尘肺与粟粒性肺转移瘤的CT鉴别特征

目的:探讨尘肺和粟粒性肺转移瘤的常规CT及高分辨CT(HRCT)特征,以提高肺内多发小结节的CT鉴别诊断。方法:回顾性分析44例尘肺和30例粟粒性肺转移瘤的CT资料,观察小结节的特点及其它并发征象。结果:尘肺组CT表现:①小结节特点:大小不均匀35例(79.55%)、密度不均匀40例(91.00%)、分布不均匀40例(90.91%),边界清晰38例(86.36%),结节钙化28例(63.64%);②其它伴发征象:团块28例(63.64%),肺气肿36例(81.82%),小叶间隔增厚36例(81.82%),磨玻璃密度12例(27.27%),胸膜增厚30例(68.18%)、其中叶间裂增厚20例(45.45%),肺门和纵隔淋巴结增大25例(56.82%)、钙化32例(72.73%)。粟粒性肺转移瘤组的CT表现:①小结节特点:大小不均匀18例(60%)、密度不均匀13例(43.30%)、分布不均匀16例(53.33%),边界清晰21例(70%),多发结节内空洞28例(93%);②其它伴发征象:小叶间隔增厚25例(83.33%),胸膜增厚16例(53.33%),肺门和纵隔淋巴结增大18例(60%)、钙化5例(16.67%)。结节密度、分布不均匀、结节钙化及肺气肿、叶间裂增厚、淋巴结钙化在尘肺的发生率高于粟粒性肺转移瘤(P0.05);多发结节小空洞在粟粒性肺转移瘤的发生率高于尘肺(P0.05)。结论:尘肺和粟粒性肺转移瘤的CT表现有一定特征;有助于对两者的鉴别诊断。     

HIV感染者和AIDS患者并发肺结核的CT表现

目的 探讨HIV感染者和艾滋病患者(HIV/AIDS)并发肺结核的CT表现特征.方法回顾性分析48例HIV/AIDS并发肺结核的CT表现.结果 HIV/AIDS患者肺结核的CT表现为:继发型肺结核19例(39.6%),病变形态以斑片状阴影为主,10例可见融合成大片的实变影;血行播散型肺结核17例(35.4%),其中急性粟粒型肺结核7例,表现为大小、分布均匀的粟粒影,而亚急性血行播散型10例,表现为大小、分布不均匀的粟粒、小结节影;多种征象混合表现10例(20.8%),表现为双肺斑片状渗出病灶与弥漫分布的粟粒、小结节灶相混杂.纵隔淋巴结肿大36例(75.0%),胸腔积液13例(27.1%),心包积液10例(20.8%).结论 HIV/AIDS并发肺结核的CT特征为局灶性肺实质病变较少而弥漫性的病变较多.     

艾滋病并发粟粒型肺结核的CT表现

目的：探讨艾滋病并发粟粒型肺结核的CT影像表现及临床特点,以提高肺部弥漫性粟粒性病变的临床影像诊断水平。方法：回顾性分析本院临床确诊的9例艾滋病并发粟粒型肺结核和42例单纯粟粒型肺结核的CT影像检查及临床相关资料,观察肺粟粒结节的大小、分布、密度、磨玻璃影、结节边缘征象等,以及观察纵隔淋巴结肿大、胸腔、心包积液的程度。结果：9例艾滋病伴粟粒型肺结核结节大小一致3例,分布均匀4例,密度均匀2例,磨玻璃影8例,结节边缘模糊6例,合并有纵隔淋巴结肿大6例,胸腔积液7例,心包积液5例,肺外结核6例。42例单纯粟粒型肺结核中,结节大小一致32例（76%）,结节分布均匀37例（80%）,密度均匀33例（78%）,磨玻璃影3例（7%）,结节边缘模糊8例（17%）,合并有纵隔淋巴结肿大12例（28%）,胸腔、心包积液11例（23%）。结论：艾滋病伴粟粒型肺结核与单纯粟粒型肺结核在结节分布、大小和密度、结节边缘征像以及合并纵隔淋巴结肿大、浆膜腔积液、肺外结核等方面差异有显著性意义（P〈0.05）。了解其相关临床影像表现特征有利于艾滋病并发肺结核的早期诊断和治疗。     

