特发性肺含铁血黄素沉着症的影像学诊断

Imaging Diagnosis of Idiopathic Pulmonary Hemosiderosis

目的 探讨特发性肺含铁血黄素沉着症 (IPH)的影像学诊断。资料与方法 7例均有完整的临床、实验室以及胸片和高分辨率CT(HRCT)检查资料 ,均经病理证实。对其平片与CT表现进行回顾性分析。结果 X线表现 :7例肺野内弥漫分布有片絮状阴影与磨玻璃样改变 ,4例有散在粟粒状、结节状阴影 ,5例有弥漫分布的网织状影。HRCT :7例两肺呈弥漫性分布片絮状实变影及磨玻璃样影 ,5例两肺弥漫分布粟粒状、小结节状影 ,4例可见多发小囊状影及网状影 ,2例可见支气管充气征 ,3例有小叶间隔增厚。结论 X线平片是发现并提示IPH最基本的检查手段。影像学检查特别是HRCT与临床表现相结合分析 ,尤其是在痰或胃液中及肺泡灌洗液内查到含铁血黄素巨噬细胞 ,可明确诊断 ,并不一定完全依赖于纤支镜或肺活检病理来确诊。

Objective To study the imaging diagnosis of idiopathic pulmonary hemosiderosis (IPH).Materials and Methods This study included 7 cases with pathologically proved IPH, all patients had complete clinical and laboratory data as well as chest film and HRCT. Their imaging findings were retrospectively analyzed.Results On plain film, diffuse flake consolidation and ground glass shadows (n=7), diffuse miliary and micronodular shadows (n=4) and diffuse reticular shadows (n=5) were demonstrated in both lungs. On HRCT, diffuse flake consolidation and ground glass shadows (n=7), diffuse miliary and micronodular shadows (n=5) and multiple follicular and reticular shadows (n=4) were displayed in both lungs. Air bronchogram was seen in 2 and thickened interlobular septum in 3 cases.Conclusion Plain radiography is the elementary means to detect this disease. Imaging findings, especially HRCT signs, combined with clinical data, particularly the presence of hemosiderin macrophagocyte in the sputum, gastric juice or alveolar lavage solution, can confirm the diagnosis. Usually, fiberoptic bronchoscopy or lung needle biopsy is not absolutely necessary for establishing the diagnosis.