内源性脂性肺炎的CT诊断探讨

CT Diagnosis of Endogenous Lipid Pneumonia

目的 探讨内源性脂性肺炎的CT诊断。资料与方法 回顾性分析 8例经手术病理证实的内源性脂性肺炎的CT征象。结果 肿块样病变 2例 (右肺上叶 ) ,肿块密度低于胸壁组织 (≤ 2 0HU)。肺叶或肺段实变 2例 ,分别位于右肺上叶及左肺上叶 ,实变区密度接近水样密度 (- 2～ 10HU)。肺叶不张 4例 ,分别位于右肺中叶、上叶及左肺上叶、下叶。病变肺组织肺泡内有大量泡沫细胞和间隔的纤维增生 ,2例有肉芽肿样改变。结论 内源性脂性肺炎多累及肺叶或肺段 ,可表现为肿块、实变或不张等多种征象 ,易误诊为结核、肿瘤等 ,最终诊断需依赖于病理组织学检查。

Objective To study CT diagnosis of endogenous lipid pneumonia.Materials and Methods CT findings in 8 patients with pathologically proved endogenous lipid pneumonia were retrospectively analyzed.Results CT findings included: (1) phymatoid lesion (n=2), located in right upper lobe with a CT value lower than soft tissue (≤20Hu); (2) lobar or segmental consolidation (n=2), located at right or left upper lobe with a CT value approximate to water (-2～10Hu); (3) lobar atelectasis (n=4), involved right middle (n=1) or upper lobe (n=1), and left upper (n=1) or lower lobe (n=1). Pathologically, large amounts of foam cells in diseased pulmonary alveoli and interstitial fibroplastic proliferation were seen, pulmonary cholesterol granuloma was found in 2 cases.Conclusion Endogenous lipid pneumonia mainly involves pulmonary lobe or segment, presenting as mass, consolidation or atelectasis, which may be easily misdiagnosed as tuberculosis or neoplasm. A definitive diagnosis dependson pathological evidence.