支气管内膜结核的CT表现及误诊漏诊原因分析

目的 总结支气管内膜结核(EBTB)的CT表现,并对其误诊、漏诊原因进行分析.方法 分析35例确诊EBTB的胸部CT表现.结果 EBTB主要表现为支气管内壁不规则增厚,管腔不规则狭窄,受累范围较长,常与肺内结核并存.CT易误诊为支气管肺癌、慢性支气管炎、支气管扩张、慢性肺炎等疾病.结论 EBTB的CT表现不典型,应加强临床认识、重视CT薄层扫描.     

气管支气管结核早期多层螺旋CT诊断（附22例报告分析）

目的了解气管支气管结核的早期16层螺旋CT影像表现，评价多层螺旋CT诊断支气管结核的价值。方法对22例经手术病理和纤维支气管镜活检证实的气管支气管结核分别进行MPR重建成像，分析其影像学表现。结果支气管结核的16层螺旋CT表现有以下特点：（1）多支段受累，好发于上肺叶及中肺叶；（2）病变支气管范围长，多为主支气管、叶支气管、段支气管连续或间断受累；（3）管腔多为不规则狭窄；（4）管壁多为不规则增厚，密度增高或钙化。22例气管支气管结核患者中，16支病变支气管表现为支气管壁不同程度向心性增厚，内壁呈浅波浪状。22例均合并肺内结核，肺内结核病灶多数分布于病变支气管所属肺组织。结论16层螺旋CT对显示气管、支气管内膜结核的累及范围有一定的优势，对支气管结核的早期诊断及治疗方法的选择有较高的临床应用价值。     

支气管结核的CT征象分析

目的分析支气管结核的CT影像表现和诊断价值。方法分析65例气管支气管结核的胸部CT影像表现。结果局部CT影像特点为：1病变范围较广,常见多个支段受累。本组病例中有50例累及2叶段以上;2病变支气管范围长,多为主支气管、叶支气管、段支气管连续或间断受累;3管腔多为不规则狭窄;4管壁多为不规则增厚,但其管壁外径未见增大,即中心性增厚,内径缩小。本组有32例管壁有增厚,伴管壁密度增高,鲜有钙化;5肺部多见结核并发灶。本组约有13例肺部合并病灶,其中8例有相应部位的肺不张;6肺门纵隔一般无肿块影,本组仅有肺门增大2例。结论 CT对显示气管、支气管结核的累及范围有一定的优势,对临床早期确诊气管、支气管结核有着重要作用。     

高分辨CT扫描对气管、支气管结核的诊断价值及临床意义

目的　探讨HRCT对气管、支气管结核的诊断价值及临床意义。方法 对32例诊断明确的气管、支气管结核住院患者行胸部HRCT扫描,结合纤维支气管镜检查,观察病变气道内壁及管腔的形态变化以及其病变远侧肺实质的病变情况。结果 气管、支气管壁病变检出率为73.9%,其中管壁轻度增厚54.3%,明显增厚19.6%;气道管腔形态改变检出率为67.4%,其中管腔狭窄<50%的41.3%,>50%的19.6%,管腔闭塞6.5%。同时观察到气管、支气管周围及纵隔淋巴结肿大7例,病变支气管远侧管腔内粘液栓12例,管腔局限性扩张5例,小叶性肺气肿18例,肺不张2例,肺内结核病灶39例。结论 HRCT检查观察气道病变部位和范围、气道病变与肺内病变的关系、危重患者纤维支气管镜检查前的定位准备及估计预后均有重要的临床意义。     

