常见肺段病变的CT诊断

CT diagnosis values for pulmonary segment lesions

目的 分析慢性肺炎、肺结核和肺癌引起的肺段病变的CT特点及诊断价值。方法 搜集 4 4例肺段病变的CT资料 (15例慢性肺炎、12例肺结核、17例肺癌 )。全部经病理、痰检结核菌证实。重点观察病灶的外形、边缘、密度、支气管和邻近改变。结果 大多数肺段病灶均有 2～ 3个以上的CT层面呈楔形或锥状 (尖朝向肺门 ,底部位于肺外周 ) ,少数病灶需将各个层面叠加起来方呈锥形外观。慢性肺炎病灶边缘多稍内凹或平直 ,楔尖支气管通畅 ,未见结节 ;密度较均匀 ,可见支气管气相或支扩 ;底部相邻胸膜增厚明显。结核病灶边缘常不规则或模糊 ;密度不均 ;楔尖未见结节 ,可有支气管狭窄 ;卫星病灶和胸膜增厚较多见。肺癌病灶边缘可见外凸 ;密度均匀或较均匀 ;楔尖支气管阻塞和结节。诊断符合率 75 %。结论 三种肺段病变CT表现有一定特点 ,诊断时须综合分析各种征象。不典型病例的诊断有赖于病理。

Objective To analyze CT features of the pulmonary segment lesions.Methods The CT findings of 44 patients with pulmonary segment lesions were reviewed. The diseases included chronic pneumonitis(n15), tuberculosis(n12),lung cancer(n17), all proved pathologically.Results Wedge-shape or cone-shape of lesions was demonstrated in most of cases. In chronic pneumonitis, the border of lesion was depression or straight without hilar mass and bronchus obstructed. Most lesion was isodensity and the air bronchogram could be found in some cases. In tuberculosis, the border was irregular or hazy with different density inside the lesion(cavity, calcification, bronchiectasis). Satellite-lesion and thickening of the pleura nearby were found commonly. In lung cancer, the hilar mass and/or obstructed bronchus were the characteristic, with the border evagination in some cases. According to the above, 75% of the cases was diagnosed correctly.Conclusion Some relative specific CT manifestation existed in the pulmonary segment lesions caused by chronic pneumonitis, tuberculosis and lung cancer. But the CT of some patients were similar to each other, of which diagnosis must be based on pathology.