结节病胸部不典型表现的影像学特点分析

Atypical computed tomography manifestations of thoracic sarcoidosis

目的 探讨结节病胸部不典型改变的CT特征.方法 回顾性分析同济大学附属上海肺科医院2000至2015年确诊结节病的190例患者的临床资料及CT表现,其中男73例（38.4%）,女117例（61.6%）,年龄27~72岁,平均52.5岁.结果 结节病胸部不典型表现主要有单侧肺门淋巴结增大伴或不伴纵隔淋巴结增大、纵隔淋巴结增大不伴肺门淋巴结增大、片样实变、结节星系征、反晕征、磨玻璃影、空气潴留征.单侧肺门淋巴结增大伴或不伴纵隔淋巴结增大12例（12/190,6.3%）,纵隔淋巴结增大不伴肺门淋巴结增大9例（9/190,4.7%）,片样实变23例（23/190,12.1%）,结节星系征22例（22/190,11.6%）,反晕征1例（1/190,0.5%）,磨玻璃影52例（52/190,27.4%）,空气潴留征象：10例行吸气相和呼气相CT扫描,8例（8/10,80%）呼气相CT扫描表现为空气潴留征.12例单侧肺门淋巴结增大伴或不伴纵隔淋巴结增大治疗后吸收好转10例（83.3%）,9例纵隔淋巴结增大不伴肺门淋巴结增大治疗后吸收好转8例（88.9%）.23例片样实变影治疗后吸收好转15例（65.2%）.22例结节星系征治疗后吸收好转16例（72.7%）.1例反晕征治疗后完全吸收.52例磨玻璃影治疗后吸收好转31例（59.6%）.8例空气潴留征治疗后吸收好转7例（87.5%）.结论 单侧肺门淋巴结增大伴或不伴纵隔淋巴结增大、纵隔淋巴结增大不伴肺门淋巴结增大,肺部片样实变、结节星系征、反晕征、磨玻璃影、空气潴留征是结节病胸部浸润的不典型改变,治疗后多数有好转,熟悉这些CT征象有利于提高胸部结节病诊断的正确率.

Objective This study evaluated the atypical computed tomography （ CT） manifestations of thoracic sarcoidosis.Methods Medical data of 190 patients with thoracic sarcoidosis were retrospectively reviewed.Results The atypical CT manifestations of thoracic sarcoidosis observed were unilateral hilar lymphadenopathy with or without mediastinal lymphadenopathy （ n =12, 6.3%）, mediastinal lymphadenopathy without hilar lymphadenopathy （n=9, 4.7%）, patchy consolidation （n=23, 12.1%）, sarcoid galaxy sign （n=22, 11.6%）, reversed halo sign （n=1, 0.5%）, and ground-glass opacities （n=52, 27.4%）.Air trapping was found in 8 of 10 patients who underwent both inspiratory and expiratory CT . Post-treatment CT scans showed improvements in most patients .Of the 12 patients with unilateral hilar lymphadenopathy with or without mediastinal lymphadenopathy , 10 （ 83.3%） improved.Of the 9 patients with mediastinal lymphadenopathy without hilar lymphadenopathy , 8（88.9%） improved.Of the 23 patients with patchy consolidation , 15 （ 65.2%） improved.Of the 22 patients with the sarcoid galaxy sign , 16 （72.7%） improved.The patient with the reversed halo sign improved completely .Of the 52 patients with ground-glass opacities, 31（59.6%） improved.Of the 8 patients with air trapping, 7（87.5%） improved. Conclusions The atypical imaging manifestations of thoracic sarcoidosis included unilateral hilar lymphadenopathy with or without mediastinal lymphadenopathy , mediastinal lymphadenopathy without hilar lymphadenopathy , patchy consolidation , the sarcoid galaxy sign , the reversed halo sign , ground-glass opacity, and air trapping.These lesions mostly improved after treatment .Familiarity with these atypical signs will help increase the diagnostic accuracy of imaging studies for thoracic sarcoidosis.