误诊为周围性肺癌的15例炎性病变的CT分析

CT analysis on misdiagnosis of 15 patients with pulmonary periphery inflammatory lesions as cancers

目的 :分析 15例炎性病变的CT误诊原因 ,总结炎性病变与周围性肺癌的鉴别诊断要点。方法 :15例误诊病例均做胸部CT平扫、增强及HRCT扫描 ,由 4位医师共同阅片 ,分析误诊原因并与病理对照。结果 :全部病例均表现为胸膜下肺孤立性肿块或结节 ,其中浅分叶征 13例 ,典型的胸膜凹陷征 8例 ,细短毛刺征 6例 ,边缘显示棘突、尖角、锯齿状 4例 ,空泡征 7例 ,偏心性空洞 2例 ,早期明显强化 10例 ,强化均匀 4例 ,肺门纵隔淋巴结肿大 13例。结论 :对肺内孤立性肿块或结节的CT表现特征认识不够准确 ,过分强调某些征象的特异性而缺乏综合分析 ,是造成误诊的主要原因。因此 ,对于CT表现不典型的病例 。

Objective:To analyze the reasons of misdiagnosis in 15 patients with pulmonary periphery spherical lesions and to summarize their CT characteristics of differential diagnosis with pulmonary periphery cancers.Methods:The patients in this study included 9 men and 6 women,with ages ranging from 50 to 78 years old.All patients were scanned by chest plain CT,enhance CT and high resolution CT.The CT films were reviewed retrospectively by two senior radiologists for analyzing the misdiagnosing reasons and were correlated with pathologic findings,Results:All cases were showed solitary pulmonary masses or nodules under the pleura,among them 13 cases were displayed superficial lobulation,8 cases were showed typical pleural retraction,6 cases with thin spiculated contour,4 cases with serrated margin,7 cases with air alveologram,1 cases with decentration cavity,10 cases were intensified distinctly and early,4 cases enhanced uniformly,13 cases with swelling lymph nodules in the hilus of lung or mediastinum.Conclusion:Not identifying accurately the CT characteristics of solitary pulmonary masses or nodules or excessively emphasizing the specificity of some signs instead of anslyzing all around are main cause of the misdiagnosis.For the cases without typical CT characteristics,entirely meticulous analysis and puncture are necessary.