肺内多发小结节的CT诊断与鉴别诊断

目的：探讨肺内多发小结节的cT特征，提高cT诊断的准确性。方法：回顾性分析经病理或临床证实的53例肺内多发小结节患者的CT分布特征，其中血行性肺转移瘤15例，粟粒性肺结核8例，癌性淋巴管炎10例，矽肺3例，肺结核支气管播散10例，细支气管肺泡癌7例。结果：血行性肺转移瘤、粟粒性肺结核、细支气管肺泡癌小结节呈随机分布；癌性淋巴管炎、矽肺小结节沿淋巴管周围分布；肺结核支气管播散呈小叶中心分布。结论：CT对肺内多发小结节具有较大的诊断价值。     

AIDS合并粟粒型肺结核的HRCT表现与CD4~+T细胞相关性分析

目的:探讨艾滋病(AIDS)合并粟粒型肺结核的高分辨CT(HRCT)表现与CD4+T细胞水平的关系。方法:对20例经临床证实的AIDS合并粟粒型肺结核的HRCT表现,临床资料以及CD4+T淋巴细胞水平进行回顾性分析,分组资料采用行×列表的χ2检验,P<0.05为差异有统计学意义。结果:粟粒结节影两侧肺野分布11例,一侧肺野分布3例,单侧肺野的某一局部分布6例;分布均匀3例,分布不均17例;大小均匀一致4例,大小不等16例;密度均匀4例,密度不均16例。合并其他影像表现有磨玻璃影7例,肺实变3例,肺门和纵隔淋巴结肿大8例,胸腔积液6例,心包积液2例。粟粒型肺结核分布、大小和密度与CD4+T细胞计数的关系:粟粒型肺结核的发生和分布范围随着CD4+T细胞计数的减少,其发生的可能性越大、累及的范围也越广泛(P<0.05);粟粒结节影的分布、大小和密度随着CD4+T细胞计数下降而表现出明显的不均匀性(P均<0.01)。结论:HRCT能很好地显示AIDS合并粟粒型肺结核的分布、大小、密度等影像特点。CD4+T淋巴细胞水平越低,粟粒型肺结核发生的可能性越大,其分布、大小和密度越不均匀。     

肺结核结节性病灶不同传播方式的HRCT表现

<正>结核结节(结核瘤)在HRCT上表现为大小不等的结节灶,这些病灶可以是血行播散而来,也可以是支气管播散所致。常规X线胸片对这些结节灶播散来源的鉴别,主要依据其在肺野内的大致分布规律。双肺对称性分布,且为大小均匀的粟粒样病灶(即所谓三均匀)被认为是血行播散性[1];局灶性     

不典型肺结节的螺旋CT与临床病理诊断的对比分析

目的: 探讨螺旋CT在不典型肺结节诊断中的应用价值.材料和方法: 回顾性分析36例经手术(33例)、穿刺(7例)确诊为不典型肺结节的CT图像和临床病理学资料.结果: CT表现: 浅分叶征(17/36)、形态不规则(25/36)、长毛刺征(5/36)、空气支气管征(1/36)、空泡征(1/36)、部分非实性结节(3/36)和实性结节(33/36).螺旋CT拟诊肺癌19例、肺结核瘤11例和肺炎性假瘤6例.病理证实: 肺癌15例(腺癌8例、鳞癌4例、肺泡癌2例和类癌1例)、肺结核瘤15例和肺炎性假瘤6例.诊断符合率: 肺癌为10/15、肺结核瘤为9/15和肺炎性假瘤为1/6.结论: 螺旋CT对不典型肺结节的定性诊断较局限,常需穿刺活检或手术病理确诊.但其对不典型肺内结节具有很好的定位、密度分辨、形态描述和复查对比价值.     

多层螺旋CT检查肺结核与矽肺的临床价值分析

目的探讨肺结核与矽肺患者的CT鉴别诊断。方法回顾性分析临床确诊的肺结核患者37例,矽肺患者35例,均行64排螺旋CT平扫及高分辨率CT(HRCT),分析其影像表现,运用统计学方法进行鉴别诊断。结果肺结核组:37例患者,结节分布双肺上叶及下叶背段29例(78.3%),结节全肺分布11例(29.7%),结节边缘模糊29例(78.4%),纤维斑块12例(32.4%),纤维空洞10例(27.0%),胸膜肥厚36例(97.3%),胸腔积液14例(37.8%),胸膜钙化4例(10.8%),纵隔肺门淋巴结肿大27例(73.0%),纵隔肺门淋巴结钙化10例(27.0%)。结核结节大小约(2.27±0.34)mm。结核纤维灶密度约(35.6±8.4)HU。矽肺组:35例患者,结节分布双肺上叶及下叶背段32例(91.4%),结节全肺分布5例(14.2%),结节边缘模3例(8.5%),纤维斑块15例(42.9%),纤维空洞2例(5.7%),胸膜肥厚25例(71.4%)胸腔积液2例(5.7%),胸膜钙化14例(40.0%%),纵隔肺门淋巴结肿大15例(42.9%),纵隔肺门淋巴结钙化14例(40.0%)。矽肺结节大小约(3.17±0.63)mm。矽肺纤维灶密度约(54.11±1.0)HU。结论矽肺与结核在常规螺旋CT及HRCT上各有异同点,能够为两者鉴别诊断提供非常有价值的信息。     

