CT扫描中PLAM征象及相关病理基础特征分析

Analysis on Signs of PLAM and Related Pathological Basic Features in CT Scan

目的分析CT扫描中PLAM征象及相关病理基础特征,以提高对本病的认识和诊断水平。方法回顾分析本院2018年2月至2019年4月收治的70例PLAM患者的临床资料。观察CT平扫及增强扫描的影像特点,主要观察病变的分布、形态和继发改变;分析PLAM的CT征象,记录患者平扫和增强后的相关数据。结果节段性病变30例,弥漫性病变40例。常规CT中30例节段性病变中,19例可见边缘模糊、密度不均匀,11例小叶间隔增厚。40例弥漫性病变中可见双侧肺野呈磨玻璃样,透亮度减低;部分合并少量胸腔积液;高分辨率CT双肺可见多个含气囊腔影,呈椭圆形或圆形,最小直径为1.9mm,最大直径为21mm,其中囊腔直径1.9mm^11mm的较多,对于囊腔影薄壁显示更加明确,壁厚不超过3mm,囊腔影边缘还可见肺血管影,囊腔之间可见正常肺组织。结论临床上确诊PLAM依赖于病理检查,其主要病理改变为淋巴管、血管及肺的小气道的平滑肌细胞不规则典型增生。CT检查对PLAM的诊断具有重要的价值,CT征象与病理学密切相关,可作为判断病变进展和预后的指标之一。

Objective To analyze the signs of PLAM and related pathological basic features in CT scan to improve the understanding and diagnosis of this disease. Methods The clinical data of 70 patients with PLAM who were admitted to our hospital from February 2018 to April 2019 were retrospectively analyzed. To observe the imaging features of CT scan and enhanced scan, mainly to observe the distribution, morphology and secondary changes of the lesions. The CT signs of PLAM were analyzed and the relevant data after the patient’s plain scan and enhancement were recorded. Results There were 30 cases with segmental lesions and 40 cases with diffuse lesions. In the 30 segmental lesions in conventional CT, 19 cases had blurred edges and uneven density, and 11 cases had thickening of interlobular septum. In 40 cases of diffuse lesions, the bilateral lung fields were ground glass-like, with reduced brightness;some were combined a small amount of pleural effusion. High-resolution CT can be seen with shadow of balloon cavity, in multiple lung, soval or round, with a minimum diameter of 1.9 mm and a maximum diameter of 21 mm. Most of the cysts had a diameter of 1.9 mm^11 mm, which clearly showed the shadow of cystic cavity and thin wall. The wall thickness was no more than 3 mm. The pulmonary vascular shadow can also be seen at the edge of the cystic cavity. Normal lung tissue can be seen between the cystic cavity. Conclusion In clinic, the diagnosis of PLAM relies on pathological examination, and its main pathological changes are irregular hyperplasia of smooth muscle cells in lymphatic vessels, blood vessels and the small airways of lungs. CT examination is of great value in the diagnosis of PLAM. CT signs are closely related to pathology and can be used as one of the indicators to judge the progression and prognosis of lesions.