胸部结节病的影像学诊断

【摘要】目的：回顾性分析胸部结节病的影像学表现,进一步提高对此病的认识,减少误诊。方法：分析36例符合诊断标准的胸部结节病的胸片及CT表现。结果：胸部淋巴结增大34例,其中两侧肺门及纵隔淋巴结增大22例,两侧肺门淋巴结增大而无纵隔淋巴结增大2例,一侧肺门及纵隔淋巴结增大7例,一侧肺门淋巴结增大而无纵隔淋巴结增大1例,仅有纵隔淋巴结增大2例。肺部病变25例,其中多发结节18例,条索状影13例,磨玻璃样影11例,支气管血管束增厚5例,空气潴留4例,实变2例。支气管改变8例,胸膜病变3例。CT对纵隔内较小淋巴结及肺内病灶的检出率明显高于胸片。结论：有典型影像学表现的胸部结节病诊断容易;不典型者诊断困难,需密切结合临床及治疗后随访。     

胸部结节病的影像学诊断

目的回顾性分析胸部结节病的影像学表现,进一步提高对此病的认识,减少误诊。方法分析36例符合诊断标准的胸部结节病的胸片及CT表现。结果胸部淋巴结增大34例,其中两侧肺门及纵隔淋巴结增大22例,两侧肺门淋巴结增大而无纵隔淋巴结增大2例,一侧肺门及纵隔淋巴结增大7例,一侧肺门淋巴结增大而无纵隔淋巴结增大1例,仅有纵隔淋巴结增大2例。肺部病变25例,其中多发结节18例,条索状影13例,磨玻璃样影11例,支气管血管束增厚5例,空气潴留4例,实变2例。支气管改变8例,胸膜病变3例。CT对纵隔内较小淋巴结及肺内病灶的检出率明显高于胸片。结论有典型影像学表现的胸部结节病诊断容易;不典型者诊断困难,需密切结合临床及治疗后随访。     

支气管囊肿的影像学诊断分析

目的：探讨支气管囊肿的影像学特征，提高对本病的认识。材料与方法收集我院2003年-2006年经手术及病理证实的支气管囊肿12例，全部病例均拍摄胸片，其中8例行螺旋CT检查，对所有病例的影像学表现进行回顾性分析。结果4例位于纵隔内，8例位于肺内孤立性囊肿10例，多发囊肿2例。12例中胸片显示：边缘光滑6例，1例（下转第54页）略呈分叶状，2例边缘不清，阻塞性炎症改变3例，有纤维化改变者2例；8例行CT检查，4例呈液性密度，3例呈软组织密度，2例其周围伴纤维化改变。结论有些支气管囊肿的影像学表现缺乏特异性，应结合临床病史及各项检查认真分析，提高对本病的诊断率。     

卡氏肺囊虫肺炎的影像学表现

目的：探讨卡氏肺囊虫肺炎（FCP）的影像学表现。方法：我院1998年以来收治8例肾移植后已明确诊断为卡氏肺囊虫肺炎，就其x线与CT影像表现做一分析。结果：x线胸片：3例均表现为双肺弥漫性病变，以近肺门、下肺后及下基底段病变明显，未见肺门区淋巴结影；1例为双肺弥漫性间质改变及大片状边缘模糊毛玻璃样改变，2例为肺纹增粗伴双肺下对称性斑片状影。CT胸片：5例为双肺弥漫性渗出性病变，病灶呈边缘模糊片状和小片状影，部分融合呈片状，其中2例片状改变影中可见支气管影，另2例为两肺弥漫性间质改变，小叶间增厚，呈网络状，间有小斑片渗出影。结论：CT观察具有高分辨率扫描，可帮助PCP病理改变的理解。X线胸片表现可以比较充分较早地提示PCP的存在，对本病早期诊断有一定价值。     

