胸膜结核瘤的MSCT影像诊断及鉴别诊断特点

The MSCT Imaging Diagnosis and Differential Diagnosis Characteristic of Pleural Tuberculoma

目的：探讨胸膜结核瘤的MSCT诊断及鉴别诊断特点,提高本病的影像诊断水平。材料与方法：收集我院2009年1月-2014年12月经病理或临床证实的32例胸膜结核瘤的MSCT图像进行回顾性分析,所有图像均由2位及以上放射科主治以上医师进行观察记录。结果：本组数据中患者主要分布在青壮年男性,男24例,女8例;31例分布在20~58岁,占96.9%,其中20~29岁17例,占53.1%。胸膜结核瘤可表现为单发和多发,本组数据中单发占14例,2枚者占7例,多发病灶者占11例。多数胸膜结核瘤分布在右侧胸腔（51/73）,以右后下胸腔多见（10/51）,其次是右侧下胸腔（9/51）、右后中胸腔（9/51）。形态主要表现为胸膜凸向肺野的“D”字形、椭圆形、梭形、乳头状软组织密度影和圆形结节,大多数与胸膜多呈宽基底相贴,边缘多清晰光滑。全部病例平扫密度均匀;增强后18例呈均匀强化,9例呈不规则环形强化,5例呈不均匀强化,内见坏死灶。3例病灶基底部胸膜移行性增厚强化,形成“胸膜尾征”。25例伴有肺内结核,18例伴有胸膜炎,1例伴肝内钙化灶。结论：胸膜结核瘤多数由肺内结核蔓延或结核性胸膜炎吸收过程中被纤维包裹的干酪样坏死团块所致,其MSCT表现具有一定的典型特征,对诊断及鉴别诊断具有重要的价值。

Purpose ： To explore the character of the multi-slice helical CT imaging diagnosis and differential diagnosis of pleural tuberculoma, so as to improve the imaging diagnostic levels of this disease. Materials and Methods： Retrospec- tive analysis was presented by collecting the images of 32 patients diagnosed as pleural tuberculoma by pathology or by clinic in Guangzhou chest hospital from January 2009 to December 2014, all images were observed and recorded by more than 2 radiol- ogists in charge. Results： Age of onset of the patient in the data is the male young and the middle-aged, 24 cases of male, 17 cases of female. 31 patients are distributed in 20 - 58 years old ; 96. 9%, 17 patients are distributed in 20 - 29 years old; 53. 1%. Pleural tuberculoma can be characterized by single and multiple. The 14 patients had single pleural tuberculoma, the 7 patients had two pleural tuberculomas, and the other 11 patients had multiple pleural tuberculomas. Most pleural tuber- culoma located in the right chest （51/73）, lesions of 10/51 occupied the posterior lower right chest wall, lesions of 9/51 oc- cupied the right inferolateral chest wall or the right middle lower chest wall, The MSCT image showed＇ D＇ letter shaped, ellip- tic, spindle, papillary and round nodes, mostly intersected with pleural wide base. The nodes margin was mostly smooth. the density of the all pleural tuberculomas was uniform. Uniform enhancement can be seen in 18 cases on contrast CT. Ring enhancement can be seen in 9 cases, Uneven enhancement can be seen in 5 cases. Pleural tail sign can be seen in 3 enhance- men cases that was at the bottom of the nodes in the pleura side among the cases. There were 25 cases with pulmonary tuber- culosis, 18 cases with pleurisy, 1 case with liver calcification. ConclUsion Mostly pleural tuberculoma is because of the spead of pulmonary tuberculosis or caseous necrosis briquette is parceled by fibrous when tuberculous pleurisy is absorbed. Pleural tuberculoma has some characters in MSCT images, it has helpful value for diagnosis and the differential diagnosis.