33例不典型肺结核球的CT所见分析

Analysis of 33 cases of atypical pulmonary tuberculosis ball by CT images

目的 探讨易误诊为肺癌的肺结核球的CT所见，以提高影像学诊断水平，避免误诊。 方法 回顾性分析山西省肺瘤医院术前经CT检查诊断为肺癌，并经手术病理证实的33例肺结核球患者的影像学特点。 结果 33例患者33处病灶均表现为结节或团块影；病灶直径为0.9～5.7 cm，平均（3.04±0.15）cm。发生于双肺上叶及下叶背段25例；病灶内部发生空洞7例（21.2%，7/33），钙化10例（30.3%，10/33）；病变边缘多发小毛刺8例（24.2%，8/33），长索条影10例（30.3%，10/33）；同一肺野内可见卫星灶8例（24.2%，8/33），其他肺野可见钙化及粒状影4例（12.1%，4/33）；胸腔积液1例（3.0%，1/33）。病变CT增强扫描表现：28例行增强扫描，其中不均匀强化占35.7%（10/28），蜂窝状强化占32.1%（9/28）；28例中17例行CT平扫加增强扫描，强化部分CT值较平扫增加值为7～58 HU，平均（24.1±1.8）HU。 结论 肺结核球CT及临床表现多样，蜂窝状强化、长索条影、卫星病灶有助于判断，同时要结合临床及实验室检查综合判断，才能降低不典型肺结核球的误诊。

Objective To raise the CT differential diagnosis level, comparative study CT imaging and clinic pathologic features in patients with atypical tuberculosis which were easily misdiagnosised as lung cancer. Methods Retrospective studies 33 cases of atypical pulmonary tuberculosis patients （confirmed by pathology） were misdiagnosised as lung cancer by CT in Shanxi Tumor Hospital. Results All the 33 focuses in 33 cases showed nodule or mass shadows,the diameter was around 0.9-5.7 cm, average value was（3.04±0.15）cm. Focuses of 25 cases were occurred at double upper lobe of lung and double lung dorsal segment of lower lobe. There were 7 cases with cavity in focuses interior（21.2%,7/33）,10 cases with calcification（30.3%,10/33）. There were marginal spiculated sign in 8 cases（24.2%,8/33） and long streaks in 10 cases（30.3%,10/33）. Eight cases were with the same lung field with satellite nodules（24.2%,8/33）,4 cases were with calcification and granular in other lung field（12.1%,4/33）.One case was pleural effusion. CT appearance with enhancement scan： 28 cases with enhancement,there were inhomogeneous enhancement 35.7%（10/28）,honeycomb enhancement 32.1%（9/28）. Seventeen cases with CT plain and enhancement scan,the results showed CT value of enhancement part can be increase 7-58HU, ave-rage（24.1±1.8）HU. Conclusion The CT appearance and clinical characteristics of atypical pulmonary tuberculosis were multiform,such as honeycomb enhancement, long streaks and satellite nodules, which can help distinguish atypical pulmonary tuberculosis from lung cancer.