系统性红斑狼疮相关性肺结核的CT诊断

目的:初步评价肺结核在系统性红斑狼疮中的CT表现特点及CT诊断价值.材料和方法:回顾性分析557例系统性红斑狼疮病人(均有激素治疗史),合并活动性肺结核31例,行肺部CT扫描,结合临床资料分析肺结核的CT表现.结果:肺结核在系统性红斑狼疮中的发病率为5.6%.其中粟粒性肺结核9例(29.0%),肺门和纵隔淋巴结肿大11例(35.5%),结核性胸腔积液7例(22.6%),空洞伴两肺气道播散3例(9.7%),两上肺索条状、结节状浸润灶5例(16.1%),两肺弥漫实变灶、磨玻璃影2例(6.5%).结论:系统性红斑狼疮相关性肺结核的发病率高,CT上以粟粒性肺结核、淋巴结肿大和胸腔积液表现为主,反映了机体对结核杆菌的免疫低下.     

40例小细胞肺癌的螺旋CT表现

目的:分析40例肺小细胞肺癌的螺旋CT表现,以提高对该病的认识.方法:收集有CT和临床资料并经病理证实的SCLC 40例,回顾性总结分析CT影像特征.结果:中央型肺癌33例,CT表现为肺门分叶状结节或肿块,伴阻塞性肺炎12例(36.4%),阻塞性肺不张7例(21.2%),30例(90.1%)伴有纵隔淋巴结肿大,8例行CT增强,肿块和淋巴结均匀轻度强化.周围型SCLC 7例,密度均匀,均呈分叶状,CT无特征性表现.结论:小细胞肺癌CT主要征象以肺门区实性肿块为主,多伴有肺门、纵隔淋巴结转移,支气管阻塞征象出现较晚.     

Pulmonary tuberculosis: CT and pathologic correlation

Typical CT findings of active postprimary pulmonary tuberculosis include centrilobular nodules and branching linear structures (tree-in-bud appearance), lobular consolidation, cavitation, and bronchial wall thickening. The CT findings of inactive pulmonary tuberculosis include calcified nodules or consolidation, irregular linear opacity, parenchymal bands, and pericicatricial emphysema. The typical appearance of primary tuberculosis on CT scans is homogeneous, dense, well-defined segmental or lobar consolidation with enlargement of lymph nodes in the hilum or the mediastinum. Miliary nodules may be seen in primary and postprimary tuberculosis. On CT, tuberculomas appear as a nodule with surrounding satellite nodules and internal cavitation on CT. Atypical radiologic manifestations of tuberculosis, encountered in as many as one third of the cases of adult-onset tuberculosis, are single or multiple nodules or masses, basilar infiltrates, miliary tuberculosis with diffuse bilateral areas of ground-glass opacity, and reversible multiple cysts. Underlying histopathologic findings of typical and atypical CT findings of tuberculosis are caseating granulomas or pneumonia in the active phase and fibrosis and dystrophic calcification in the inactive phase.     

螺旋CT及三维重组技术在肺结核中的诊断价值

目的探讨螺旋CT及各种三维重组技术在肺结核诊断中的价值。方法回顾性分析经病理和临床证实的肺结核病例145例,全部病例行螺旋CT扫描,针对不同病例行CTVE、MPR及CPR等不同类型三维重组。结果螺旋CT(尤其是HRCT)能够显示小叶中心结节、树芽征、结核空洞、干酪肺炎、粟粒结节、支气管播散、支气管结核、淋巴结肿大和钙化等肺结核的不同表现。螺旋CT诊断正确率为96.6%,结合各种三维重组方式后,诊断正确率99.31%。结论螺旋CT结合各种三维重组法能够对肺结核做出准确诊断。     

HRCT in miliary lung disease.

