不典型机化性肺炎CT影像表现及病理特征分析

Analysis of CT Imaging Manifestations and Pathological Features of Atypical Organizing Pneumonia

目的分析不典型机化性肺炎常见的CT影像学表现及其病理特征,旨在提高对该病的认识。方法回顾性分析近5年来经过手术及病理证实的21例机化性肺炎患者的临床、影像及病理资料,在CT上观察其发病部位、大小、形态、密度、邻近周边情况以及强化表现等CT影像学表现,并结合其病理特征进行分析。结果机化性肺炎病例共21例,其中单发病灶(n=19)、多发病灶(n=2);发病部位位于肺外带/胸膜下(n=16)、位于肺中内带(n=5);病灶形态呈肿块状(>3 cm,n=16)、呈结节状(<3 cm,n=5);病灶形态不规则(n=14)、呈类圆形/椭圆形(n=7);病灶密度不均匀(可见明显低密度区,n=19)、密度较均匀(n=2);病灶周边清晰(n=3)、邻近可见磨玻璃影/炎性渗出(n=18);增强扫描明显强化(增加CT值>60 HU,n=18)、轻中度强化(增加CT值<60 HU,n=3)。机化性肺炎病灶病理特征以周围肺组织充血/水肿,较多淋巴细胞、中性粒细胞、泡沫细胞浸润及部分肺泡上皮轻/中/重度不典型增生为主要表现。结论机化性肺炎的误诊率较高,掌握不典型机化性肺炎常见的CT影像表现及病理特征,在临床工作中可以提高对其的认识。

Objective To analyze the CT imaging manifestations and pathological features of atypical organizing pneumonia to improve the understanding of organizing pneumonia.Methods The clinical,imaging and pathological data of 21 patients with organizing pneumonia confirmed by surgery and pathology in our hospital in recent 5 years were retrospectively analyzed,and the CT imaging manifestations such as the location,size,morphology,density,surrounding conditions and enhancement were observed on CT,and the pathological characteristics were analyzed.Results There were 21 cases of organizing pneumonia,including single lesion(n=19)and multiple lesion(n=2).The site of the disease was located in the outer lung band/subpleural(n=16)and in the middle lung band(n=5).The morphology of the lesions was mass(>3 cm,n=16)and nodular(<3 cm,n=5).The morphology of lesions was irregular(n=14)and almost round/oval(n=7).The density of lesions was not uniform(obvious low density area,n=19),and the density was uniform(n=2).Clear peripheral lesion(n=3),ground glass shadow/inflammatory exudation nearby(n=18).Enhancement scan showed significant enhancement(increased HU>60,n=18)and mild to moderate enhancement(increased HU<60,n=3).The pathological features of organizing pneumonia lesions were hyperemia/edema in surrounding lung tissues,infiltration of lymphocytes,neutrophils and foam cells,and mild/moderate/severe atypical hyperplasia in part of alveolar epithelium.Conclusion The misdiagnosis rate of organizing pneumonia is high,to master the CT images and pathological features of atypical organizing pneumonia can improve our understanding of it in clinical work.