慢性肺炎的影像学表现

Imaging of Chronic Pneumonitis

目的 研究慢性肺炎的影像学表现特点 ,探讨误诊原因。材料与方法 搜集 1988年 10月～ 2 0 0 0年 12月因各种原因经手术治疗的慢性肺炎患者 3 4例 ,其中慢性肺炎 17例 ,机化肺炎 16例 ,慢性肺炎合并机化性肺炎 1例 ,均有术前胸片及CT扫描检查(薄层靶区及靶区HRCT 19例 )。对其影像学表现进行回顾性分析。结果 (1)胸片表现 :肺叶、肺段实变而根部无肿物 8例 ,局灶性病变 2 4例 ,可表现为不规则、类椭圆形及球形 ,边缘可清楚或模糊 ,密度均匀或不均 ,其余 2例胸片未显示。(2 )CT表现 :①局灶性病变 2 6例 ,病变最大径 1.3～ 6.0cm ,平均 3 .5cm ;病变位于右肺 16例 (61.5 % ) ,左肺 10例 (3 8.5 % ) ,病变宽基底贴近胸膜 15例(5 8% ) ;轮廓光整 10例 ,轮廓呈波浪状或锯齿状 14例 ,呈沟回状 2例 ;病变扁平状并宽基底贴近胸膜 6例 ,病变中心层面与邻近层面之形态陡然变化 5例 ;边缘可呈模糊 (8例 )、清楚 (9例 )、毛刺 (9例 ) ;病变内水样低密度区 9例且低密度区边缘较光整 ,小空洞 3例 ,其内壁光整 ,空泡 5例 ,支气管充气征 4例 ,钙化 3例 ;病变周边可见毛玻璃晕环 (5例 )、增粗血管影 (9例 )、长条索影 (7例 )、局部胸膜肥厚 (12例 ) ;②肺叶、肺段实变 8例 ,根部无肿物 ,伴支气管扩张 4例。 (3 )动态?

Objective To study the radiological characteristics of chronic pneumotitis, and to analyze the causes of misdiagnosis.Materials and Methods The radiological findings of 34 patients with pathologically-proved chronic pneumonitis, encountered during 1988～2000, were reviewed. The diseases included chronic pneumonitis (n=17), organizing pneumonitis (n=16) and chronic accompanied with organizing pneumonitis (n=1). All patients underwent chest radiography and chest CT scan before surgery, additional thin-slice CT scanning and HRCT of the target area were made in 19 patients.Results (1) Chest film findings: ① lobar or segmental consolidation without hilar mass (n=8); ② focal lesion (n=26), oval or spherical or irregular in shape (n=24), with hazy or well-delineated margin, homogeneous or inhomogeneous attenuation (n=24); ③ normal chest film (n=2). (2) CT findings: ① Focal lesions (n=26), with the maximal diameter 1.3～6cm (mean 3.5cm), which were localized in right (n=16, 61.5%) and left lung (n=10, 38.5%), 68% (n=15) of which located peripherally with the long axis parallel to the pleura. The contour of lesion was smooth (n=10), serrated (n=14) or insular (n=2). The lesion displayed plaque-like sub-pleural shadow (n=6), showing marked alteration of configuration in consecutive slices (n=5). The lesion's margin was hazy (n=8), or well-defined (n=9), or spiculated (n=9). The content within the lesion showed water-like low attenuation, with smooth margin (n=9), small cavity (n=3), small vacuole (n=5) air bronchogram (n=4), or calcification (n=3). Ground-glass like halo (n=5), convergence of vessels (n=9), thickened stripes (n=7) and concomitant pleural thickening were seen around the lesions; ② In 8 cases with lobar or segmental consolidation, no hilar mass could be seen. Bronchiectasis was found with the consolidation in 4 patients. (3) Dynamic changes during follow-up: decrease in lesion's size was seen on both chest film (8/11) and CT scan (4/5). (4) Pre-operative diagnosis: correct in 12 cases, misdiagnosed as lung cancer in 15 cases, and uncertain in 7 cases.Conclusion (1) Focal chronic pneumonitis usually manifests itself as a plaque-like lesion with its long axis closely contact to the pleura. When analyze CT scans, multiple consecutive CT slices should be viewed together. The margin of the low-attenuation area within the lesion and the wall of small cavity are often smooth. Ground-glass like halo, convergence of vessels and thickened stripes can be found around the focallesion. (2) Lobar or segmental consolidation without hilar mass in the patients with a long course of disease is one of the most characteristic findingsfor chronic pneumonitis. (3) Analysis of CT findings should be closely combined with chest film. (4) Comprehensive and detailed clinical data together with previous imaging materials should be reviewed carefully.