PURPOSE: To analyze high resolution CT (HRCT) features of a miliary pattern in different diseases. MATERIAL AND METHODS: Eight HRCT studies with a miliary lung pattern were retrospectively reviewed with the diagnoses tuberculosis (n=3), Candida albicans (n=1), sarcoidosis (n=3), and metastatic adenocarcinoma (n=1). RESULTS: In all cases, HRCT showed diffusely disseminated nodules up to 3 mm. In 2 cases of tuberculosis and 1 of sarcoidosis, the lesions predominated in the upper/middle lung zones. In the case of metastatic adenocarcinoma the nodules were more sparse in the lung periphery while in 1 case of sarcoidosis, HRCT revealed a predominance of the lesions in the outer third of the lungs. Cyst-like lesions of 12 mm were observed in 2/3 cases of tuberculosis and in metastatic adenocarcinoma. Notably thickened interlobular septa and interlobar fissures were each seen in 2/3 cases of sarcoidosis. In general, a random relationship of miliary nodules to secondary lobular structures and bronchovascular bundles was observed, despite the co-existence of centrilobular, subpleural and paraseptal nodules. CONCLUSION: HRCT features that potentially contribute in making a differential diagnosis are: a) A peripheral distribution of nodules, an increased number of thickened interlobular septae, and a notable thickening of interlobar fissures, all of which are indicative of sarcoidosis; and b) Multiple cyst-like lesions which should direct attention to tuberculous or metastatic origin. The predominance of miliary nodules in relation to cephalocaudal axis, their margin and size are not helpful features to the differential diagnosis of diseases presenting a miliary pattern.     

Miliary brain metastases from adenocarcinoma of the lung: MR imaging findings with clinical and post-mortem histopathologic correlation

Introduction Miliary dissemination is a rare form of brain metastasis. The clinical and pathologic features of this form are unclear. Methods We report a 66-year-old man with miliary brain metastases from adenocarcinoma of the lung, describing MRI and neuropathologic findings in the context of previously reported cases. Results Initial disorientation progressed to an apallic state within 6 months. Although, CT with administration of contrast agent failed to demonstrate any lesions, MRI with Gd-DTPA administration showed multiple enhancing miliary nodules in the cerebral cortex, basal ganglia, thalamus, cerebellum, and brainstem. Some of those nodules also could be seen on T2-weighted imaging without Gd-DTPA, but were difficult to identify conclusively. A histopathologic examination at autopsy disclosed diffusely distributed miliary tumor nodules in a perivascular distribution without surrounding focal edema or reactive gliosis. Notably, this patient with miliary brain metastases developed disorientation followed by unconsciousness, which overshadowed other focal neurologic signs at that time. Conclusion We should consider this pattern of brain dissemination when a cancer is associated with unexplained disturbance of consciousness.     

Miliary hepatic tuberculosis not associated with splenic or lung involvement. A case report

Miliary hepatic involvement is a frequent finding on autopsy in patients with disseminated tuberculosis. Imaging studies may reveal hepatosplenomegaly and/or parenchymal inhomogeneity and, in a minority of cases, focal lesions, invariably associated with miliary lung disease. An unusual case of disseminated tuberculosis with manifestations of miliary hepatic involvement, abdominal and neck lymphadenopathy on US and CT without any evidence of active disease in the lungs, spleen or other organ, is described.     

肺继发性淋巴瘤的CT多样性

目的：探讨肺继发性淋巴瘤的CT表现特征，以提高诊断正确率。材料和方法：回顾性分析临床或病理证实的26例肺继发淋巴瘤的CT征象，其中15例为非霍奇金淋巴瘤（NHL），11例为霍奇金病（HD）。本研究采用GE Hispeed CT／i，10例平扫，16例直接增强扫描。结果：CT表现多样：肺内毛玻璃样影（NHL 13vs HD6）；单发或多发肿块结节及肿块样实变（NHL 10vs HD8），其中仅HD组肿块中有4例病灶密度不均匀，5例见毛玻璃样晕症；黍粒样结节（NHL1）；支气管血管束增粗（NHL 1vs HD1）；肺门纵隔淋巴结肿大（NHL 9vs HD8）；胸膜侵犯（NHL 5vs HD2）；心包累及（NHL 2vs HD1）；常为多个征象合并出现（NHL 12vs HD5）。可分为以下四个类型：肺炎肺泡型（NHL 3vs HD1），肿块（结节）型（NHL 2vs HD2），黍粒型（NHL1），混合型（NHL 12vs HD5）。结论：多样性为肺继发性淋巴瘤的特点，不均匀的肿块或伴有病灶周围的毛玻璃样晕症多见于HD，对诊断可能有帮助。