吸烟与小气道病变CT表现

吸烟的肺部表现为微小结节、磨玻璃密度影象、肺气肿及呼吸性细支气管炎、支气管扩张、支气管壁增厚和支气管内粘液栓。肺内微小结节也可见于结节病，硬皮病，癌性淋巴管炎。小叶中心磨玻璃影象可见于感染性经支气管或血行播散病变、过敏性肺泡炎及剥脱性间质性肺炎。     

粟粒型肺结核和粟粒性肺转移瘤的螺旋CT鉴别特征

目的探讨粟粒型肺结核和粟粒性肺转移瘤的螺旋CT表现特征,以提高肺部弥漫性粟粒性病变的影像诊断水平。方法收集经临床证实的34例粟粒型肺结核和54例粟粒性肺转移瘤的螺旋CT资料,观察肺粟粒结节的分布、大小,肺密度,肺门、纵隔淋巴结增大及肺内并发病灶。结果CT图像上,34例粟粒型肺结核中,结节均匀分布28例(28/34,82%),大小一致23例(23/34,68%),密度均匀25例(25/34,74%)以及毛玻璃征26例(26/34,76%)。54例粟粒性肺转移瘤的粟粒结节分布、大小、密度大多不均匀,分别为49例(49/54,91%),39例(39/54,72%),41例(41/54,76%),毛玻璃征(GGO)8例(8/54,15%)。两者在结节分布、大小、密度均匀性和伴毛玻璃征方面均有统计学差异(P<0.05)。肺内其它改变:9例(9/34,26%)结核的肺门和纵隔淋巴结增大,而肺转移瘤有29例(29/54,54%);结核性胸腔积液15例(15/34,44%),肺转移瘤30例(30/54,56%);心包积液中,结核8例(8/34,24%),肺转移瘤20例(20/54,37%)。结论血行播散型肺结核和粟粒性肺转移瘤在结节分布、大小和密度等方面螺旋CT表现特征明显不同,这些特征与它们的血行播散途径和相应的病理解剖改变有密切关系。     

青年细支气管肺泡癌X线平片及CT表现分析

目的:研究青年细支气管肺泡癌的胸片与CT表现特征性和病理学发生基础及临床特点,提高对该病诊断认识水平。方法:回顾性对比分析24例。经纤支镜,穿刺活检,手术病理证实的细支气管肺泡癌的胸片及CT表现以及转移灶的特征表现,探讨各型病变的影像学特征。结果:根据大体病理及相对影像上病变形态和分布特点,可将细支气管肺泡癌分为孤立结节型5例占21%,多发结节型11例占46%,弥漫型8例占33%。其中孤立结节型相对特异型征象较多,如分叶征,支气管充气征,胸膜凹陷征;多发结节型;胸片表现为两肺中下叶棉球样征象,但CT显示为两肺弥漫多发结节状,碎路石征象,常伴有胸膜牵拉等征象;弥漫粟粒型:两肺中下叶呈粟粒样改变,部分病例有融合,实变现象,临床上易误诊为粟粒型肺结核,转移瘤或肺炎等疾病。另外,细支气管肺泡癌骨骼转移灶呈浸润性破坏,分布较广,以肋骨和锁骨侵犯为多见。结论:细支气管肺泡癌的影像表现复杂多样,对各型的征象表现进行深入细致地分析,结合临床特点,可提高对本病的诊断符合率。     

急性血行播散型肺结核X线平片诊断体会

急性血行播散性肺结核在临床较为常见，X线平片诊断中经常与肺部一些弥散性病变相混淆。本文报告28例，讨论了急性血行播散性肺结核的主要表现，以及与矽肺、栗粒型肺血行性转移癌、肺泡微石症、栗粒性肺炎等肺部弥漫病变X线平片的鉴别要点.     

弥漫型细支气管肺泡癌的CT诊断

目的：探讨弥漫型细支气管肺泡癌的CT诊断要点，以减少误诊。材料和方法：回顾性分析23例病理证实的弥漫型细支气管肺泡癌的CT影像，其中13例首次CT误诊，分别为炎症7例、结核3例、转移瘤3例。结果：CT表现可分为多发结节型5例、肿块型2例及肺炎样型16例。其中仅2例典型叶段分布者，3例叶段实变为主及4例蜂房样者提出了弥漫型肺泡癌的诊断，弥漫结节型、肿块型及散在斑片影均未能有效提示诊断。结论：弥漫型肺泡癌表现类型多样，典型叶段分布的多发结节、有血管造影征和支气管充气征的单／多叶段实变、蜂房状浅淡密度等较有特征性，可提示诊断。     