气管支气管内膜结核的CT诊断

目的：分析气管支气管内膜结核的CT表现，探讨其影像学特征及其病理基础。方法：收集痰菌、病理及临床证实的气管与支气管结核52例，分析其CT与HRCT表现。结果：CT表现有以下特点：①96．1％CT显示长段不规则气管或支气管壁增厚，其增厚的支气管壁范围较长为特征之一；②25％CT显示远处肺或对侧肺结核支气管播散病灶；③支气管狭窄、阻塞不伴有肺门肿块；④11．5％可见增厚的气管或支气管壁出现钙化。此征象具有特征性；⑤支气管阻塞性肺部病变中，若出现阻塞性肺气肿伴气肿区分支条状或指套样高密度灶、支气管阻塞远端实变、肺内或不张肺内出现大量无壁空洞、“蜂窝样”改变或伴有不规则或“串珠状”支气管扩张表现者也具有一定特征性诊断价值，其中后者考虑为继发于支气管壁破坏或实变与不张肺内病灶纤维化继发的牵拉性支气管扩张所致。结论：气管支气管内膜结核的CT表现，尤其是HRCT表现，有一定特征性，是诊断及鉴别诊断的有效于段。     

新生儿肺透明膜病的临床及X线诊断（附40例报告）

目的：研究新生儿肺透明膜病临床及X线诊断。40例患儿中，男28例，女12例，顺产19例，剖宫产21例，本组均为早产儿，病例中死亡18例。方法：对该40例患儿胸部表现进行分析，结果X线表现两肺透光度减低40例，合并颗粒状阴影22例，毛玻璃样改变合并支气管充气征越出心脏轮廓为35例，两肺普遍呈云絮状影—白肺8例。结论：X线胸片是诊断肺透明膜病的主要方法，能够做出早期诊断，并得到合理有效的治疗，减少病死率。     

SARSX线胸片、CT影像学分析（附32例报告）

目的 探讨SARS病毒浸润肺部后引起的X线胸片、CT影像学特征。方法 收集临床诊断病例32例(男13例，女19例。年龄18～58岁，平均31岁，其中医院工作人员9例)。总结其胸片、CT的影像学表现。结果典型的影像学表现是：两肺多发斑片状、结节状致密阴影、肺周边居多；或两肺弥漫性多叶多段肺实变，支气管充气征明显。结论 早期胸片CT表现为单发或多发小点片状阴影，直径小于1cm；2～3天复查，病灶迅速增多、增大，则有重要的诊断价值。     

肺泡微石症的影像学诊断

目的：探讨肺泡微石症的影像学特征。方法;报道肺泡微石症6例,全部病例均行胸部X线检查,2例行常规CT,1例行HRCT。并对全部影像学表现进行了回顾性分析。结果：6例胸片表现为弥漫粟粒样微细结节（2例）。“鱼子样”或“暴风沙样”（2例）、“白肺样”（1例）及高密度“面纱样”改变（1例）,CT可明确肺内微细结节的钙化密度,肺尖部气肿样改变及支气管血管束增粗并呈钙化密度,HRCT则可进一步显示肺野磨砂玻璃样改变,小叶间隔,叶间胸膜及支气管血管束钙化密度与串珠状增厚,小叶中心分布的微细结节与胸膜下蜂窝,结论：肺泡微石症是一种罕见病,其影像学表现具有特征性,影像学检查尤以HRCT检查对该病的诊断有决定性作用。     

百草枯中毒肺内改变的临床及CT表现

目的探讨百草枯中毒肺的CT表现及其临床应用价值。方法回顾24例百草卡占中毒患者肺损坏的CT资料,根据时间分早期（1～2天）,中期（3～14天）,晚期（14〉天）3个阶段,对中毒患者的CT资料与临床表现进行对照。结果24例百草枯中毒中16例死亡,8例肺纤维化。早期CT表现：3例无异常,7例肺纹理增多、模糊,14例毛玻璃样改变;中期CT表现：3例肺纹理增多、模糊,4例肺纹理增多、模糊,双下肺斑点状密度增高影,2例胸模下线,10例毛玻璃样改变,马赛克征,5例肺实变,5例出现伴行支气管扩张,21例胸膜腔积液。晚期CT表现：8例毛玻璃样改变,马赛克征,16例肺实变伴行支气管扩张,4例纵隔内积气,8例肺纤维化。结论百草枯中毒肺的CT表现及临床表现基本相符,具有相对分期特征,有助于临床对病情的及时评估,从而指导临床治疗。     

