不典型肺结核HRCT表现特征及鉴别诊断

HRCT characteristics of atypical pulmonary tuberculosis and itsdifferential diagnosis

目的探讨不典型肺结核HRCT表现特征及鉴别诊断价值。方法回顾分析59例经临床和病理证实的不典型肺结核患者的HRCT资料,其中临床证实43例,病理证实16例。结果 59例不典型肺结核中,肺实变型25例(42.4%),孤立性结节或肿块型13例(22.0%),肺门及纵隔淋巴结肿大7例(11.8%),支气管内膜结核5例(8.5%),肺炎样肺结核5例(8.5%),粟粒结节状肺结核4例(6.8%)。经痰涂片抗酸染色阳性而诊断43例(72.8%),经支气管镜获得组织病理检查诊断8例(13.6%),经CT引导下肺穿刺活检诊断5例(8.5%),经手术取得组织病理诊断3例(5.1%)。结论不典型肺结核影像表现多样,HRCT上一些影像特征对肺结核的诊断及鉴别诊断有一定价值。

Objective To investigate HRCT characteristics of atypical pulmonary tuberculosis and its differential diagnosis. Methods HRCT data of 59 patients with atypical pulmonary tuberculosis proved clinically and pathologically were retrospectively analyzed, among them 43 cases wereproved clinically and 16 cases were proved pathologically respectively. Results The study demonstrated that there were 25 cases ofpulmonary consolidation type, 13 cases of solitary nodule or mass type, 7 cases of lymph node enlargement of hilus pulmonis and mediastinus, 5 cases of endobronchial tuberculosis, 5 cases of pneumonia tuberculosis type, 4 cases of miliary tuberculosis type among 59 patients. 43 cases （72.8%） were proved by positive acid-fast stain with sputum smear, Histopathologic examination throughbronchoscopy biopsy confirmed the diagnosis in 8 patients （13.6%）, CT-guided lung biopsy proved the diagnosis in 5 patients（8.5%）, Histopathologic examination after surgery confirmed the diagnosis in 3 patients（5.1%）. Conclusion Atypical pulmonary tuberculosis has various imaging manifestations,HRCTcharacteristicsis of great importance in diagnosis and differential diagnosis of atypical pulmonary tuberculosis.