing were performed. Results： The main clinical manifestations were fever, local pain and swelling. The main CT findings included ： ① bony destruction,including rib （n =8）, costal cartilage （n =3） ,sternum （n=3） and scapula （n=1）,showingmousebitten erosion （n =2） or expansive bone destruction （n =12）; ②chest wall cold abscess （n =10） ,showed as plate-like or fusiform cystic lesion,which located anterior/posterior to ster-num or ribs,or behind the mammary gland;③soft tissue thickening,lumps and calcification of chest wall （n=4） ;@ extra pleural mass of the chest wall （n=2）. The other findings included mediastinal calcifications （ n = 3）, lesions in pulmonary （n= 16）,liver （n=1） and abddominal wall （n=2）. Most of the lesions （n=15） located at anterior chest wall,1. 0cm× 2.0cm-8.5cm×4.3cm in size,well or ill-defined margin,with ring like enhancement and well circumscribed inner surface after contrast administration. The thickened chest wall showed mild to moderate heterogeneous enhancement. Only bone de- struction could be seen on radiography and cystic changes （n= 7） was shown on ultrasonography as hypoechoic areas with no blood flow inside. Thin slice reformatted CT images with proper window technique can detect microcalcifications or mi-nor bone destruction. According to CT findings,there were 4 types of chest wall TB appearance including bone destruction （ n=13 ）, cystic lesions （ n = 10）, soft tissue thickening （ n = 4 ） and parietal pleural tuberculoma （ n= 2）. Conclusion ： The loca-tion of chest wall TB could be clearly demonstrated on CT, showing bone destruction, cold abscess, soft tissue mass or thick-ening,or extra chest wall lesions. Enhanced CT might further clarify the extent, depth or nature of lesion and play an impor-tant role for clinical treatment guidance.