肺非结核性分支杆菌病的X线和CT表现

目的 认识肺非结核性分支杆菌病的X线和CT表现。方法 回顾性分析经确诊的22例肺非结核性分支杆菌病的X线胸片表现，其中10例同时有CT扫描。记录异常所见和主要累及的肺叶；比较胸片和CT所见的异同。结果 胸片显示：(1)全部病例都有病变；(2)病变多数为两侧多叶分布(17例)，右侧比左侧多(20：16，)，上叶比下叶多(18：15)；(3)在病变形态上斑片状实变(19例)、空洞(18例)、纤维性变(14例)、结节(12例)是胸片上的主要表现；(4)多数病例(19例)多种病变同时出现。CT则以结节最常见(10例均可见)，其次为实变和空洞，各为8例，此外尚可见5例支气管扩张、3例“树芽征”和2例纵隔淋巴结肿大，这些征象在胸片上均未能检出。结论 气腔实变、空洞、结节、纤维化是胸片的常见表现，在CT上还可见支气管扩张、“树芽征”和纵隔淋巴结肿大。该病变的形态和分布难以和继发型肺结核区别，多种病变同时累及多肺叶是该病的特点。     

传染性非典型肺炎首次阳性胸片分析

目的：探讨传染性非典型肺炎初始发病时的胸部X线表现，提高该病的诊断符合率。方法：回顾性分析260例传染性非典型肺炎患者首次阳性胸片的X线表现。结果：260例传染性非典型肺炎首次阳性胸片的胸部X线表现为斑片状影176例(67．7％)，大片状影56例(21．5％)，间质改变72例(27．7％)，44例(16．9％)斑片状影伴间质改变；单肺受累117例(45．0％)，双肺受累143例(55．0％)；163例(62．7％)片状影内可见支气管气像。结论：斑片状影、大片状影、间质改变是传染性非典型肺炎首次阳性胸片的主要X线表现，胸片检查应作为传染性非典型肺炎常规检查方法。最后诊断应结合临床和实验室检查。     

Summer-type hypersensitivity pneumonitis: comparison of high-resolution CT and plain radiographic findings.

Summer-type hypersensitivity pneumonitis is an immunologic disease that occurs only in Japan. It is a form of hypersensitivity pneumonitis in which the clinical symptoms appear in the summer and subside spontaneously in mid autumn. The purpose of our study was to determine the CT findings in this condition, to compare the CT findings with those on chest radiographs, and to assess the variations in the CT findings over time. Accordingly, high-resolution CT scans and chest radiographs of 15 patients with summer-type hypersensitivity pneumonitis were retrospectively studied. Seven patients had sequential CT examinations 18-37 days apart. The CT scans and chest radiographs were reviewed by two observers independently. CT findings included diffuse micronodules (n = 15), slightly elevated lung density (n = 13), and patchy air-space consolidation (n = 13). In one patient, the findings on a chest radiograph were normal, while CT showed parenchymal abnormalities. In two cases, follow-up CT showed micronodular abnormalities after findings on the chest radiograph had returned to normal. Our results show that high-resolution CT findings of summer-type hypersensitivity pneumonitis include pulmonary micronodules, increased lung density, and air-space consolidation. High-resolution CT appears to be more useful than plain chest radiographs in the evaluation of pulmonary parenchymal abnormalities in this condition.     

Pediatric diffuse lung disease: diagnosis and classification using high-resolution CT.

OBJECTIVE: Our purpose was to categorize high-resolution CT findings in children with diffuse lung disease and to evaluate the accuracy of diagnoses made using CT. MATERIALS AND METHODS: The chest radiographs and high-resolution CT scans of 20 children (1-16 years old; median, 9 years old) with biopsy-proven chronic diffuse lung diseases were reviewed separately by two independent chest radiologists. Thirteen types of diffuse lung disease were included in the study. Radiographic and CT features were noted, and three choices of diagnosis were recorded, with the confidence level. RESULTS: Diagnoses were made with a high degree of confidence (definite or probable) in 25 of 40 interpretations of CT scans, compared with only five of 40 interpretations of chest radiographs (p < .001). Fourteen (56%) of the 25 confident first-choice diagnoses on CT scans were correct, compared with two (40%) of the five interpretations on chest radiographs. Diseases were classified as belonging to one of five distinct groups on the basis of dominant CT features. Airway disease (n = 5) (bronchiolitis obliterans or bronchocentric granulomatosis) showed geographic hyperlucency on CT. Septal disease (n = 4) (lymphangiomatosis, hemangiomatosis, or microlithiasis) showed septal thickening. Infiltrative lung disease (n = 7) (desquamative interstitial pneumonitis, hypersensitivity pneumonitis, or lymphoid interstitial pneumonitis) showed ground-glass opacity. Air-space disease (n = 3) (aspiration, vasculitis, or bronchiolitis obliterans organizing pneumonia) showed lung consolidation. Langerhans' histiocytosis (n = 1) showed cysts and nodules. Surprisingly little overlap was seen among these groups. CONCLUSION: CT increases the level of diagnostic confidence for pediatric infiltrative lung disease, improves diagnostic accuracy, and provides a useful classification system.     