细支气管肺泡癌的影像诊断

目的探讨细支气管肺泡癌（BAC）影像表现。方法收集我院10例经手术、CT引导下肺穿病理证实的细支气管肺泡癌的临床、胸片、CT及病理资料，并进行分析。结果多发结节型3例；弥漫结节型3例；炎症型2例；混合型2例。10例BAC中3例合并胸水。动态观察：多发结节型1例1年变化不显著，两个月后病变有所增大；2例在3个月内病灶有轻度增大。弥漫结节型1个月内病变有较明显进展。炎症型动态观察见病灶出现实变，空气支气管征可消失。误诊情况：误诊为肺炎1例、粟粒结核1例，尘肺1例，未能作出明确诊断1例。结论细支气管肺泡癌影像表现复杂，需结合多种影像检查结果，动态观察，综合分析，有利于对此病作出正确诊断，也利于肺部其它弥漫性病变的鉴别。     

肺内多发小结节的高分辨率CT鉴别诊断

肺内小结节是指直径在 1ｃｍ以下的结节病变[1] 。两肺多发小结节在肺内可呈弥漫性或为局限性分布 ,此种征象见于多种疾病。高分辨率ＣＴ(ＨＲＣＴ)是鉴别诊断的重要方法。可发生肺内多发小结节的疾病以肺转移瘤、肺结核、结节病、尘肺等较多见 ,是鉴别诊断的重点。其他原因的肺内多发小结节的疾病还见于细支气管及肺泡的多种感染及非感染疾病。对于肺内多发小结节进行ＨＲＣＴ鉴别诊断需首先认识单个小结节的形态特点 ,并需明确各个小结节与肺小叶结构的关系。在此基础上得出肺内多发小结节的分布规律 ,再结合其他ＣＴ表现和临床检查进一步…     

浅谈肺内多发小结节病变的HRCT诊断

多种疾病在肺部CT片上表现为多发小结节，其中直径小于10mm的称小结节，一般将小于7mm的结节称微小结节，小于3mm的称粟粒结节，两肺多发小结节在肺内可弥漫分布，或为局限性，HRCT是鉴别诊断的重要方法。目前一般将肺内多发小结节大致分为3类：血源性结节、淋巴管周围分布结节和小叶中心分布结节，而不同的疾病分属于不     

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。     

肺部HRCT应用及影像分析

高分辨力CT(HRCT)采用薄层横断扫描能获得比普通层厚扫描具有更高清晰度和层次的图像。本文收集了1995年-2002年间肺部病变HRCT肺部检查83例。其中支气管扩张症32例；周围型肺癌12例；癌性淋巴管炎共3例；肺间质性肺炎5例；肺急性、亚急性血行播散行性肺结核6例；肺气肿12例；结核瘤6例；炎性假瘤7例。就其应用诊断作一介绍。     

青年肺癌的CT表现与误诊探讨

目的探讨青年肺癌CT表现及误诊分析。方法回顾分析33例病理确诊的40岁以下原发性支气管肺癌的CT表现及临床资料。结果CT表现为肿块13例、结节8例、肺叶实变7例,支气管腔内结节并肺叶不张3例,支气管壁增厚管腔狭窄并阻塞性肺炎,空洞、多中心各1例。8例胸腔积液或合并胸膜结节,7例双肺结节,6例淋巴结肿大,2例骨性胸廓骨质破坏,4例肿瘤直接侵犯纵隔或/和纵隔内血管,胸部转移率为81.8%。初诊时误诊为肺炎6例,结核15例,误诊率63.6%。结论青年肺癌CT主要表现为肿块、结节、肺叶实变,大多数确诊时已为晚期,易误诊为肺结核,误诊率高。     

CT of pulmonary dirofilariasis--differential diagnosis from lung cancer]

We present here four cases of pulmonary dirofilariasis in which histological examination of the surgical specimen showed occlusion of the peripheral pulmonary artery by filariae and formation of a necrotic mass surrounded by reactive inflammation and hemorrhage. Radiological examination showed a solitary pulmonary nodule in three cases and a wedge-shaped consolidation in one case. Although pulmonary nodules in dirofilariasis closely mimic bronchogenic carcinoma on radiographs , it is possible to distinguish them from bronchogenic carcinoma on the basis of the following findings: (1) coexistence of subtle satellite lesions, (2) absence of pleural involvement, (3) fine marginal speculations, and (4) lack of concentric marginal speculations (eccentric speculation). In each case of dirofilariasis, CT showed the peripheral pulmonary artery entering the mass. This finding differentiates this disease from metastatic lung tumor, because in tumor metastasis via the pulmonary arteries, visible vessels are not usually involved.     

