如何正确判断肺门病变

<正>在X线诊断中,经常会遇到肺门淋巴结是否增大的争议,误诊、漏诊的现象时有发生,常常不能正确判断淋巴结是否增大。虽然近年来多种影像技术如CT及磁共振成像在胸部疾病诊断中应用,突破了X线诊断像在胸部疾病诊断中的应用,突破了X线诊断的限度,提高了肺门病变的检出率和鉴别诊断能力,但胸片仍是基本检查方法。几年来,我们在教训中反复重温了有关肺门病变的胸部平片资料,结合临床实践,现总结如下。     

导致胸部结节病初诊困难的原因分析

目的　分析胸部结节病的影像学表现 ,探讨造成结节病初诊困难的原因。资料与方法　回顾性分析 5 7例胸部结节病临床资料及其影像学 (X线平片及CT)表现。其中有 32例初诊为其他疾病 ,但需进一步检查除外结节病。结果　 5 7例均可见胸部淋巴结增大 ,其中 4 2例纵隔、双侧肺门淋巴结均增大 ;8例纵隔、单侧淋巴结增大 ;7例仅见纵隔淋巴结增大。 36例出现肺部病变 (包括 2 6例肺内多发结节 ,8例斑片状阴影 ,2例肺纤维化 ) ;4例胸膜病变。结论　结节病的胸部影像及临床表现缺乏特异性 ,肺部病变及不典型胸部淋巴结增大是导致结节病初诊困难的主要原因     

免疫损害患者肺结核的影像诊断

目的　探讨几种免疫损害疾病并发肺结核患者的X线和CT所见 ,包括糖尿病、肾移植术后及获得性免疫缺陷综合征 (AIDS)。方法　回顾分析合并有肺结核的 2 0例糖尿病患者的胸部CT所见、10例肾移植术后患者的胸部X线片及 2例AIDS患者的CT片。结果　糖尿病并发肺结核的CT表现为 :大片融合性肺实变 (10例 ) ,在单一病变区内有多发小空洞 (9例 ) ,病变不按肺段分布(2例 ) ,多数病变具有卫星灶。肾移植术后并发肺结核的胸部X线表现为 :斑片及大片融合实变(6例 )和粟粒型肺结核 (4例 )。AIDS病合并肺结核的CT表现为 :纵隔淋巴结肿大 (1例 ) ,肺内浸润(1例 )及胸部以外的结核病变 (2例 ) ,包括颈部及腹膜后淋巴结肿大。结论　 3种免疫损害病变患者并发肺结核的主要CT及X线表现为大片融合病变、单一病变内的多发小空洞、粟粒型肺结核、纵隔淋巴结肿大及胸部以外的淋巴结肿大     

SARS的胸部X线表现

目的 报道严重急性呼吸综合征(SARS)的胸部X线表现。方法 分析105例SARS的胸部X线表现及特征。所有病人均为2003年1月30日至3月31日期间诊治的病人，并符合中华人民共和国卫生部制定的《传染性非典型肺炎临床诊断标准(试行)》，在住院治疗期间有完整的胸部X线片资料。根据病变早期表现及进展情况，将其分为4型。(1)局限型：由肺内单一局部病灶到病变发展或广泛分布。(2)多发型：早期即见肺内多发片状或(和)结节状病灶。(3)间质-实质型：以肺部间质性炎症为早期主要表现，其后出现明显的肺实质渗出性病变。(4)间质型：以肺间质异常为主要表现。结果 SARS患者的胸部X线表现形式多样，75例表现为肺内渗出性实变病灶，其中局限型57例，多发型18例。25例呈间质性炎症征象，随后出现明显肺内实变。5例主要表现为肺间质性炎症。首次见肺内病变至病变完全吸收的时间为7～46d，平均为19d。结论 SARS的X线表现以肺实质渗出性病变和间质性炎症为主，病变早期发展迅速，肺内实变于首诊后7～10d达高峰，其后大部分病人可完全吸收。绝大多数病人预后良好，目前尚未见有后遗症。     

