肺放线菌病7例CT影像学观察及文献复习

CT Imaging Features of Pulmonary Actinomycosis

目的探讨肺放线菌病的CT影像特征,降低其漏诊率。方法回顾性分析本院7例经病理确诊肺放线菌病患者的影像及临床资料,总结其CT特征。结果 7例患者中,4例经手术、2例经纤维支气管镜活检、1例经CT引导下肺穿刺活检病理确诊。CT表现为团片影4例,团块影2例,团块与团片影共存1例;7例病灶中央均见低密度区,5例增强均呈环形强化;空洞形成4例,其中1例空洞内形成液-气平面;实变4例;周边伴节段肺不张4例,磨玻璃影3例;胸膜黏连7例,增厚4例,患侧胸腔积液2例;纵隔淋巴结增大6例,患侧肺门淋巴结增大4例。病变共累及3个肺叶,8个肺段,以右肺上叶尖段和后段多见。CT误诊为肺肿瘤4例,肺脓肿1例,肺结核1例,肺炎1例,仅2例将肺放线菌病列入鉴别诊断。结论肺放线菌病常有下列影像特征:团片或团块影,中心见低密度区、空洞,呈环形强化,邻近胸膜增厚、黏连,周边磨玻璃影等,认真分析影像细节,结合临床,可以降低其漏诊率。

Objective To investigate the CT imaging features of pulmonary actinomycosis so as to reduce the rate of misdiagnosis. Methods A retrospective analysis of cases spanning from 2010 to 2015. Seven patient cases with pathologically confirmed lung actinomycosis images and clinical data were analysed and a summary of the CT features was compiled. Results 7 patients, 4 cases after surgery, two cases of fiberoptic bronchoscopy, and 1 case of pulmonary CT-guided needle biopsy were confirmed. CT showed patchy hypodensity with ill-defined margins in 4 cases, 2 cases of mass shadow and mass and patchy hypodensity with ill-defined margins coexistence in one case. 7 cases had central low-density areas, 5 cases showed ring enhancement; cavitation was seen in 4 cases, 1 case had air-fluid levels within the cavity ; consolidation in four cases; the surrounding atelectasis segment with 4 cases, 3 cases of ground glass opacities. 7 cases had pleural adhesions, of which 4 case had pleural thickening, ipsilateral pleural effusion in 2 cases ; mediastinal lymphadenopathy in 6 cases and ipsilateral hilar lymph node enlargement in 4 cases. Lesions involving a total of three lobes and eight lung segments were the most commonly found in the apex and the base of the right lung？ CT misdiagnosed 4 cases of lung cancer, I case of lung abscess, 1 case of tuberculosis, 1 case of pneumonia, in which only two cases of lung actinomycosis included in the differential diagnosis of the misdiagnoses. Conclusion Pulmonary actinomycosis is characterized by these imaging features： patchy hypodensities or mass shadow, central low-density areas, cavitation, annular enhancement, adjacent pleural thickening, adhesion, and other surrounding ground glass opacities. A careful analysis of the image details and clinical presentations can reduce the rate of misdiagnosis.