Bronchogenic carcinoma after lung transplantation: frequency,clinical characteristics,and imaging findings

PURPOSE: To determine the frequency, clinical characteristics, and radiologic findings of bronchogenic carcinoma in patients surviving more than 1 month after lung transplantation. MATERIALS AND METHODS: The study population was composed of 2,168 consecutive patients at seven lung transplantation centers who survived longer than 1 month after lung transplantation. Medical records, chest radiographs, and computed tomographic (CT) scans obtained at the time of diagnosis and prior images when available were reviewed for various items of information and imaging features. RESULTS: Twenty-four (1%) of the 2,168 patients, all with single-lung transplants, developed cancer in the native lung. Eighteen patients had emphysema, and six had pulmonary fibrosis. The frequencies of cancer in patients with emphysema and fibrosis were 2% (18 of 859 patients) and 4% (six of 147 patients), respectively. Twelve (50%) of their 24 cancers were detected at chest radiography. Fourteen (58%) patients had clinical symptoms. Twenty-one (88%) of the 24 patients had one (n = 11) or more (n = 10) nodules, and nine (38%) had one (n = 8) or more (n = 1) masses visible on CT scans. Nodules and masses were visible on 12 (50%) and seven (29%) of 24 chest radiographs, respectively. Eleven (48%) of 23 cancers for which prior chest radiographs were available were seen retrospectively on prior chest radiographs. CONCLUSION: Bronchogenic carcinoma develops in the native lung of transplant recipients with emphysema and pulmonary fibrosis with frequencies of 2% and 4%, respectively. The carcinomas most commonly manifest as a pulmonary nodule or mass on chest radiographs, with more nodules seen on CT scans.     

Chronic lung diseases: specific diagnosis by using CT

We evaluated patterns of abnormal lung parenchyma on CT scans in six specific chronic lung diseases and then applied those findings in the differential diagnosis of these lung parenchymal patterns in 56 subjects. There were 48 patients with chronic lung diseases (43 with histologic proof) consisting of usual interstitial pneumonia (n = 20), sarcoidosis (n = 16), lymphangitic carcinomatosis (n = 7), lymphangioleiomyomatosis (n = 2), drug toxicity (n = 2), and eosinophilic granuloma (n = 1). Including eight CT scans of normal control subjects, 56 CT scans were assessed independently by two readers (R1 and R2). Chest radiographs, most of which were obtained within 1 week of CT examination, were available in 48 of the 56 subjects. CT scans were evaluated for specific parenchymal features including disease distribution, lung distortion, thickening of bronchovascular bundles and polygon walls, bronchiectasis, cysts, and nodules, to determine the association of each abnormal feature with the different diseases. Diagnosis was then made from the overall CT appearance of the lungs and, on a separate occasion, from the appearance of the chest radiograph. The correct diagnosis was made from the CT appearance in 54 of 56 patients (R1) and in 50 of 56 patients (R2). Correct diagnoses were made from the chest radiographs in 42 of 48 patients (R1) and 43 of 48 patients (R2). We have identified features that are reproducible and useful when describing CT scans of patients with chronic lung diseases. Interpretation of the appearance of the lung on CT scans was accurate in diagnosing usual interstitial pneumonia, sarcoidosis, and lymphangitic carcinomatosis.     

