肺结核的不典型影像特征的总结及机制探讨

Atypical computed tomography manifestations and mechanism of pulmonary tuberculosis

肺结核(pulmonary tuberculosis, PTB)是威胁人类健康与生活的一类重要传染病,早期识别、诊断,减少误诊、漏诊是PTB防治工作的核心环节。在PTB的诊断中,影像学几乎起主导地位,常见的PTB计算机断层扫描(computed tomography, CT)影像学表现主要有空洞、树芽征、结节和肺实变等,但由于患者的年龄、合并基础疾病及免疫功能水平的差异,部分PTB失去了典型影像学征象,这些不典型的肺结核征象给临床诊断带来了巨大的困难,导致漏诊、误诊率的增加。为进一步加强对不典型PTB的认识,减少PTB的漏诊及误诊率,本文通过归纳总结不典型PTB的影像学表现,主要包括:微结节聚集征、反晕征、肺气肿合并肺结核、类转移瘤多发结节以及机化性肺炎表现,分别从几种不典型影像学表现的临床特征、产生机制、临床诊断意义及治疗转归进行总结分析,以期为肺结核的诊断提供依据。

Pulmonary tuberculosis(PTB) is a serious infectious disease that threatening human health and life, early identification and diagnosis of PTB and reduction of misdiagnosis and missed diagnosis are the core links of prevention and treatment. Imaging plays an almost dominant role in the diagnosis of PTB, the main imaging manifestations of PTB in computed tomography(CT) are cavities, tree buds, nodules and lung consolidation. However, due to differences in age, underlying diseases and immune function, some PTB have lost their typical imaging signs. These atypical signs of tuberculosis bring great difficulties to clinician, resulting in the increase of missed diagnosis and misdiagnosis rate. In order to further enhance the understanding of atypical PTB and reduce the rate of missed diagnosis and misdiagnosis of PTB, this paper summarizes the imaging manifestations of atypical PTB, mainly including: micronodular aggregation sign, inverse halo sign, emphysema with tuberculosis, multiple nodules of metastatic tumor and organizing pneumonia. The clinical features, mechanisms, clinical diagnostic significance and treatment outcome of the atypical imaging manifestations are summarized and analyzed to provide a basis for the diagnosis of tuberculosis.