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。     

High-resolution CT findings of diffuse bronchioloalveolar carcinoma in 38 patients

OBJECTIVE: The purpose of this study was to analyze the high-resolution CT features of diffuse bronchioloalveolar carcinoma and determine the useful findings in differential diagnosis. MATERIALS AND METHODS: High-resolution CT scans of 38 patients with pathologically proven diffuse bronchioloalveolar carcinoma were reviewed. Sequential CT scans were obtained in 15 patients. The high-resolution CT findings were compared with those of eosinophilic pneumonia (n = 22), multiple pulmonary metastases (n = 12), and tuberculosis (bronchogenic: n = 22; miliary: n = 12). RESULTS: High-resolution CT findings of diffuse bronchioloalveolar carcinoma included ground-glass opacity (n = 29), consolidation (n = 29), nodules (n = 28), centrilobular nodules (n = 26), peripheral distribution (n = 19), and air bronchogram (n = 18). According to the major features, high-resolution CT findings of diffuse bronchioloalveolar carcinoma could be classified into three patterns: predominantly ground-glass (n = 4), consolidative (n = 22), and multinodular (n = 12). Most patients with diffuse bronchioloalveolar carcinoma had a mixture of these findings. The frequency of findings of diffuse bronchioloalveolar carcinoma on high-resolution CT was not different from that of tuberculosis, but the predominant distribution of the nodules and areas of ground-glass attenuation differed between the two. Difference in distribution between bronchioloalveolar carcinoma and bronchogenic tuberculosis included ground-glass opacity remote from the consolidation and a lower lung predominance. CONCLUSION: Although these high-resolution CT findings are not specific, the combination of consolidation and nodules and the coexistence of centrilobular nodules and remote areas of ground-glass attenuation are characteristic of diffuse bronchioloalveolar carcinoma.     

肺结节少见CT征象对病变的诊断价值

目的探讨肺结节的少见CT征象,提高周围型肺癌的诊断正确率。方法回顾分析经手术病理或临床治疗证实的186例肺内结节(139例周围型肺癌和47例其它肺内结节)的少见CT征象(多囊状透亮影、肿瘤胸膜侧的模糊小片状影、磨玻璃影)在肺癌和其它结节中的出现率。结果多囊状透亮影和肿瘤胸膜侧模糊小片状影在肺癌中出现率明显高于肺内其它结节(P<0.05)。磨玻璃影在肺癌和其它结节的出现率无显著差异。在肺癌中,磨玻璃影在细支气管肺泡癌中的出现率明显高于其它类型肺癌(P<0.001)。结论多囊状透亮影和肿瘤胸膜侧模糊小片状影对肺癌的诊断有较高价值,肺癌中磨玻璃影的出现常提示细支气管肺泡癌的可能。     

MSCT增强扫描方式的优化对肺孤立小结节的诊断价值

目的:探讨MSCT肺部3期增强扫描方式对肺部孤立性小结节(SPN)的诊断价值。方法:收集30例应用改进的增强扫描方式(即3期扫描)检查的SPN患者的影像资料。3期扫描包括动脉期30 s,静脉期60 s,平衡期120 s,分析SPN的强化程度及增强方式,并绘制时间-密度曲线。结果:通过曲线首尾两点做直线,对照发现,代表慢性炎症的直线斜率要大于代表肺癌的直线斜率。肺癌和慢性炎症通过肺3期增强扫描,CT值增长幅度较大,肺癌增强扫描后最大增长值平均为25 HU,且一般会均匀强化,慢性炎症为35 HU,且一般为周边强化明显;结核增长幅度不大,平均为10.9 HU,且一般中央不强化。结论:通过3期增强扫描,结核比较容易区分,而肺癌和慢性炎症因为增长幅度都较大,增强CT值之间有交叉,所以通过时间-密度曲线首尾两点做直线,其斜率可对慢性炎症和肺癌进行鉴别诊断。     

经肺动脉灌注碘油对肺转移瘤的血供研究

目的 通过肺动脉灌注少量碘油研究肺动脉与肺转移瘤的血供关系.方法 10例肺转移瘤患者,其中原发灶为肝癌5例、肾癌3例、脊索瘤1例和恶性神经纤维瘤1例.胸部CT平扫排除钙化;肺动脉插管造影观察有无肿瘤血管和染色.超选到转移瘤所在肺叶动脉造影排除肺动静脉瘘及其他异常交通循环,确定管头位置后严格透视下释放少量碘油,肺叶动脉用量0.5～1.5 ml,总量不超过3 ml.随即送至CT室平扫,观察碘油沉积情况.结果 除2例患者肺动脉注入碘油后出现胸闷咳嗽外,余均无不适症状.共观察27个转移灶,全部病例未见肺动脉增粗或肺动脉肿瘤染色征象,6个结节内碘油积聚呈云雾样,5个肿块内碘油积聚呈散在细小砂粒样,另有16个结节无明显碘油积聚.结论 肺动脉部分参与肺转移瘤的供血,对于肺野外带转移灶其供血比例较高;经肺动脉灌注少量碘油是安全的,肺野的密度升高在一段时间后可以恢复正常.     

