巨大淋巴结增生症肺部CT表现

CT manifestations of lung in Castleman disease

目的探讨巨大淋巴结增生症(CD)患者肺部病变的CT特征。方法收集14例肺部有异常表现的CD患者,包括多中心型(MCD)8例,单中心型(UCD)6例,对其肺部CT表现进行回顾性分析。结果 3例肺门UCD表现为肺门单发均质等密度类圆形肿物,增强后均质明显或显著强化;1例腹膜后UCD合并副肿瘤性天疱疮,表现为两肺闭塞性细支气管炎;2例纵隔UCD两肺见多发边缘清晰、小叶中心分布小结节。8例MCD均以两肺多发小结节为主,2例见最大径为1~2cm大结节;4例结节边缘模糊,4例边缘清晰;小结节以小叶中心分布为主,其中3例见少许小结节分布于胸膜下。其他征象包括小叶间隔增厚4例,磨玻璃密度影4例,索条影4例,斑片状实变3例,囊腔2例,血管支气管束增粗1例。结论 CD肺部CT表现复杂多样,可能与病理分型有关。

Objective To explore CT manifestations of the lung in Castleman disease （CD） patients. Methods Totally 14 CD patients with abnormal pulmonary manifestations were enrolled, including 8 multicentric CD （MCD） and 6 unicentric CD （UCD）. CT manifestations of the lung were analyzed retrospectively. Results In 3 patients of pulmonary hilar UCD, CT showed circular masses with solitary homogeneous density, obviously or markedly enhanced after contrast media administration. Bronchiolitis obliterans was found in 1 patient of retroperitoneal UCD with paraneoplastic pemphigus. Two patients of mediastinal UCD showed well defined centrilobular nodules in the lung. Eight patients of MCD mainly showed multiple small nodules, and large nodules with diameters of 1-2 cm were found in 2 of them. Four patients showed poorly defined nodules, and the rest 4 showed well-defined nodules. The nodules were mainly demonstrated as small centrilobular nodules, and a few of them located in subpleural regions in 3 patients. Other CT signs included interlobular septal thickening in 4 patients, ground glass opacity in 4 patients, streaks in 4 patients, patchy consolidation in 3 patients, cysts in 2 patients and thickening of the bronchovascular bundles in 1 patient. Conclusion CT manifestations of the lung in CD patients are complex and variable, and might be related to pathological types.