肺部误诊为肺结核病例的CT分析

Analysis of the CT Findings of Pulmonary Diseases Misdiagnosed as Tuberculosis

目的分析并总结肺部误诊为肺结核病例的CT表现,以降低肺部疾病的误诊误治率。方法搜集52例经手术病理、纤维支气管镜、穿刺活检、临床其他综合检查或治疗证实且行胸部CT扫描并误诊为肺结核病例的CT资料,观察病变的CT表现,根据其影像学特点进行分型,并统计各型的发生率。结果根据误诊病例的CT特点可分为7型:(1)淋巴结肿大型(9.6%,5/52):以纵隔和(或)肺门淋巴结肿大为主要表现,包括转移性淋巴结肿大3例,淋巴瘤1例,结节病1例,均误诊为胸内淋巴结结核;(2)多发小结节型(11.5%,6/52):以双肺多发小结节为主要表现,包括尘肺3例,结节病2例,血行性肺转移1例,均误诊为血行播散性肺结核;(3)多发多态型(13.5%,7/52):病变以多发性和多形性为特点,包括炎性肺癌6例,淋巴瘤1例,均误诊为继发性肺结核;(4)多发空洞型(5.8%,3/52):病变以肺内片状密度增高影伴多发空洞为主要特点,误诊为干酪性肺炎,病理均证实为鳞癌;(5)孤立结节、肿块或团片型(46.2%,24/52):病变表现为肺内孤立结节、肿块或团片状影,边缘欠规则,包括肺癌21例,炎性假瘤2例,错构瘤1例,误诊为结核球或结核性肉芽肿;(6)伴树芽征型(7.7%,4/52):病变表现为肺门旁结节影伴远端肺组织内多发小叶中央结节及树芽征,误诊为肺结核,病理均证实为中央型肺癌;(7)肺癌合并肺结核(5.8%,3/52):诊断中仅考虑到结核,忽略了对肺癌的观察。上述病例中以肺癌误诊为肺结核最常见。结论肺部误诊为肺结核病例的CT表现多样,但仍有一定规律可循,因此需要正确把握肺结核及与之具有相似影像学表现的肺部疾病之间的CT鉴别要点,紧密结合临床并综合判断,才能减少误诊。

Objective Analyzing and summarizing the CT manifestations of pulmonary diseases misdiagnosed as tuberculosis to reduce the rate of misdiagnosis. Methods The CT data of 52 cases misdiagnosed as pulmonary tuberculosis that received chest CT scan and were confirmed by surgical pathology,bronchoscopy,biopsy and other comprehensive clinical examination or treatment were retrospectively analyzed. These cases were classified according to their CT findings and the incidence of each type was counted. Results According to the CT features of misdiagnosed cases,they could be divided into 7 types. Type 1 with mediastinal and（ or） hilar lymph node enlargement as the main performance was found in5 cases（ 9. 6%）,including 3 cases of metastatic lymph nodes,1 case of lymphoma and 1 case of sarcoidosis,which were misdiagnosed as lymphoid tuberculosis. Type 2 with multiple small pulmonary nodules as the main manifestation was found in 6 cases（ 11. 5%）,including 3 cases of pneumoconiosis,2 cases of sarcoidosis and 1 case of hematogenous metastasis,which were misdiagnosed as hematogenous pulmonary tuberculosis. Type 3 characterized by multiple lesions and varied morphology was found in 7 cases（ 13. 5%）,including 6 cases of pneumonic-type lung cancer and 1 case of lymphoma,which were misdiagnosed as secondary pulmonary tuberculosis. Type 4 mainly characterized by pulmonary patchy shadow with multiple cavities was found in 3 cases（ 5. 8%）,which were misdiagnosed as caseous pneumonia and finally confirmed as squamous cell carcinoma by pathology. Type 5 characterized by pulmonary solitary nodule,mass or patchy shadow with irregular margin was found in 24 cases（ 46. 2%）,including 21 cases of lung cancer,2 cases of inflammatory pseudotumor and 1 case of hamartoma,which were misdiagnosed as tuberculoma or tuberculous granuloma. Type 6 characterized by a parahilar nodule with multiple small centrilobular nodules and tree-in-bud pattern in the lung field distal to it was found in 4 cases（ 7. 7%）,which were misdiagnosed as tuberculosis and finally confirmed as central lung cancer by pathology. Type 7 showing lung cancer complicated with pulmonary tuberculosis was found in 4 cases（ 5. 8%）,in which the diagnosis of tuberculosis was made only and that of lung cancer was ignored. In all of the above cases,lung cancer misdiagnosed as tuberculosis was the most common. Conclusion There are a variety of CT manifestations of pulmonary diseases misdiagnosed as pulmonary tuberculosis,but there are still some rules to follow. We must correctly grasp these key points of differentiation of CT appearances between pulmonary tuberculosis and other pulmonary diseases with similar imaging manifestations to it,combine with the clinical manifestations closely and make a synthetic judgment to reduce the rates of misdiagnosis.