高分辨CT扫描对气管、支气管结核的诊断价值及临床意义

目的：探讨HRCT对气管、支气管结核的诊断价值及临床意义。方法：对32例诊断明确的气管、支气管结核住院患者行胸部HRCT扫描，结合纤维支气管镜检查，观察病变气道内壁及管腔的形态变化以及其病变远侧肺实质的病变情况。结果：气管、支气管壁病变检出率为73．9％，其中管壁轻度增厚54．3％，明显增厚19．6％；气道管腔形态改变检出率为67．4％，其中管腔狭窄＜50％的41．3％，＞50％的19．6％，管腔闭塞6．5％，同时观察到气管、支气管周围及纵隔淋巴结肿大7例，病变支气管远侧管腔内粘液栓12例，管腔局限性扩张5例，小叶性肺气肿18例，肺不张2例，肺内结核病灶39例，结论：HRCT检查观察气道病变部位和范围，气道病变与肺内病变的关系，危重患者纤维支气管镜检查前的定位准备及估计预后均有重要的临床意义。     

肺结核患者的不典型CT表现

目的 探讨和分析肺结核患者的不典型CT表现特点。 方法 回顾性分析我院2010年1月至2012年9月CT表现不典型的肺结核患者73例,根据其图像特点进行分类并分析。 结果 所有患者按图像特点分为6型,其中多空洞型7例,表现为肺内多发空洞,无结核播散灶;肺间质型20例,表现为肺内大片细网织样密度增高影,与周围正常肺组织分界清晰,病变区内部分病灶融合实变,并可见多发垂直于胸膜的小叶间隔增厚影;雪花型16例,4例合并间质型,表现为多发腺泡样结节沿小支气管及其分支周围分布,受累各级支气管管腔充盈,内形成多发“小树芽征”及小叶性实变;肿块型29例,病灶边缘可见光滑、深分叶、长毛刺及胸膜凹陷征,未见短毛刺征,病灶平扫为等密度,其中3例肿块呈薄壁或厚环形强化,7例有不同程度的强化;肺门及纵隔淋巴结结核并假性动脉瘤型1例,表现为环形强化的淋巴结内出现假性动脉瘤;实变型4例,为多发段、叶实变,段、叶支气管腔内无异常改变。 结论6种肺结核的不典型CT表现中,肺间质型、雪花型和肺门及纵隔淋巴结结核并假性动脉瘤型有一定特异性,但所有类型需结合临床、化验检查等做出诊断。     

支气管腔常见病变的CT鉴别诊断

目的:评价CT对肿瘤性和非肿瘤性支气管腔病变诊断和鉴别诊断的价值。方法:回顾性分析49例有CT检查的支气管病变患者,均经手术病理或随访证实。患者被分为肿瘤组和非肿瘤组,对2组患者最初的临床特征和CT所见进行对比分析。结果:49例患者,肿瘤性31例,非肿瘤性18例(黏液栓塞13例,血栓栓塞5例)。在临床症状和体征上2组有统计学意义。肿瘤组CT主要表现是支气管壁僵硬和管腔变窄或闭塞、支气管周围形成软组织肿块和纵隔肺门淋巴结肿大;增强CT可见软组织肿块和支气管壁强化。非肿瘤组CT主要表现是支气管管壁完整、病灶只沿腔内曼延及密度不均匀,无支气管周围软组织肿块和纵隔肺门淋巴结肿大,支气管壁无强化。在CT特征表现上2组有统计学意义。结论:螺旋CT对支气管病变能提供有用的影像学信息,有助于临床上肿瘤性和非肿瘤性支气管腔内病变的诊断和鉴别诊断,特别是支气管肺癌与黏液栓塞和血栓栓塞的鉴别诊断。     

重症甲型H1N1流感并肺炎的CT表现

目的探讨甲型H1N1流感并肺炎的CT表现。方法 5例临床确诊甲型H1N1流感的重症患者共8次胸部CT扫描(复查3例)资料。结果 5例中均为双肺多叶、多段实变灶,无明显肺叶、肺段或特定体位分布趋势;大片肺实变表现为双侧沿支气管树分布的肺段实变;内有明显的空气支气管征;相邻肺段实变融合或在叶间裂处相邻的肺叶实变扩展,于影像接触部位融合,形成更大片实变影;肺内小病灶均为双肺多发,呈类圆形或棉团状,沿肺纹理分布最多见;大片肺实变可呈均匀致密实变、磨玻璃样变、蜂窝状实变,小病灶与大片实变灶一致,磨玻璃样变可出现在初诊和吸收期病例;反应性胸膜增厚及胸膜积液常见;无纵膈、肺门淋巴结肿大。结论 CT改变提示:甲型H1N1重症病例并肺炎在病程发展阶段,病变有经支气管肺泡系播散的特点。     