Pulmonary blastoma: radiologic findings in five patients

PURPOSE: To determine the radiologic findings of pulmonary blastoma on chest radiograph and CT. MATERIALS AND METHODS: Chest radiographs and CT scans of five patients with pathologically proven pulmonary blastoma were retrospectively evaluated and radiologic findings were correlated with histopathologic findings. RESULTS: On chest radiograph, the pulmonary blastoma manifested as a solitary parenchymal mass (n = 2), a solitary parenchymal nodule (n = 1), hilar bulging with fingerlike parenchymal opacities (n = 1), or opacification of hemithorax (n = 1). On CT, the pulmonary blastoma manifested as a solitary parenchymal mass (n = 2), a solitary parenchymal nodule (n = 1), an endobronchial mass with postobstructive pneumonitis (n = 1), or a parenchymal mass with multiple subpleural masses and pleural effusion (n = 1). CONCLUSION: Pulmonary blastomas most commonly manifested as a solitary parenchymal mass on chest radiograph and CT. These radiologic features are nonspecific and many primary or metastatic tumors of the lung could be included in differential diagnosis.     

Imaging findings of pulmonary vascular disorders in portal hypertension

PURPOSE: The purpose of this study was to demonstrate and compare the imaging findings of hepatopulmonary syndrome and portopulmonary hypertension. MATERIALS AND METHODS: We retrospectively reviewed the imaging findings of five patients with hepatopulmonary syndrome and four patients with portopulmonary hypertension. We evaluated chest radiographs, chest and abdominal computed tomography (CT) scans, 99mTc-macroaggregated albumin (MAA) lung perfusion scans, and pulmonary angiograms. RESULTS: In patients with hepatopulmonary syndrome, the presence of peripheral pulmonary vascular dilatation was detected by chest radiograph, chest CT scan, and pulmonary angiogram, especially the basilar segment. 99mTc-MAA lung perfusion scan showed extrapulmonary tracer distribution (brain, thyroid, and kidney), which revealed pulmonary R-L shunting. In patients with portopulmonary hypertension, chest radiographs and chest CT scans showed the classic findings of primary pulmonary hypertension. In patients with both disorders, extrahepatic features of portal hypertension including ascites, splenomegaly, and portosystemic collateral vessels were seen on abdominal CT. CONCLUSION: In conclusion, chest radiographs and CT in hepatopulmonary syndrome usually showed peripheral pulmonary vascular dilatation, whereas those in portopulmonary hypertension showed central pulmonary artery dilatation. The extrahepatic features of portal hypertension might be helpful for the diagnosis of both disorders.     

Spontaneous pneumothorax and pneumomediastinum in IPF

Patients with idiopathic pulmonary fibrosis (IPF) are at risk for a variety of acute pulmonary complications, including pneumothorax and pneumomediastinum. Our aim was to describe the radiographic and CT findings and to determine the frequency of complicating spontaneous pneumothorax and pneumomediastinum in patients with IPF. A retrospective study was performed including 78 consecutive patients who underwent CT scanning of the chest and who had confirmed IPF. The chest radiographs and CT scans were reviewed by two chest radiologists and classified as showing features of extra-alveolar air collections. The CT scans showed extra-alveolar air in 9 (11.2 %) of 78 patients (six females and three males; age range 26–90 years, mean age 65 years). Pneumothorax was demonstrated in 5 patients and mediastinal air collections in 4 patients. All patients had dyspnea for 1–48 months (mean 14 months). Of the five cases with pneumothorax, four developed acute onset of dyspnea and pleuritic chest pain, whereas 1 patient had a relatively stable functional status. Of the 4 patients with pneumomediastinum, three presented with nonpleuritic chest pain and acute dyspnea. Chest radiographs showed extra-alveolar air in 6 patients. Three cases were predicted to be negative by chest radiographs. Follow-up CT showed that air collections had resolved completely in 5 patients. Two patients died of respiratory failure within 4 months after CT. Extra-alveolar air should be recognized as a relatively common IPF-related complication. Chest CT is a useful imaging method in determining air collections in patients with IPF that become acutely breathless and their chest radiograph fails to reveal the presence of extra-alveolar air. Received: 9 October 1998; Revised: 26 January 1999; Accepted: 6 April 1999     

严重急性呼吸综合征胸部X线和CT诊断

目的 探讨严重急性呼吸综合征(SARS)的X线和CT表现，以提高对本病的认识。资料与方法 回顾性分析我院收治的37例SARS病例，所有患者均摄有胸部X线片，6例行胸部CT平扫。结果 SARS胸部X线表现分为5型，其中局限型7例(19％)，局限扩散型21例(57％)，间质型2例(5％)，间质扩散型5例(14％)，结节-实变型2例(5％)。结论 X线和CT对SARS的诊断具有重要意义。