肺内球形结核CT增强特征及其临床意义

目的：探讨肺球形结核动态CT增强表现及其临床应用价值。方法：对42例共54个肺部球形结核进行研究,增强前后均对病变局部薄层扫描,层厚及间隔均为2．0mm。结果：54个球形结核病灶中51个（94．4％）最大增强CT值均＜20HU,3个（5．6％）最大增强CT值≥20HU。54个病灶中无任何强化型有27个（50．0％）;包膜强化型24个（44．4％）;周围强化型1个（1．9％）;广泛强化型2个（3．6％）。CT平扫对球形结核诊断正确率为25．9％,增强后提高到94．4％（χ^2=50.1,P＜0．05）。广泛强化型和周围强化型病灶抗结核疗效最好,包膜强化型次之,无任何强化型疗效较差。结论：动态CT增强扫描可以提高球形结核诊断的正确率。不强化或包膜样强化提示结核的诊断。病灶增强特征在一定程度上有助于判断抗结核的疗效。     

成人纵隔淋巴结结核的CT诊断

目的：评价成人纵隔淋巴结结核在CT,特别是增强CT扫描时的表现。方法：对17例经手术、穿刺活检和（或）临床抗结核治愈证实的成人纵隔淋巴结结核作了影像学分析,其中男10例,女7例,年龄16－74岁,平均45．9％;全部病例均作了胸部平片和CT扫描,6例作了增强CT扫描。结果：胸部平片仅发现右上纵隔肿块和（或）右肺门肿块者6例,CT则在17例中共发现37个纵隔和（或）肺门肿大淋巴结,肿大淋巴结位于2R和（或）4R者共22个（59．4％）,平扫时淋巴结内呈不均匀低密度者30个（81．1％）,6例16个淋巴结增强扫描均呈边缘环形强化（100．0％）。结论：CT,特别是增强CT扫描是确诊本病的首选方法。     

艾滋病肺门纵隔淋巴结结核的影像学表现

目的探讨获得性免疫缺陷综合征(AIDS)合并肺门和纵隔淋巴结结核的影像学表现。方法回顾性分析9例AIDS合并肺门和纵隔淋巴结结核的影像学表现(包括胸部平片、CT和MR扫描)。全部病例均作了胸部平片、CT扫描，5例作了增强CT扫描，1例作了MR检查。结果AIDS合并肺门和纵隔淋巴结结核时，增大的淋巴结主要位于7区9／9例，4R区7／9例，2R区5／9例。结论AIDS合并肺门和纵隔淋巴结结核的影像学表现为多组淋巴结增大，可相互融合及出现淋巴结外侵犯表现，CT和MR扫描对本病的诊断有重要意义。     

NMR evaluation of hilar and mediastinal lymphadenopathy

Eighteen patients with hilar or mediastinal masses demonstrated at CT were selected for examination by nuclear magnetic resonance (NMR). Only regions identified as abnormal on CT scans were scanned by NMR. All patients had histologically proved disease or characteristic findings on the CT scan. The NMR images of two patients were uninterpretable, but all other images clearly distinguished masses from either blood vessels or normal mediastinal tissues without the use of contrast medium. In four cases NMR showed a greater extent of disease than did CT. NMR is a promising modality for visualizing hilar and mediastinal masses.     

Testicular seminoma presenting with mediastinal lymphadenopathy and gynecomastia

Chest computed tomography (CT) of a 22-year-old man with a history of long-term low fever and nonproductive cough demonstrated lymphadenopathy in the superior, middle, and posterior mediastinum. Slight bilateral gynecomastia was also observed on the CT scan. Subsequent physical examination and ultrasonography revealed a left testicular mass, and abdominal CT showed retroperitoneal lymphadenopathy. Left orchiectomy was performed, with the histological examination confirming the diagnosis of seminoma.     

儿童纵隔淋巴结肿大的CT诊断与鉴别

目的 分析儿童纵隔淋巴结肿大的CT特征及其在鉴别诊断中的作用.方法 回顾性分析经临床或细菌学检查证实的纵隔淋巴结炎症29例、结核18例、肿瘤(包括淋巴瘤、急性淋巴细胞白血病及纵隔神经母细胞瘤)12例的CT检查资料,对肿大淋巴结影像学表现进行统计学分析.结果 3组间肿大淋巴结的面积(S)及最短径(D)存在显著差异(P＜0.05).其中炎症组与结核组间肿大淋巴结面积及短径存在显著统计学差异,结核患儿纵隔淋巴结肿大程度明显高于炎症组;在强化程度和方式上,肿瘤组纵隔内肿大淋巴结倾向于完全强化(P值),而中央低密度,增强环状强化伴钙化则是结核感染的较具特征性征象,肿瘤及炎症则少见此征象;出现3组和3组以上纵隔淋巴结肿大者倾向于结核和肿瘤的诊断(P值).结论 纵隔肿大淋巴结的面积、短径、密度及分布对引起纵隔淋巴结肿大的疾病鉴别有较高的提示作用.     

