老年人肺结核的CT表现

The CT findings of pulmonary tuberculosis in old age

目的 分析老年人肺结核的CT表现 ,评价CT检查对肺结核诊断的价值。方法 1993年8月至 2 0 0 0年 3月间 16 0例老年 (6 5～ 89岁 ,平均 72 .5岁 )肺结核患者做CT检查 ,其中 112例行病灶高分辨扫描 (HRCT)、84例做增强扫描。并进行综合回顾分析。结果 CT表现为 :(1)结核病灶分布在一叶以上占 78.6 % ;上、下叶均受累占 5 6 .4 % ,上叶受累占 2 0 .5 % ,下叶受累占 2 3.0 %。 (2 )病变以纤维化为主占 89.4 % ;伴有空洞者占 4 8.5 % ;伴有钙化占 4 0 .8% ;胸膜增厚占 18.4 % ;结核瘤占 6 .8%。 (3)增强扫描显示病灶呈明显不均匀强化者占 90 .5 %。 (4)具有结核活动征象者占 76 .8% ,HRCT表现为 2～ 4mm小叶中心结节和分支状结构 ,或 5～ 8mm模糊结节、小叶间隔增厚及邻近支气管壁增厚。 (5 )肺结核合并肺癌占 9.4 % (15 16 0 )。结论 老年肺结核的CT表现以纤维化为主 ,累及下肺叶比例较高 ,增强CT病灶呈明显强化 ,合并肺癌的发生率较高。HRCT可作为判断结核有无活动性的方法。

Objective To analyse the computed assisted tomographic (CT) manifestations of pulmonary tuberculosis (TB) in old people and the usefulness of CT scan in the diagnosis of pulmonary TB.Methods From August 1993 to March 2000 160 aged patients (age range: 65 89 years; mean age 72.5 years) with pulmonary TB underwent chest CT scan. High resolution CT (HRCT) were done in 112 patients. 84 patients were performed contrast enhanced CT scan. Results The characteristics of the chest CT scan in this series included: (1) The lesions were distributed in more than one lobe in 78.6% of the patients. Both the upper and lower lobe were involved in 56.4%, upper lobes were involved in 20.5%, and only involvement of the lower lobes in 23.0%. (2)Fibrosis as the predominantly manifestation was seen in 89.4%. The presentations of cavity,calcification,pleural thickness,tuberculoma were seen in 48.5%, 40.8%, 18.4%, and 6.8%, respectively. (3)Contrast enhancement CT showed that lesions were markedly enhanced in 90.5% (76/84). (4) The findings of the active lesions were presented in 76.8%, which manifested as 2～4mm centrilobular nodules and branching linear opacities,or 5～8 mm fuzzy nodules associated with thickening of the interlobular septa and the bronchial wall. (5) Pulmonary TB associated with lung cancer was seen in 9.4% (15/160) of the patients.Conclusion The characteristics of pulnonary TB in aged people included predominant fibrosis,preferring to involvement of the lower lobes, and marked lesion enhancement. The incidence of TB associated with lung cancer is relatively high. HRCT is useful for determinated the activity of pulmonary TB.