周围性肺结核瘤超声造影表现及其病理基础

Contrast-enhanced ultrasonograpy of pleural-based pulmonary tuberculoma:enhancement patterns and their histopathological basis

目的研究周围性肺结核瘤的超声造影特征及其病理基础。方法对21例周围性肺结核瘤患者先行超声造影检查,参照增强表现,对增强表现不同区域进行穿刺活检,将增强表现与穿刺病理进行对照分析。结果 21例周围性肺结核瘤中,环状增强12例(57.1%),其中央无增强区病理证实为干酪样坏死或液化坏死,周边环状高增强证实为炎性肉芽肿伴有大量淋巴细胞浸润及郎罕氏细胞;均匀增强5例(23.8%),病理表现为显著的淋巴细胞浸润,肺泡渗出及血管扩张,无明显坏死;不均匀增强4例(19.1%),病理表现为慢性肉芽肿炎症伴有散在的点片状坏死。结论环状增强是周围性肺结核瘤超声造影的典型表现,超声造影表现与周围性肺结核瘤的病程病理密切相关。

Objective To investigate the enhancement patterns of pleural-based pulmonary tuberculoma on contrastenhanced ultrasonography （CEUS） and their histopathological basis. Methods CEUS was performed in 21 patients with biopsyproven pleural-based pulmonary tuberculoma. Based on the enhancement patterns, biopsy of specific zone of different enhancement presentations was performed for each lesion, the enhancement patterns and their histopathological manifestations were compared and analyzed. Results Rim enhancement pattern was presented in 57.1% （ 12/21 ） of pulmonary tubereulomas. Pathologic study revealed that the central non-enhancement portion was corresponded to caseous or liquefied necrosis, while the peripheral hyper-enhancement portion was constituted of fibroplasias, Langerhans giant cells, and lymphocyte infiltrastion. 23.8% （5/21） showed homogeneous enhancement which was pathologically corresponded to prominent lymphocyte infiltration and exudation without obvious necrosis. 19.1% （4/21） manifested heterogeneous enhancement which showed granular inflammatory with patches caseous necrosis pathologically. Conclusion Rim enhancement pattern may be the most common enhancement presentation of pleural-based pulmonary tuberculomas, and enhancement patterns are closely related to their pathologic changes.