肺结核不典型CT表现及误诊分析

Analysis of CT features and misdiagnosis of atypical pulmonary tuberculosis

目的对肺结核不典型的CT影像特点进行分析,并总结分析各种不典型CT影像的误诊原因,以减少误诊率。方法从2011年11月～2012年11月这一时期内因患有肺结核而被收入武警浙江省总队嘉兴医院感染科治疗的患者中抽取CT影像特点不典型的216例作为本次研究的观察对象,回顾性分析上述患者的CT报告及病程记录,根据其CT影像特点将其误诊原因进行分类并总结分析。结果根据CT影像特点,结果可分为下列几种类型:①不常见肺部空洞者40例:肺组织内多处空洞且不伴有结合病灶;②病灶呈结节或肿块者136例:边缘清晰光滑的有102例,边缘粗糙的有26例,轻度分叶的有8例;③病灶呈片状实性改变的有32例:形态不规则,密度分布均匀,边缘不清晰;④纵隔及肺门淋巴结肿大者8例:肺门及纵膈淋巴结中出现肿块。通过对上述216例肺结核患者的不典型CT影像报告及病程记录进行回顾性分析后,发现有42例患者被误诊为其他肺部疾病,误诊率高达19.44%。结论 CT检查是临床上常用的肺结核诊断辅助检查手段,对容易误诊的不典型CT影像特点进行分类与总结分析可以避免误诊的发生,提高正确诊断率,从而提高患者的治疗效果。

Objective To analyze the CT imaging features of atypical tuberculosis,and summary the analysis of the causes of misdiagnosis of various atypical CT image,in order to reduce the rate of misdiagnosis. Methods From November 2011 to November 2012,216 patients with internal cause suffering from tuberculosis and extraction treatment of Hospital of Jiaxing of Armed Police Corps in Zhejiang Province infected patients imaging features not typical were chosen as the research object of observation,retrospective analysis of the patients with CT report and course record were done,according to the CT imaging features of the causes of misdiagnosis were classified and analyzed. Results According to the characteristics of CT image,the results could be divided into the following several types： ①40 cases were not common in the lung tissue of pulmonary cavities： multiple empty and not associated with combined lesions; ②there were 136 cases of nodular or mass： clear smooth edge were 102 cases,rough edges were 26 cases,mild lobe were 8 cases; ③this showed patchy areas of change were 32 cases： irregular shape,uniform density,the edge was not clear; ④8 cases were mediastinal and hilar lymph node enlargement： mass of hilar and mediastinal lymph nodes. A retrospective analysis was carried out on the 216 cases of pulmonary tuberculosis patients with atypical CT imaging reports and records,42 patients were found to have been misdiagnosed as other pulmonary disease,misdiagnosis rate was as high as 19.44%. Conclusion CT examination is commonly used in clinical diagnosis of pulmonary tuberculosis auxiliary examination means,the atypical CT imaging features of easy misdiagnosis are classified and analyzed,and can avoid misdiagnosis,improve the correct diagnosis rate,thereby improving patient outcomes.