肺泡蛋白沉积症的高分辨CT诊断分析

目的探讨肺泡蛋白沉积症的高分辨CT(HRCT)的影像表现,提高对该疾病的认识及诊断;因其治疗方法特殊,因此HRCT准确诊断对临床十分必要。方法回顾性分析2009年1月至2018年1月期间20例经病理证实的肺泡蛋白沉积症患者的肺部HRCT表现,归纳其特征。结果肺泡蛋白沉积症分布肺内随机,无肺段叶、肺野分布规律。HRCT主要影像表现有以下五点:磨玻璃影(GGO ground glass opacity) 20例,"铺路石征"17例,"地图样改变"13例,气管走行自然、管腔清晰的空气支气管征3例,蜂窝状片状影2例。另外,双侧胸膜轻度增厚且无胸腔积液11例,纵隔可见淋巴结但淋巴结不肿大5例。结论 PAP的HRCT表现有一定特征,肺内分布随机,主要以边界清晰的GGO为基本表现,"铺路石征""地图样表现"常见,发展较重或合并其它类型感染时可出现支气管走行自然的"空气支气管征"及"蜂窝状影"; PAP有可能累及胸膜出现轻度胸膜征像;纵隔淋巴结不肿大支持其诊断。     

成人纵隔和肺部淋巴结结核破溃后的CT表现及其治疗转归分析

目的 探讨成人纵隔和肺部淋巴结结核破溃后的CT表现特点并对其治疗转归进行分析。 方法 搜集广州市胸科医院2009年1月至2017年12月收治的成人纵隔和肺部淋巴结结核并发破溃的52例患者进行回顾性分析。根据病变淋巴结破溃的位置而将其分成3组:只向气管支气管内破溃为气管支气管组39例;只向肺内破溃为肺组13例;同时向气管支气管和肺内破溃为气管支气管-肺组20例。分析各组患者的CT表现征象,总结破溃淋巴结的治疗转归情况。 结果 52例患者共有84个破溃淋巴结。气管支气管组共23个淋巴结,14个肿大淋巴结并相应支气管水肿增厚的黏膜、肉芽局部向支气管腔内呈结节状突出,CT增强扫描示13个淋巴结坏死区向气道内突出,1个为均匀强化表现,其余9个淋巴结相应瘘口侧的气道壁欠光滑但无结节征象。肺组共13个淋巴结,肿大淋巴结跨纵隔-肺、肺门-肺组织形成结节状或者肿块状,肺内病灶周围可见晕征或斑片状模糊影,CT增强扫描示12个淋巴结呈环形或分隔样强化,其内坏死区局部向肺组织内延伸,1个呈均匀强化。气管支气管-肺组患者共48个淋巴结,并发纵隔及肺门多区域多淋巴结明显肿大,其中11个向气道内、20个向肺组织内突出,CT增强扫描示后淋巴结内坏死区向瘘口侧突出,除了1个均匀强化,其余16个淋巴结相应瘘口侧的气道壁欠光滑但无结节征象。经抗结核药物、向气道内破溃的淋巴结同时经支气管镜钳取肉芽肿、抽吸坏死物等治疗,患者遗留瘘口处支气管狭窄33例,肺内遗留瘘口相关的纤维硬结灶18例。 结论 成人纵隔和肺部淋巴结结核发生破溃,以向气管支气管内、肺内破溃为主,CT平扫及增强有助于其早期诊断;破溃的纵隔和肺部淋巴结结核治疗后有一定效果,但部分患者遗留不同程度的支气管瘢痕性狭窄。     

