100例老年肺结核X线平片分析

目的:为了提高对老年肺结核X线表现的认识,以便与其它肺部疾病鉴别诊断。材料和方法:从2986例肺结核胸片中随机抽取100例老年肺结核胸片进行回顾性分析并确定其类型,观察病灶的范围与性质。结果:浸润型58例,血行播散型31例,慢性纤维空洞型8例。病灶范围以双肺发病多见,占74％,单肺发病占26％,病灶范围广泛者占65％。病灶性质以渗出为主占37％,干酪坏死为主占26％。粟粒结节占31％,空洞形成占46％,支气管播散灶占32％。结论:①老年肺结核浸润型多见,血行播散型次之;②多双肺发病,病灶范围广泛;③病灶性质以渗出及干酷样坏死为主,容易形成空洞及支气管播散。     

小儿肺结核X线征象分析

目的：探讨X线检查在小儿肺结核病的普查和诊断价值。资料与方法：对40例已确诊为肺结核儿童患者的X线表现及其某些病例初诊误诊的教训进行分析。结果：X线表现有如下特点：(1)肺门及气管旁淋巴结肿大28例(70％)；病灶边缘模糊30例(75％)；病灶周围炎12例(30％)(右侧8例，左侧4例)；横膈抬高6例(15％)；肺不张8例(20％)；空洞8例(20％)；胸廓不对称1例(2．5％)。结论：评价小儿肺结核X线表现在诊断中的作用，以提高对小儿肺结核X线表现的进一步认识。     

老年肺结核的X线、CT征象（附260例分析）

目的了解老年肺结核的影像特征,进一步提高诊断准确率。方法260例临床及病理证实的老年性肺结核患者均经胸部x线平片检查,其中157例经CT平扫,对所有患者X线、CT表现进行了回顾性分析,对X线与CT诊断肺结核的能力进行了比较,以及观察分析病变的部位、范围、形态、类型。结果本组260例肺结核中,X线平片正确诊断191例（73.5％）,漏诊及不能确诊69例（26.5％）。老年性肺结核的主要X线征象：空洞及纤维性空洞性病变175例,增殖性病变142例,纤维病变及钙化81例,渗出性病变52例。CT正确诊断146例（93％）,漏误诊11例（7％）。肺结核主要CT表现：纤维空洞性病变,片状渗出性病变,增殖性病变,纤维及钙化,淋巴结增大,结核球。本组X线漏诊69例,后经CT明确诊断。被CT漏诊的2例由X线胸片明确诊断。结论CT对老年肺结核的诊断准确率明显高于x线平片。老年肺结核具有临床症状不典型,影像表现多样,典型征象少,病变部位不固定等特点,只有综合分析才能做出正确的诊断。     

老年肺结核X线表现（附50例分析）

自 198 9年 3月～ 1996年 12月 ,我们共搜集了 6 0岁以上的老年肺结核 5 0例 ,以分析老年肺结核的Ｘ线表现。1　方法　　 5 0例中男 35例 ,女 15例。≥ 6 0～ 6 5岁 2 5例 ,>6 5～70岁 13例 ,>70岁以上 12例。诊断依据 :(1)肺内发现病变 ,痰菌阳性者 ;(2 )痰菌阴性 ,经抗痨治疗Ｘ线复查有吸收好转者。凡具备以上二者之一 ,系认为肺结核。2　结果　　经过综合分析 ,老年肺结核主要以浸润型肺结核为主 ,病理改变主要表现为增殖性病变及干酪性病变 ,同时伴有空洞和并发症较多。表 1　 5 0例老年肺结核占肺结核分类的百分比病灶分型例数 %浸润型…     

恶性疟疾肺部X线征象(附86例分析)

目的　观察恶性疟疾肺部X线的改变。方法　对确诊为恶性疟疾伴有发热呼吸道症状者共 86例行常规胸部X线检查 ,观察肺部改变。结果　 86例恶性疟疾胸片 ,5 8例有异常改变 ,其中肺纹理增粗 3 3例 ,粟粒状、小片状、大片状改变 2 4例 ,多发球形病灶 1例。结论　恶性疟疾肺部X线改变呈多样性 ,但其共同特征为多分布于肺的外带和基底部 ,这与疟原虫致血液动力学异常以及受累组织病理学改变有关     