胸部结节病的CT表现

目的 分析胸部结节病的CT表现，探讨其CT扫描和诊断价值。方法 13例胸部CT扫描患者，均在深吸气状态下摄片。在常规深吸气后屏气进行CT扫描，观察胸部淋巴结，肺部病变及胸膜病变。结果 13例均有胸部淋巴结增大，其中9例对称性两侧肺门淋巴结增大伴纵隔淋巴结增大，3例纵隔淋巴结增大伴单侧肺门淋巴结增大，1例仅有纵隔淋巴结增大而无肺门淋巴结增大。胸部病变有8例，占所有病例61．52％，表现为肺内多发结节，其中，3例伴肺内斑片状实变影，2例伴肺组织纤维化。胸膜病变仅1例，表现为胸膜多发小结节伴胸腔积液。结论 CT扫描是诊断结节病和鉴别诊断结节病的非常有效的方法，明显优于胸片。     

肾移植术后卡氏肺囊虫肺炎的影像学表现

目的：探讨肾移植术后卡氏肺囊虫肺炎的影像学表现。资料与方法：搜集经病理证实的肾移植术后继发卡氏肺囊虫肺炎5例，均摄胸部X线片，其中2例行胸部CT扫描。结果：胸片示病变呈双侧性网状结节影、浓密的斑片状影和云团状影及全肺实变影。CT扫描示肺内毛玻璃样、片状影以及正常肺与病变肺交织嵌合构成马赛克图形。结论：卡氏肺囊虫肺炎的影像表现呈多样性，X线胸片对本病的诊断有重要价值，最终确诊有赖于病理检查。     

气管-支气管结核的胸部X线与CT诊断

目的 了解气管-支气管结核的胸部X线与CT征象及其诊断价值。方法 36例气管-支气管结核患，其中临床证实16例，手术病理证实20例，均经胸部X线与CT检查，对全部患的胸部X线与CT表现进行了回顾性分析。结果 36例患中，胸部X线显示肺段叶及全肺不张12例，两肺结核性病灶18例，其中有陈旧性结核灶，粟粒播散灶，浸润灶及肺门淋巴结肿大。病变支气管表现有完全性支气管阻塞10例，支气管肺内结节状突起5例；胸部CT扫描显示支气管管腔变窄伴管壁增厚25例，管腔表面凹凸不平5例。管腔内有结节状突起6例，纵隔淋巴结肿大及钙化15例。结论 对气管-支气管结核的胸部X线与CT表现进行综合分析。大大有助于提高其诊断准确性。     

100例新生儿肺炎与湿肺的X线诊断

目的：进一步明确新生儿肺炎和新生儿湿肺的X线表现以期提高诊断水平。资料与方法：收集我院2003—2006两年间住院病人中临床诊断明确的新生儿肺炎72例，湿肺28例X线胸片资料进行对比分析，复习有关文献，找出各自的X线表现特点。结果：新生儿肺炎72例表现为明显的肺气肿，肺纹理增多增粗和两肺内、中带夹杂有点状或斑片状阴影。湿肺28例表现为由肺门向外伸展呈放射状肺纹理改变，常为两侧对称性，肺野内显示广泛小片状浅淡密度增高影或局限性均匀分布的颗粒阴影。肺气肿情况不如前者显著。结论：仔细分析胸部X线表现结合病史，X线平片可以对新生儿肺炎和湿肺作出明确诊断。     

创伤性湿肺的X线、CT诊断

目的 :总结X线、CT胸部检查对创伤性湿肺的诊断价值。材料和方法 :分析临床证实的创伤性湿肺 2 6例 ,全部病例行胸部X线及CT检查。结果 :创伤性湿肺多出现伤侧或双侧中下肺野 ,表现为间质型 10例 ,节段实变型 4例 ,弥漫实变型 3例 ,云雾型 9例。对病变的显示CT明显优于X线检查。结论 :对临床疑为创伤性湿肺患者建议首选胸部CT检查 ,对确诊的患者行胸部X线监测     

