先天性肺囊性腺瘤样畸形的影像特征及误诊分析

Radiological Characteristics and Misdiagnosis of Congenital Cystic Adenomatoid Malformation of the Lung

目的探讨先天性肺囊性腺瘤样畸形(CCAM)的影像特征,并分析误诊原因,总结防范误诊措施。方法回顾性分析2020年5月—2023年11月收治经手术和病理检查证实的CCAM 9例的临床资料。结果本组5例主要表现为间断性咳嗽、咳痰、痰中带血、发热及气短等,3例为住院期间常规查体发现肺部异常,1例为常规体检发现肺部异常。术前首诊确诊2例,误诊7例。误诊为支气管源性肺囊肿3例,肺脓肿、囊性支气管扩张伴感染、肺隔离征和先天性大叶性肺气肿各1例。误诊时间8 d~2周。9例CT检查4例为大囊型,CT表现为占据胸腔的较大含气体或液体的囊腔,囊内见弯曲细线样分隔或气液平面;5例为小囊型,CT表现为局限于一侧肺叶多发薄壁小囊,部分呈蜂窝状改变,部分见短小气液平面。9例皆行单操作孔电视胸腔镜肺叶或肺段切除术,病理检查示4例大囊型为StockerⅠ型,5例小囊型为StockerⅡ型。9例出院后随访0.5~1.0年,均预后良好。结论CCAM因病理分型不同而影像学特征各异,虽易误诊,但仍具有一定影像学特征,确诊需病理学检查。

Objective To investigate the imaging features of congenital cystic adenomatoid malformation(CCAM)of lung,to analyze the causes of misdiagnosis,and to summarize the preventive measures.Methods The clinical data of 9 patients with CCAM confirmed by surgery and pathological examination from May 2020 to November 2023 were retrospectively analyzed.Results The main manifestations of 5 patients in this group were intermittent cough,sputum,blood in sputum,fever and shortness of breath,etc.Three patients were found abnormal lung by routine physical examination during hospitalization,and 1 patient was found abnormal lung by routine physical examination.Two patients were diagnosed and 7 patients were misdiagnosed,including 3 patients misdiagnosed with bronchogenic lung cyst,1 patient with pulmonary abscess,1 patient with cystic bronchiectasis with infection,1 patient with pulmonary isolation sign and 1 patient with congenital lobar emphysema.Misdiagnosis lasted 8 d to 2 weeks.CT examination showed that 4 of the 9 patients had large cystic type.CT showed a large cystic cavity containing gas or liquid occupying the chest cavity,and there were curved thin line compartments or gas-liquid planes in the cystic cavity.In 5 patients with small cystic type,the CT findings showed multiple thin-walled sacs confined to one lobe of the lung,some of which were honeycomb-like,and some showed short gas-liquid plane.All 9 patients underwent single-port video-assisted thoracoscopic lobectomy or segmental resection,and the pathological examination showed Stocker typeⅠin 4 patients of large cystic type and Stocker typeⅡin 5 patients of small cystic type.All the 9 patients were followed up for 0.5-1.0 year after discharge,and the prognosis was good.Conclusion CCAM has different imaging features due to different pathological types.Although it is more likely to be misdiagnosed,it still has certain special imaging characteristics,and pathological examination is needed to confirm the diagnosis.