肺结核X线诊断分类1000例的探讨

目的　旨在明确肺结核X线分类中两型合并的分类。方法　本文收集临床、肺结核细菌学和常规胸片确诊的肺结核1000例，进行X线分类的探讨。结果　X线分类，原发型214例，合并胸膜炎11例，血型播散型140例，合并胸膜炎45例，继发型612例，合并胸膜炎148例，结核性胸膜炎34例。Ⅰ～Ⅲ型肺结核合并胸膜炎204例，占总病例数的20.4%。结论　依据病因发病机理，中国结核病分类法（1998），按原发型肺结核合并结核性胸膜炎，血行播散型肺结核合并结核性胸膜炎，继发型肺结核合并结核性胸膜炎，进行X线分型。     

老年肺结核不典型X线、CT表现及误诊原因分析

目的进一步认识老年肺结核的X线、CT特征,分析总结误诊原因。方法抽取60例经手术、临床及病理确诊的老年不典型肺结核的完整资料,男32例,女28例,年龄60~80岁,平均67岁。均摄胸部正位片,48例摄胸部侧位片,23例行CT检查,13例行增强CT,14例行支气管镜检查,12例穿刺活检确诊。采用双盲法读片,总结X线及CT表现,分析其误诊原因。结果60例不典型肺结核中结节肿块型14例,其中边缘光滑者11例,浅分叶者3例,支气管内膜结核12例,节段实变及肺叶型各6例,空洞型6例,下肺叶结核5例,多发结核瘤4例,粟粒结节状结核3例,肺不张型结核2例。共误诊22例,其中误诊为肺癌12例,炎症4例,转移癌2例,肺泡癌1例,肺不张2例,炎性假瘤1例。结论老年肺结核具有症状不典型,病灶部位形态不典型,以及影像表现多样等特点。影像科医师过分依赖某些征象的诊断价值,影像检查不全面或忽视临床等为主要误诊原因。     

老年肺结核的X线、CT表现 (附200例分析)

目的总结老年肺结核的影像特点,提高诊断准确率。方法回顾分析200例老年肺结核X线、CT表现。结果本组肺结核中:Ⅱ型13例(6.5%);Ⅲ型163例(81.5%),合并胸膜炎44例(22%);Ⅳ型24例(12%)。表现为:陈旧性病灶85例(42.5%);渗出增殖性病变81例(40.5%);干酪性肺炎47例(23.5%);空洞性病变127例(63.5%);结核球12例(6%);粟粒状改变13例(6.5%);结核性胸膜炎68例(34%);淋巴结增大57例(28.5%)。结论老年肺结核病变部位不典型,病灶形态多种多样,只有综合分析,才能对本病做出正确诊断。     

初治涂阳肺结核临床与X线转归对比分析(附3229例报告)

目的探讨新发初治涂阳肺结核短程化疗的短期疗效与X线转归。方法新发初治涂阳肺结核3229例,全部采用2H3R3Z3S3/4H3R3或2H3R3Z3E3/4H3R3化疗方案,完成疗程时将临床疗效与X线转归进行对比。结果3229例完成疗程时,临床治愈3163例,治愈率98%;X线评价治愈664例,病灶吸收好转2499例,X线显示总有效率98%。结论新发初治涂阳肺结核采用标准化疗方案,临床治愈率高;X线显示化疗总有效率高;提示对于临床治愈时X线显示肺部病灶吸收好转的病例应进一步追踪观察。     

初治涂阳肺结核临床治愈后X线动态观察(附2499例报告)

目的探讨初治涂阳肺结核(简称肺结核)临床治愈时肺部尚未完全吸收病灶的X线转归以及化疗方案的远期疗效。方法对2499例临床治愈的肺结核病例分别在治愈后3、6、12、18、24及36个月摄胸部正位片,分别与治愈时胸片进行对比,分析X线变化。结果临床治愈后36个月显示:(1)肺部病灶吸收好转2334例,占93.4%;(2)肺部病灶未见变化101例,占4.0%;(3)肺部病灶增多,总共64例,仅占2.6%。结论肺结核采用标准化疗方案和全程督导短程间歇化疗(DOTS)管理,远期疗效显著;临床治愈早于X线治愈,且可靠有效;X线检查对检测肺结核的治疗效果及预防复发等方面均有重要意义。     

Chest Radiographic Findings in Primary Pulmonary Tuberculosis: Observations from High School Outbreaks

Objective

To describe the radiographic findings of primary pulmonary tuberculosis (TB) in previously healthy adolescent patients.