胸部创伤的X线影像分析

患者因为胸部受到创伤经过X线检查，在X线片上因为受到创伤的性质、类别、程度和病变发展的不同所表现形态多种多样，而且相当复杂。我们经过多年的X线胸片及随访观察分析，归纳其X线表现形态以肺挫伤、湿肺、肺撕裂伤和肺血肿为主要类型，前两者与后两者多数以混合形式出现。     

恶性组织细胞病的肺部CT表现

探讨胸部CT对恶性组织细胞病肺部浸润的诊断价值。材料和方法：分析经骨髓和胸水细胞学证实的5例恶性组织细胞病的CT资料。结果：CT主要表现为多发、大小不等的结节以及片状、斑片状浸润，伴胸腔积液。结论：CT是检查恶性组织细胞病肺浸润的一种重要方法，典型征象为多发结节、多个结节互相融合。     

恶性组织细胞增生症的X线表现 (附26例分析)

目的探讨恶性组织细胞增生症的X线表现.方法收集并分析我院经骨髓、淋巴结穿刺或手术病理证实的26例恶性组织细胞增生症的X线资料.结果恶性组织细胞增生症的X线表现主要为肺间质性病变或渗出性病变,骨质破坏,骨质硬化,骨质增生或骨质疏松,肠壁结节样增厚和肠腔狭窄.结论恶性组织细胞增生症的X线表现虽然没有特异性,但是正确认识它对恶性组织细胞增生症的诊断是很有必要的.     

肝硬化伴肝肺综合征X线表现分析

目的：讨论肝硬化伴肝肺综合征Ｘ线表现,分析其中意义。方法：分析经临床诊断有完整资料的３１例肝硬化伴肝肺综合征Ｘ线胸片。结果：肝肺综合征中Ｘ线表现如中下肺外带类似“海绵状”间质性改变,斑点影与粟粒点影,具有一定特异性。结论：除临床症状与血气检测等外,Ｘ线表现对诊断肝肺综合征意义重大     

Langerhans cell histiocytosis: unusual skeletal manifestations observed in thirty-four cases

Objective. Unusual manifestations are occasionally encountered in Langerhans cell histiocytosis and may be a source of confusion. The objective of this study was to determine the frequency of occurrence of the unusual manifestations in our case material. Design and patients. Thirty-four children, average age 4.4 years (range 3 months to 16 years) with 262 skeletal lesions of biopsy-proven Langerhans cell histiocytosis (LCH) were retrospectively reviewed to determine the frequency of occurrence of unusual manifestations defined either as an atypical location of a skeletal lesion or an atypical radiographic appearance of the lesion. Results. Twenty-four unusual lesions were found in this retrospective review. Among these were epiphyseal lesions, transphyseal lesions, extracranial ’button’ sequestra, posterior vertebral arch lesions, dural extension of vertebral lesions, and fluid-fluid levels. The finding of fluid-fluid levels has not previously been described in the radiologic literature. Involvement of unusual sites included clavicles and small bones of the hands and feet. Conclusions. Radiographic, computed tomographic, and magnetic resonance imaging of LCH yield a variety of unusual manifestations. Recognition of these varied appearances of LCH may prevent confusion of such appearances with other pathologic processes. When the unusual manifestation occurs as the initial finding of the disease, LCH should be included in the differential diagnosis.     

Differential diagnosis of mediastinal tumor: malignant histiocytosis

On chest X-ray picture a mediastinal mass may be an indication for manifestation of malignant histiocytosis. The history of two own cases is detailed. More common radiological features are reticular or nodular opacities or other interstitial infiltrations, pleural effusions and circumscribed lymphnode enlargements.     

肺不张的少见X线表现

目的　探讨少见类型肺不张的X线征象。方法　回顾性分析了 48例胸部X线误诊的少见类型肺不张 ,男 17例 ,女 3 1例。所有病例均由CT或纤维支气管镜证实。结果　 48例少见类型肺不张中 ,两肺上叶不张 16例 ,右肺中叶不张 2例 ,两肺下叶不张 3 0例。引起不张的主要原因是支气管肺癌、支气管扩张和支气管内膜结核等。结论　熟悉肺不张的各种X线征象是减少误诊的关键     

Langerhans cell histiocytosis of bone.