Primary localized amyloidosis manifested as supraclavicular and mediastinal lymphadenopathy

Thoracic involvement of amyloidosis is relatively rare, but mediastinal lymphadenopathy in the absence of pulmonary parenchymal involvement is extremely rare. The case presented here is of a previously healthy elderly woman who developed a palpable mass in the right supraclavicular area. The chest CT scan showed extensive, contiguous and homogeneous low attenuated lymphadenopathy with stippled calcification in the right supraclavicular area and mediastinum. Amyloidosis was confirmed histopathologically on a biopsy specimen from a right supraclavicular lymph node. Because there were no other sites found to be affected by amyloidosis and there was no underlying chronic disease, we made a final diagnosis of primary localized amyloidosis involving only the supraclavicular and mediastinal lymph nodes.     

Evaluation of mediastinal lymphadenopathy with endoscopic US-guided fine-needle aspiration biopsy

PURPOSE: To evaluate the safety and accuracy of endoscopic ultrasonography (US)-guided fine-needle aspiration biopsy (FNAB) of lymph nodes in the paratracheal, aortopulmonic, subcarinal, and posterior mediastinal regions. MATERIALS AND METHODS: Eighty-six consecutive patients with mediastinal lymphadenopathy who did not have a primary gastrointestinal neoplasm were examined. In 29 patients, endoscopic US-guided FNAB of mediastinal lymphadenopathy was performed as a component of staging non-small cell lung cancer (NSCLC); in the remaining 57 patients, it was performed to obtain a primary diagnosis. Final diagnosis was based on clinical follow-up, cytologic, and/or surgical results. RESULTS: In 82 patients in whom a final diagnosis was available, the sensitivity, specificity, accuracy, negative predictive value, and positive predictive value of endoscopic US-guided FNAB in distinguishing benign from malignant mediastinal lymph nodes were 96%, 100%, 98%, 94%, and 100%, respectively. In those patients who underwent staging of NSCLC, endoscopic US-guided FNAB had superior mediastinal lymph node staging accuracy compared with endoscopic US alone (79%) and CT alone (79%) (P =.01). The results of endoscopic US-guided FNAB prompted a change to nonsurgical management in 66 (80%) of 82 patients who underwent the procedure. One minor complication, postprocedural fever that resolved with oral antibiotics, occurred (1%; 95% CI: 0%, 6%). CONCLUSION: Endoscopic US-guided FNAB is accurate and safe for biopsy of mediastinal lymph nodes to stage NSCLC, establish a primary diagnosis, or examine patients with prior inconclusive biopsy results.     

Tuberculous epididymitis associated with abdominal lymphadenopathy (2004:1b)

Although the predominant form of tuberculosis is pulmonary disease, an increasing number of cases with extra-pulmonary involvement have been reported. The diagnosis of extra-pulmonary tuberculosis is often difficult because of its protean clinical manifestations and non-specific laboratory findings. Abdominal lymph node involvement may be present alone or in combination with involvement of the gastrointestinal tract, peritoneum, and solid viscera. Tuberculous epididymitis occurs sporadically and represents a specific secondary subacute or chronic inflammatory process involving the epididymis. We present the imaging findings in a patient with tuberculous epididymitis associated with abdominal tuberculous lymphadenopathy.     

成人纵隔淋巴结核的CT诊断

目的分析纵隔淋巴结核的多层螺旋CT特点，提高其诊断水平。方法回顾性分析8例经手术、穿刺活检或临床抗结核治愈证实的成人纵隔淋巴结结核的CT表现，其中，男2例，女6例，年龄17～65岁，平均35岁。结果8例均有不同程度纵隔或肺门肿大淋巴结，其中，3例平扫时淋巴结内呈不均匀低密度，增强扫描呈边缘环形强化。结论CT扫描，特别是增强CT扫描是确诊本病的首选方法。