肺炎型肺癌的CT诊断与鉴别诊断

CT diagnosis and differential diagnosis of pneumonia-type lung cancer

目的分析肺炎型肺癌的CT表现,并探讨需要与肺炎型肺癌鉴别的相关疾病。方法回顾性分析17例经皮穿刺活检、纤维支气管镜、痰脱落细胞学检查及手术证实的肺炎型肺癌的CT表现。结果 17例肺炎型肺癌中腺癌14例,腺鳞癌2例,细支气管肺泡癌1例。CT表现包括磨玻璃密度13例,小结节影15例,实变影17例,支气管充气征16例,枯枝征14例,血管造影征12例,胸膜牵拉增厚或叶间裂膨隆16例,空泡征13例,蜂窝征5例,铺路石征9例,肺门和(或)纵隔淋巴结大13例,骨质破坏4例,胸腔积液11例。12例CT增强扫描的患者中7例呈明显强化(CT值增加大于30 Hu),5例呈轻度强化。结论当CT表现有磨玻璃征、多发结节、枯枝征、空泡及蜂窝征、铺路石征、临近纵隔胸膜增厚,增强后实变区较明显强化和轻度强化并见血管造影征,呈外周分布,结合临床有刺激性咳嗽、咳大量白色黏液痰、痰中带血,以及肿瘤标志物升高时,高度提示肺炎型肺癌。

Objective To explore the CT manifestations of pneumonia-type carcinoma of the lung（ PTCL） and to discuss related diseases that need to be identified together with PTCL. Methods CT manifestations of 17 patients with PTCL confirmed by percutaneous biopsy, fiberoptic bronchoscopy and sputum exfoliated cytology examination and surgery were retrospectively analyzed.Results Among the 17 cases of PTCL,there were 14 cases of adenocarcinoma,2 cases of adenosquamous carcinoma and 1 case of bronchioloalveolar carcinoma. CT manifestations included ground-glass density（ 13 cases）,small nodular shadows（ 15 cases）,consolidation shadows（ 17 cases）,air bronchogram（ 16 cases）,dead branch signs（ 14 cases）,angiogram signs（ 12 cases）,pleural thickening（ 16 cases）,cavitation（ 13 cases）,honeycomb signs（ 5 cases）,crazy paving signs（ 9 cases）,lymphadenectasis in the mediastinum and/or hilus pulmonis（ 13 cases）,bone destruction（ 4 cases）,and hydrothorax（ 11 cases）. Among the 12 cases who had undergone CT enhancement scan,7 cases were obviously enhanced and 5 cases were slightly enhanced. Conclusions PTCL is likely when CT manifestations include ground glass density signs,multiple nodules,dead branch signs,cavitation and honeycomb signs,crazy paving,pleura thickening near the mediastinal pleura,or when the consolidation areas of the lung are obviously or slightly enhanced after CT enhancement scan and there are angiography signs or peripheral distribution,or when the above symptoms are accompanied by irritating cough,white mucus,blood in phlegm,and an increase of tumor markers.