肺结核合并支气管结核97例临床分析

目的探讨肺结核合并支气管结核的临床特点。方法回顾性分析97例肺结核合并支气管结核临床资料。结果临床以咳嗽(82.5%)、咳痰(80.4%)、发热(45.4%)、不同程度咯血或血丝痰(23.7%)等为主要症状,胸部CT以肺不张或膨胀不全(44.2%)及浸润增殖性病灶(37.9%)为主要表现,并可见支气管狭窄阻塞、支气管扩张、支气管播散、支气管充气征、纵隔淋巴结增大、纵隔淋巴结钙化等表现,痰涂片或培养检查抗酸杆菌阳性率较高(63.9%),尤其在多叶段浸润增殖病灶患者中其阳性率高达83.3%。纤支镜检查以主支气管及叶支气管开口受累显著(64.8%),多气管支气管受累患者达81.4%,且多种支气管镜下表现类型并存,纤支镜刷检抗酸杆菌、组织活检阳性率分别为55.9%、69.4%。接受纤支镜介入治疗的患者仅有18例,其中6例支气管狭窄闭塞并肺不张患者行气管镜下支气管球囊扩张术治疗,5例支气管狭窄好转。结论肺结核合并支气管结核患者临床表现无特异性。胸部CT对观察支气管损伤及淋巴结病变能提供较大帮助。气管镜检查仍为其重要诊断手段,镜下可见多气管支气管受累,且镜下表现类型相互重叠。球囊扩张术可有效改善支气管狭窄。     

支气管结核并发黏液栓嵌塞的CT表现与诊断

目的 分析支气管结核（EBTB）并发黏液栓嵌塞（MPI）的CT表现与特点,提高对其影像学诊断的水平。 方法 对经纤维支气管镜检查确诊的25例EBTB并发MPI患者的CT表现和形态特点进行分析。 结果 EBTB并发MPI后典型的CT表现：（1）直接征象：树杈状阴影10例（40.0%）,挤牙膏状阴影8例（32.0%）,手套状阴影7例（28.0%）。（2）病灶分布与形态：不规则的团块状阴影均分布在各肺叶内2/3的肺野中,膨胀性强,边缘清晰,呈向心性分布。（3）伴随征象：25例中23例（92.0%）患者主体病灶阴影周围有多发性斑点状和小片状卫星灶,13例（52.0%）患者伴病灶区肺纹理聚拢,肺叶容积缩小,肺气肿形成等慢性过程。6例（24.0%）患者CT检查显示左或右主支气管明显狭窄。（4）CT增强表现：25例中12例患者CT增强扫描后团块状病灶CT值均＜20 HU。25例患者经确诊后进行规则的抗结核治疗均获得较好的疗效。 结论 EBTB并发MPI后易形成树杈状、挤牙膏状、手套状阴影,掌握其CT表现与特点有利于提高EBTB并发MPI影像学诊断水平。     

干酪坏死型支气管结核72例临床分析

目的了解干酪坏死型支气管结核(EBTB)的临床表现,电子气管镜下表现及胸部CT常规平扫表现的特点和该型的治疗预后。方法回顾性分析72例确诊为干酪坏死型EBTB的临床特点,电子支气管镜下直视特点及胸部CT常规平扫特点。结果干酪坏死型EBTB具有刺激性咳嗽,不同程度的发热,易并发肺部感染。实验室检查痰菌阳性率高,红细胞沉降率、C反应蛋白(CRP)高。电子支气管镜下较容易识别该型,胸部CT常规平扫对该型EBTB诊断率不高。积极治疗取得了一定的疗效。结论干酪坏死型EBTB具有一定的临床特点。电子支气管镜是发现干酪坏死型EBTB的主要方法。给予积极的治疗可以有一定的疗效,但具有难治性。     