Materials and Methods

The Institutional Review Board approved this retrospective study, with a waiver of informed consent from the patients. TB outbreaks occurred in 15 senior high schools and chest radiographs from 58 students with identical strains of TB were analyzed by restriction fragment length polymorphism analysis by two independent observers. Lesions of nodule(s), consolidation, or cavitation in the upper lung zones were classified as typical TB. Mediastinal lymph node enlargement; lesions of nodule(s), consolidation, or cavitation in lower lung zones; or pleural effusion were classified as atypical TB. Inter-observer agreement for the presence of each radiographic finding was examined by kappa statistics.

Results

Of 58 patients, three (5%) had normal chest radiographs. Cavitary lesions were present in 25 (45%) of 55 students. Lesions with upper lung zone predominance were observed in 27 (49%) patients, whereas lower lung zone predominance was noted in 18 (33%) patients. The remaining 10 (18%) patients had lesions in both upper and lower lung zones. Pleural effusion was not observed in any patient, nor was the mediastinal lymph node enlargement. Hilar lymph node enlargement was seen in only one (2%) patient. Overall, 37 (67%) students had the typical form of TB, whereas 18 (33%) had TB lesions of the atypical form.

Conclusion

The most common radiographic findings in primary pulmonary TB by recent infection in previously healthy adolescents are upper lung lesions, which were thought to be radiographic findings of reactivation pulmonary TB by remote infection.     

艾滋病合并肺结核的影像学特征分析

目的探讨艾滋病合并肺结核病的影像学特征方法回顾性分析21例艾滋病合并肺结核患者胸部X线平片和CT表现,并与40例单纯肺结核患者对照结果21例艾滋病合并肺结核中,15例病变发生在单纯继发性肺结核非好发部位,14例累及2个或以上肺段,12例影像学表现为小片状淡薄影,7例伴弥漫粟粒性病灶,11伴肺门和/或纵隔淋巴结肿大,6例伴有肺外结核而40例单纯肺结核中有29例发生在上叶的尖后段、下叶的背段,30例仅累及1个肺段,31例影像表现为致密的斑片影,23例伴有纤维增殖灶,19例有1个或多个空洞两者差异有统计学意义结论艾滋病合并肺结核与单纯肺结核在影像学表现上有明显差别     

Radiological Findings of Extensively Drug-Resistant Pulmonary Tuberculosis in Non-AIDS Adults: Comparisons with Findings of Multidrug-Resistant and Drug-Sensitive Tuberculosis

Objective

This study was designed to describe the radiological findings of extensively drug-resistant (XDR) pulmonary tuberculosis (TB) and to compare the observed findings with findings of drug-sensitive (DS) and non-XDR multidrug-resistant (MDR) TB in non-AIDS patients.

Materials and Methods

From September 1994 to December 2007, 53 MDR TB patients (M:F = 32:21; mean age, 38 years) and 15 XDR TB non-AIDS patients (M:F = 8:7; mean age, 36 years) were enrolled in the study. All of the MDR TB patients had received no treatment or less than one month of anti-TB treatment. In addition, all XDR TB patients received either no anti-TB treatment or only first-line anti-TB drugs. In addition, 141 consecutive DS TB patients (M:F = 79:62; mean age, 51 years) were also enrolled in the study for comparison. Chest radiograph, CT and demographic findings were reviewed and were compared among the three patient groups.

Results

For patients with XDR TB, the most frequent radiographic abnormalities were nodules (15 of 15 patients, 100%), reticulo-nodular densities (11 of 15, 73%), consolidation (9 of 15, 60%) and cavities (7 of 15, 47%) that were located mainly in the upper and middle lung zones. As seen on radiographs, significant differences were found for the frequency of nodules and ground-glass opacity lesions (all p < 0.001) (more frequent in DS TB patients than in MDR and XDR TB patients). For the use of CT, significant differences (more frequent in MDR and XDR TB patients) were found for the frequency of multiple cavities, nodules and bronchial dilatation (p = 0.001 or p < 0.001). Patients with MDR TB and XDR TB were younger as compared to patients with DS TB (p < 0.001). Imaging findings were not different between patients with MDR TB and XDR TB.

Conclusion

By observation of multiple cavities, nodules and bronchial dilatation as depicted on CT in young patients with acid-fast bacilli (AFB) positive sputum, the presence of MDR TB or XDR TB rather than DS TB can be suggested. There is no significant difference in imaging findings between patients with XDR TB and MDR TB.     

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.