支气管结核并发黏液栓嵌塞的CT表现与诊断

目的 分析支气管结核（EBTB）并发黏液栓嵌塞（MPI）的CT表现与特点，提高对其影像学诊断的水平。 方法 对经纤维支气管镜检查确诊的25例EBTB并发MPI患者的CT表现和形态特点进行分析。 结果 EBTB并发MPI后典型的CT表现：（1）直接征象：树杈状阴影10例（40.0%），挤牙膏状阴影8例（32.0%），手套状阴影7例（28.0%）。（2）病灶分布与形态：不规则的团块状阴影均分布在各肺叶内2/3的肺野中，膨胀性强，边缘清晰，呈向心性分布。（3）伴随征象：25例中23例（92.0%）患者主体病灶阴影周围有多发性斑点状和小片状卫星灶，13例（52.0%）患者伴病灶区肺纹理聚拢，肺叶容积缩小，肺气肿形成等慢性过程。6例（24.0%）患者CT检查显示左或右主支气管明显狭窄。（4）CT增强表现：25例中12例患者CT增强扫描后团块状病灶CT值均＜20 HU。25例患者经确诊后进行规则的抗结核治疗均获得较好的疗效。 结论 EBTB并发MPI后易形成树杈状、挤牙膏状、手套状阴影，掌握其CT表现与特点有利于提高EBTB并发MPI影像学诊断水平。

CT manifestations and diagnosis of bronchial tuberculosis with mucus impaction

Objective The CT manifestations and features of endobrochial tuberculosis(EBTB) complicated by mucous plug impact(MPI) were analyzed in order to improve the levels of imaging diagnosis.Methods CT features and morphological characteristics of 25 cases of EBTB complicated by MPI who were confirmed the diagnosis by fiberoptic bronchoscopy was analyzed.Results There were typical CT features in EBTB complicated by MPI:(1)Direct signs: 10 cases(40.0%) of crotch-like shadow,8 cases(32.0%) of squeezing toothpaste-like shadow,7 cases(28.0%) of glove-like shadow.(2) Distribution and morphology of lesions: irregular lumpy shadows distributed in interior 2/3 lung fields in each lobe,lesions are expansive,with sharp edges,and concentrically distributed.(3)Characteristic of accompanied signs: around the main lesions,23(92.0%) cases surrounded by multiple punctate and small pieces of satellite lesions,13(52.0%) patients had chronic formation process,like concentrated lung-markings in focals,reduced lung volume,and emphysema.6 cases(24.0%) with CT examination showed the left or right main bronchus stenosis.(4)Characteristic of enhanced CT: CT valuation of mass focals of 12 patients was less than 20HU for enhanced CT.After the regular anti-TB treatment,all 25 patients had good therapeutic effect.Conclusion EBTB complicated by MPI could display crotch,squeezing-toothpaste or glove-like signs.Mastering the CT manifestations and features is conducive to improve the imaging diagnosis levels of EBTB complicated by MPI.