肺泡蛋白沉积症的高分辨CT诊断分析

Analysis of high resolution CT findings in the diagnosis of pulmonary alveolar proteinosis

目的探讨肺泡蛋白沉积症的高分辨CT(HRCT)的影像表现,提高对该疾病的认识及诊断;因其治疗方法特殊,因此HRCT准确诊断对临床十分必要。方法回顾性分析2009年1月至2018年1月期间20例经病理证实的肺泡蛋白沉积症患者的肺部HRCT表现,归纳其特征。结果肺泡蛋白沉积症分布肺内随机,无肺段叶、肺野分布规律。HRCT主要影像表现有以下五点:磨玻璃影(GGO ground glass opacity) 20例,"铺路石征"17例,"地图样改变"13例,气管走行自然、管腔清晰的空气支气管征3例,蜂窝状片状影2例。另外,双侧胸膜轻度增厚且无胸腔积液11例,纵隔可见淋巴结但淋巴结不肿大5例。结论 PAP的HRCT表现有一定特征,肺内分布随机,主要以边界清晰的GGO为基本表现,"铺路石征""地图样表现"常见,发展较重或合并其它类型感染时可出现支气管走行自然的"空气支气管征"及"蜂窝状影"; PAP有可能累及胸膜出现轻度胸膜征像;纵隔淋巴结不肿大支持其诊断。

Objective To explore the high resolution CT findings of pulmonary alveolar proteinosis（PAP） so as to improve the diagnosis of the disease; Because of its special treatment method, HRCT diagnosisis correct and is very necessary for clinical practice. Methods From January 2009 to January 2018, 20paitients that had been proven PAP by pathplogy were retrospectively reviewed with their high resolution CTscan and postprocessing images, to sum up characteristics. Results Intrapulmonary lesions in alveolarproteinosis were randomly distributed, of non segmental lobe or lung field pattern. The main performance are thefollowing five points： 20 cases of ground glass opacity（GGO）appeared in the patients, 17 cases of paving stonesign,13 cases of map-like performance, 3 cases of natural air bronchogram, 2 cases of honeycomb shadow; Inaddition, Bilateral pleural mild thickening without effusion in 11 cases and mediastinal lymph node but notenlarged in 5 cases. Conclusions HRCT findings of pulmonary alveolar proteinosis has certain characteristics：Random distribution in lung, Ground glass opacity （GGO） with clear boundary is the basic representation,Paving stone sign and map-like performance is common, Natural air bronchogram and honeycomb shadow mayoccur when severe or combined with other types of infection are developed. And Then, PAP may involve mildpleural signs, but no lymphadenopathy.