肺部局限性韦格纳肉芽肿的CT诊断

CT diagnosis of localized Wegener′s granulomatosis of the lung

目的 探讨肺部局限性韦格纳肉芽肿CT表现及其诊断价值。方法 搜集经皮穿刺活检或术后病理确诊的 11例肺部局限性韦格纳肉芽肿 ,均经CT平扫和增强扫描检查 ,层厚、层距5mm ,兴趣区加 2mm薄层重建。结果 所有病例均显示肺内散在分布多发性结节和结节性空洞 ,7例伴有楔形病灶 ,4例伴有片状浸润性阴影。结节和楔形灶呈边缘性强化 ,并可见血管阴影进入 (“供养血管征”)。结论 多发性肺结节、结节性空洞伴楔形灶及其变化规律和强化特点对局限性韦格纳肉芽肿具有重要的诊断意义。

Objective To evaluate the diagnostic value of CT manifestations of the lung in localized Wegener′s granulomatosis(LWG). Methods CT findings of the lung in 11 patients with LWG verified by pathology were retrospectively analyzed. Results All the cases presented with multiple nodules of soft dense varying from 0.5 cm to 3.0 cm in diameter which distributed in the lung. Cavities were commonly seen in the larger nodules. Seven cases showed the wedge-shaped lesions with their bases situated externally on the pleural surface and with their convex apices directed at the hilum. The massive shadow with blurred margins was found in 4 cases. The nodules and wedge-shaped lesions demonstrated peripheral enhancement. Some of them presented with “vascular sign”. Conclusion The CT features of LWG were multiple nodules and cavities within nodules coexisting with wedge-shaped lesions, peripheral enhancement of nodules, and “vascular sign”. The law of change and the features of enhancement were relatively characteristic to the diagnosis of LWG.