空气支气管征和空泡征并存对非结节肿块型肺隐球菌病CT诊断价值的初步观察

目的探讨同一病灶内空气支气管征和空泡征并存现象在非结节肿块型肺隐球菌病（PC）CT诊断中的价值。方法回顾性分析65例经穿刺或手术病理证实PC患者的CT图像，观察同一病灶内空气支气管征和空泡征并存的PC患者的CT图像特点。结果65例PC中非结节肿块型PC有41例，该组中10例患者的CT图像上同一病灶内并存空气支气管征和空泡征，出现率为24．4％。根据CT影像PC分为3种类型：结节或肿块型、斑片浸润型、混合型，其中该现象存在于斑片浸润型中6例、存在于混合型中4例，未出现在结节或肿块型；同时存在空气支气管征和空泡征的病灶均位于肺的下叶，左右肺下叶各5例。出现空气支气管征时舍气支气管走行自然、管壁光滑，未见局部扩张、狭窄、迂曲；出现空泡时7例为单发，3例为多发空泡，多发空泡的2例散在分布、1例部分融合。两者位置关系为空泡位于支气管远端7例、近端1例、并行2例。两者均不相通。空泡内径均大于伴行支气管内径。结论同一病灶内并存空气支气管征和空泡征可能是非结节肿块型PC一个特殊的CT征象，在PC与其它肺部病变的鉴别上可能具有一定的诊断价值。

Objective To investigate the value of air bronchogram and vacuole sign coexistence in CT diagnosis of non-nodular or mass type pulmonary cryptocoeeosis, Methods The CT images of 65 PC patients were retrospectively analyzed which were confirmed by biopsy or surgical pathology, the CT characteristics of PC patients were evaluated, especially air bronchogram and vacuole sign coexistence. Results Of the 65 PC patients, 41 eases were non-nodular or mass type, the air bronchogram and vacuole sign coexistence were found in 10 cases in CT images, the occurrence rate was 24.4%.According to the CT images, the PC could be divided into 3 types： nodule or mass type, patchy infiltration type, mixed type.The phenomenon were presented in patchy infiltration type 6 cases and in mixed type 4 cases, did not appear in the nodule or mass type. These lesions were located in the fight lower lobe and the left lower lobe, each had 5 cases （ n=5 ） .When air bronchogram appeared, the bronchial wall was smooth without local expansion, narrow or tortuosity. When vacuole sign appeared, 7 cases had single vacuole and 3 cases had multiple vacuoles.2 cases with vacuoles were scattered distributed, 1 case with vacuoles was partially fused in the others.The relationship between the two was that the vacuoles were located in the distal end of the bronchus in 7 cases, proximal in 1 case, parallel in 2 cases.The vacuoles and the bronchus were not connected：The diameter of the vacuole was greater than bronchial lumen. Conclusion Air bronchogram and vacuole sign coexistence may be a special CT sign of non-nodular or mass type PC, which may have a great value in differential diagnosis of PC and the other pulmonary lesions.