Langerhans cell histiocytosis (LCH), previously called histiocytosis X, refers to a spectrum of disease characterized by idiopathic proliferation of histiocytes producing focal or systemic manifestations. Causes and pathogenesis remain unclear. However, recent studies suggest abnormal immune regulation as an important factor. The three classic syndromes may have considerable clinical overlap: eosinophilic granuloma, in which the disease is limited to bone in patients usually 5-15 years old; Hand-Schüller-Christian disease, characterized by multifocal bone lesions and extraskeletal involvement of the reticuloendothelial system (RES) usually seen in children 1-5 years old; and Letterer-Siwe disease, in which there is disseminated involvement of the RES with a fulminant clinical course in children less than 2 years old. Osseous involvement is typically in the flat bones, with lesions of the skull, pelvis, and ribs accounting for more than half of all lesions. About 30% of lesions are in long bones. Radiographic appearance of osseous LCH depends on site of involvement and phase of the disease. Early lesions appear aggressive with poorly defined margins and lamellated periosteal reaction. Late lesions appear well defined and may show sclerotic margins and expanded remodeled appearance.     

Malignant primary chest wall neoplasms: a pictorial review of imaging findings

Malignant primary chest wall neoplasms (MCWN) are uncommon. Although benign chest wall neoplasms are most commonly asymptomatic, MCWN typically manifest as painful, fast growing masses. While the imaging features of malignant masses can be nonspecific, knowledge of the typical radiologic manifestations of MCWN may suggest a specific diagnosis. We review imaging features of the most common MCWN with images collected at an outpatient academic oncologic center.ObjectiveWhile the imaging features of patients with malignant masses can be nonspecific, knowledge of the typical radiologic manifestations of MCWN may suggest a specific diagnosis. We review distinguishing imaging features of the most common MCWN, including epithelial and mesenchymal malignancies, with images collected at an outpatient oncologic center.ConclusionChest wall neoplasms encompass 5% of all thoracic tumors, with nearly half of chest wall neoplasms being malignant. Out of these malignant neoplasms, 50% are primary and the commonest one is chondrosarcoma. Although distinguishing imaging features may suggest a specific diagnosis in the majority of MCWN, most affected patients undergo biopsy for a definitive diagnosis.     

Nuclear medicine studies in evaluation of skeletal lesions in children with histiocytosis X

Radiographs were compared with 99mTc scans of the bones and bone marrow as well as 67Ga-citrate scans to evaluate their sensitivity in identifying skeletal lesions in 21 children with histiocytosis X. Seven of 20 bone scans were completely normal in patients with extensive radiographic evidence of skeletal disease. In only one patient were bone scan changes demonstrated prior to radiographic abnormalities. None of the lesions was "cold" on the bone scans. 99mTc-sulfur colloid bone marrow scans and 67Ga-citrate whole-body scans were not valuable. Radiographic survey of the skeleton should be the primary diagnostic test employed in patients with histiocytosis X who have suspected skeletal lesions. Bone scans should be obtained only when the radiographs are normal or equivocal.     

原发性胸壁肿瘤的影像学诊断(附35例分析)

目的探讨原发性胸壁肿瘤的影像学表现及其诊断价值. 资料与方法搜集原发性胸壁肿瘤病例35例,其中胸壁骨肿瘤11例,软组织肿瘤24例;良性25例,恶性10例.35例均摄有胸部正侧位片,17例行CT增强扫描,对全部病例影像学表现进行了回顾性分析. 结果胸壁肿瘤的影像学诊断步骤为(1)明确肿块是否来源于胸壁;(2)明确肿块来自于胸壁软组织抑或胸壁骨组织;(3)明确肿块是良性抑或恶性;(4)肿瘤组织学分类诊断.将该组疾病影像学表现分为Ⅵ型,分型对肿块的定位及定性诊断均有重要的临床价值. 结论综合分析X线与CT表现,不仅可对大多数胸壁肿瘤进行精确的定位及定性诊断,而且尚可对大部分胸壁脂肪瘤、神经源性肿瘤及血管瘤等作出组织学诊断.