成人原发型肺结核的CT表现

CT findings of primary tuberculosis in adults

目的 探讨成人原发型肺结核并具有原发综合征的CT特点 ,提高对该病的诊断水平。方法 回顾性分析 3 9例经临床确诊的原发型肺结核并具有原发综合征患者的CT资料 ,其中肺内病变局部行高分辨率CT扫描 ,3 0例行增强CT扫描。结果 肺内原发病灶位于右肺 2 5例 (64 1% ) ,左肺 14例 (3 5 9% )。表现为小叶实变或斑片、结节影者 2 8例 (71 8% ) ,扇形肺叶或肺段实变者 11例(2 8 2 % )。 2 6例合并其他肺叶支气管播散病灶。 96 3 % (3 7例 )的患者表现为多组淋巴结肿大 ,2R、4R和 7区多见。 3 0例增强扫描示 ,肿大淋巴结有 4种强化方式 ,均匀强化 10例、环行强化 2 0例、多灶性分隔样强化 18例和淋巴结破溃 4例 ,13例有两种以上强化方式 ;14例可见区域淋巴结粘连成团 ,增强后粘连的淋巴结可有不同强化方式。结论 肺内炎症浸润合并肺门、纵隔淋巴结肿大是原发综合征的基本特征。

Objectives To discuss the CT features of primary tuberculosis in adults Methods CT images of 39 adult patients with primary tuberculosis were retrospectively analyzed and 30 cases were also examined after injection of contrast materials Results 39 patients had both mediastinal tuberculous lymphadenitis and parenchymal infiltration There were 25 cases (64 1%) with primary lesions involving the right lung and 14 cases (35 9%) in left side 28 cases(71 8%) appeared as patchy shadows,nodules,and lobular consolidation; 11 cases (28 2%) were with segmental or lobar consolidation In 30 cases with contrast enhanced CT,the mediastinal tuberculous lymphadenitis appeared as homogenous enhancement in 10 cases, irregular enhancement in 18 cases,central low attenuation and peripheral rim enhancement in 20 cases 14 cases showed that the nodes were confluenced with inhomogenous enhancement There were 26 cases with acute bronchogenic spread tuberculosis Conclusion The parenchymal infiltration and mediastinal tuberculous lymphadenitis are the basic features in adult primary tuberculosis Acute bronchogenic spread into other fields and the features of node enhancement after injection of contrast materials are very important findings in the diagnosis of primary tuberculosis