肺隐球菌病肿块结节型CT表现以及同肺癌的鉴别诊断研究

Pulmonary cryptococcosis mass nodular CT manifestations and differential diagnosis of lung cancer

目的观察肺隐球菌病肿块结节型CT表现并探讨其与同肺癌的鉴别诊断要点。方法纳入对象为惠州市第一人民医院2015年1月至2019年12月收治的92例肺隐球菌病肿块结节型患者,分析其CT表现,找出与肺癌的鉴别诊断要点。结果92例患者中52.2%为单发病灶,47.8%为多发病灶,以右肺分布更多;88.0%位于肺外周,12.0%同时分布于肺门与肺外周;共181个病灶,平均长径为(2.9±0.5)cm;结节状病灶多有光滑边缘,且呈现出类圆形改变,28.3%结节周边存在磨玻璃样密度影;73.9%病灶密度均匀且较高;31.5%轻度强化,60.9%中度至明显强化;60.9%相贴于胸膜,26.1%邻近胸膜存在粘连增厚征象,9.8%存在胸膜牵拉,10.9%单发肿块相贴于胸膜,7.6%合并肺不张;38.0%病灶引流支气管壁增厚,7.6%支气管截断征象,63.0%肺血管纹理变粗并伸入至病灶。结论肺隐球菌病特征性CT表现为病灶处于胸膜下或肺外周、病灶多发、肺血管伸入病灶且存在晕征,需与肺癌鉴别诊断,最大限度减少误诊。

【Objective】To observe the nodular CT manifestations of pulmonary cryptococcosis mass and explore the main points of differential diagnosis from lung cancer.【Methods】The subjects included in this study were 92 cases of pulmonary cryptococcosis nodular patients admitted in our hospital from January 2015 to December 2019.The CT findings were observed to find the main points of differential diagnosis from lung cancer.【Results】Among the 92 patients,52.2%were single lesions,47.8%were multiple lesions,more distributed in the right lung;88.0%were located in the periphery of the lung,and 12.0%were distributed in both the hilum and the periphery of the lung;a total of 181 lesions with an average long diameter of 2.9±0.5 cm;the nodular lesions mostly had smooth edges and showed round-shaped changes.There were ground glass-like density shadows around 28.3%of the nodules;73.9%of the lesions had uniform and high density;31.5%were mild enhanced,60.9%moderate to marked enhancement;60.9%adhered to the pleura,26.1%had signs of adhesion thickening adjacent to the pleura,9.8%had pleural traction,10.9%had a single mass attached to the pleura,and 7.6%had atelectasis;38.0%of the lesions had thickened bronchial walls,7.6%had bronchotomy signs,and 63.0%had thickened pulmonary blood vessels and deepened into the lesions.【Conclusion】The characteristic CT manifestation of pulmonary cryptococcosis is that the lesion is under the pleura or the periphery of the lung,often multiple,and the pulmonary blood vessels are deep into the lesion and there are halo signs.It needs to be differentially diagnosed from lung cancer to minimize misdiagnosis.