以烟花征为主要表现的肺结核多层螺旋CT表现及转归

Multislice spiral CT findings and outcomes of pulmonary tuberculosis with fireworks sign as the main manifestation

目的分析以烟花征为主要表现的肺结核多层螺旋CT征象及其转归表现,以提高对该型肺结核的认识。方法选取2018年6月至2020年11月于台州市立医院确诊的肺结核且CT主要表现为烟花征的患者55例,分析其治疗前后的CT表现及转归。结果纳入患者病灶以双肺弥漫分布为主,占49.09%。烟花征形态包括均匀样、反晕征样和晕征样,其中以均匀样为主,占比50.90%(28/55);21例患者同时出现2种及2种以上形态的烟花征,其中20例可见均匀样。伴随活动性肺结核征象包括小叶中心结节、树芽征、亚段或小叶实变、空洞、胸腔积液、胸膜增厚等,其中小叶中心结节最为常见,检出率100%。51例患者治疗有效,主要表现为病灶缩小、结节减少、密度减低;2例患者病灶融合成高密度结节及斑块影;2例患者病灶起初吸收不明显,2个月后病灶逐步吸收。结论肺内烟花征是肺结核经支气管播散在CT上的形态学改变,主要表现为均匀样或均匀样合并反晕征样,其转归主要表现为病灶缩小、结节减少、密度减低。

Objective To analyze multislice spiral CT signs and prognosis of pulmonary tuberculosis with fireworks sign as main manifestations,and to improve the understanding of this type of pulmonary tuberculosis.Methods Fifty-five patients with pulmonary tuberculosis diagnosed in Taizhou Municipal Hospital from June 2018 to November 2020 with the main CT manifestations of fireworks sign were selected to analyze the CT manifestations and outcomes before and after treatment.Results The lesions of the included patients were mainly diffuse in both lungs,accounting for 49.09%.The fireworks signs include homogenous pattern,halo pattern and reversed halo pattern,and homogenous pattern was the main one,accounting for 50.90%.Twenty-one patients showed two or more forms of fireworks sign at the same time,and 20 of them showed homogenous pattern.Signs of active pulmonary tuberculosis included centrilobular nodules,tree-in-bud signs,subsegmental or lobular consolidation,cavities,pleural effusion,and pleural thickening,etc.Among them,centrilobular nodules was the most common,with a detection rate of 100%.The treatment was effective in 51 patients,and the main manifestations were reduced lesion morphology,nodule reduction and density reduction.In 2 patients,the lesions fused into high-density nodules and plaque shadows.In 2 patients,the absorption of the lesion was not obvious at first,but gradually after 2 months.Conclusion Intrapulmonary firework sign is the morphologic change of tuberculosis spread through bronchus on CT,which is mainly manifested as homogenous pattern or homogenous pattern combined with reversed halo pattern,and its outcome is mainly manifested as reduced in the morphology,nodule and density.