Pulmonary nodules and masses in lung transplant recipients: clinical and CT findings

Objectives

The purpose of this study was to review the clinical and CT findings of pulmonary nodules and masses in lung transplant recipients and to determine distinguishing features among the various aetiologies.

Methods

This retrospective study included 106 lung transplant recipients who had a chest CT performed over a 7-year period in a single institution.

Results

Twenty-four cases of pulmonary nodules and masses were observed on CT. Among the single lesions, three (50 %) were due to infections, one (17 %) to organizing pneumonia, and two (33 %) remained of undetermined origin. Among the multiple lesions, 14 (78 %) were due to infection, three to post-transplant lymphoproliferative disorder (17 %), and one to bronchogenic carcinoma (5 %). The two main microorganisms were P. aeruginosa and Aspergillus spp. Among 12 solid nodules >?1 cm, four (33 %) were due to malignancy: three post-transplant lymphoproliferative disorders (25 %), and one bronchogenic carcinoma (8 %). Among five cavitary nodules four (80 %) were due to aspergillosis.

Conclusion

Infection is the most frequent aetiology of pulmonary nodules and masses in lung transplant recipients, but other causes such as post-transplant lymphoproliferative disorder, bronchogenic carcinoma, or organizing pneumonia should be considered.

Key points

? Pulmonary nodules and masses are frequent in lung transplant recipients. ? Infection is the most frequent aetiology of solitary and multiple pulmonary nodules. ? Differential diagnosis includes post-transplant lymphoproliferative disorder, bronchogenic carcinoma, and organizing pneumonia. ? Clinical and CT findings are often non-specific. ? CT findings may be suggestive of some aetiologies that justify a biopsy.     

中央型小细胞肺癌的CT诊断及鉴别诊断

目的:探讨中央型小细胞肺癌(Small Cell Lung Cancer,SCLC)的CT表现特点,并找出与非小细胞肺癌(NSCLC)、肺结核、结节病、纵隔淋巴瘤的鉴别诊断要点。方法:回顾性分析经病理证实的57例中央型SCLC、60例NSCLC,5例肺结核,2例结节病,3例纵隔淋巴病的胸部平片及CT资料,全部病例均行胸部平片和CT平扫、增强检查。结果:57例中央型SCLC,CT主要表现为沿支气管长轴生长的肺内肿块,肺门与纵隔广泛淋巴结肿大,而肺不张相对少见。NSCLC60例主要表现为肺门肿块,支气管阻塞性改变相对多见。5例肺结核表现为肺内结节和肺门、纵隔淋巴结肿大,伴有同侧和/或对侧肺内结核病灶。2例结节病,表现为双侧肺门对称性淋巴结肿大。3例纵隔淋巴病表现为中前纵隔的弥漫性软组织肿块。结论:沿支气管长轴生长的肺内肿块、肺门及纵隔淋巴结肿大。支气管阻塞改变少见,随访1～2个月,肿块体积增大1倍以上,是中央型SCLC的CT诊断要点,据此特征诊断正确率达80％。结合临床与其他检查方法可与NSCLC、肺结核、结节病、纵隔淋巴瘤鉴别。     

Pulmonary infarction associated with bronchogenic carcinoma

Pulmonary infarction may be associated with bronchogenic carcinoma. Radiopathological correlation was performed in four patients. There were two cases of squamous cell carcinoma, one case of adenocarcinoma and one case of large cell carcinoma. Infarcts in patients with squamous cell carcinoma were obscured on plain radiographs by a large primary tumor or atelectasis of the affected lobe. Infarcts in adenocarcinoma and large cell carcinoma were clearly demonstrated on plain radiographs; 1 to 2 cm in size, round or polygonal in shape, blurred in margin, and located at the periphery of the same lobe as the primary tumor. Rapid appearance of infarcts was helpful in distinguishing from intrapulmonary metastasis. Invasion of the pulmonary artery, pulmonary vein and bronchial wall in hilar region was thought to be responsible for pulmonary infarction. Pulmonary infarct should be considered in patients with centrally invasive bronchogenic carcinoma, when a small ill-defined opacity appears at the periphery of the involved lobe over a short period.