258例支气管结核的临床分析并支气管结核分型的探讨

目的 分析支气管结核的支气管镜下表现,并对支气管结核的镜下分型进行探讨.方法 对支气管黏膜组织病理确诊为支气管结核的258例患者的临床症状、胸部影像学表现、发病部位及镜下表现进行回顾性分析:结果 258例支气管结核中炎症浸润型47.3%,溃疡及干酪坏死型22.1%,肉芽增生型16.3%.瘢痕狭窄型9.7%,淋巴结支气管瘘3.1%,管壁软化型1.6%;其中上叶及下叶背段支气管结核占60.9%.结论 将支气管结核分为炎症浸润型、溃疡及干酪坏死型、肉芽增生型、瘢痕狭窄型、管壁软化型及淋巴结支气管瘘6型较为合理,有利于指导诊断和治疗.     

Changes in the levels of interferon-gamma and transforming growth factor-beta influence bronchial stenosis during the treatment of endobronchial tuberculosis

BACKGROUND: Endobronchial tuberculosis (EBTB) has been shown to frequently complicate bronchial stenosis, a condition which can induce dyspnea as a result of airway obstruction, and is also frequently misdiagnosed as either bronchial asthma or lung cancer. OBJECTIVES: This study attempted to determine whether there was a correlation between interferon-gamma (IFN-gamma) and transforming growth factor-beta (TGF-beta) levels in the serum and bronchial washing fluid (BWF), and the results of the treatment of EBTB patients. METHODS: Thirty patients, all of whom were diagnosed as EBTB, were enrolled, as were 10 healthy control subjects. IFN-gamma and TGF-beta levels were measured by the ELISA method in the serum and BWF of these 30 EBTB patients before and after treatment. The EBTB patients were divided into two groups: those who exhibited bronchial stenosis after treatment and those who did not. Chest computed tomography (CT) and pulmonary function test (PFT) were performed in 16 and 25 patients, respectively, at initial bronchoscopy. RESULTS: IFN-gamma and TGF-beta levels in the BWF of the EBTB patients were elevated compared to the controls (p < 0.05). After 2 months of treatment, 13 of the 30 EBTB patients exhibited bronchial fibrostenosis and the other 17 cases had recovered without sequelae. In the bronchial stenosis group, the initial serum TGF-beta levels were lower than in the patients without bronchial stenosis (p < 0.05). Moreover, the levels of serum TGF-beta after treatment were shown to have decreased more than in the patients without bronchial stenosis (p < 0.05). On chest CT findings of 16 EBTB patients, bronchial narrowing was suspected except in 2 cases (1 edematous-hyperemic type, 1 actively caseating type of segmental bronchus). The common features of PFT in EBTB at the initial diagnosis were a restrictive pattern and normal ventilatory function. CONCLUSIONS: Elevated IFN-gamma and TGF-beta levels in the BWF of the EBTB patients may be related to EBTB pathogenesis. Lowered initial serum TGF-beta levels as well as the observed changes in the levels of TGF-beta in the serum after treatment have been implicated in bronchial fibrostenosis during the course of the disease.     

Bronchoscopic, radiologic and pulmonary function evaluation of endobronchial tuberculosis

OBJECTIVE: Endobronchial tuberculosis (EBTB) causes problems in both making a diagnosis and following up the endobronchial lesion, because the lesion is not evident in simple chest radiograph. Frequently, the diagnosis and follow up of EBTB lesion during treatment mainly depend on bronchoscopy. Chest computed tomography (CT) and pulmonary function test (PFT) have also been used in evaluating EBTB and differentiating it from the other diseases. Primary purpose of the present study was to observe the change of EBTB lesion during treatment and determine the optimal time and the indication of follow-up bronchoscopy. We also evaluate the usefulness of chest CT and PFT in EBTB. METHODOLOGY: Eighty-one biopsy-proven EBTB patients were enrolled from 1992 to 1997. Endobronchial tuberculosis was classified into seven subtypes: actively caseating, fibrostenotic, oedematous-hyperaemic, tumorous, ulcerative, granular, and non-specific bronchitic type according to bronchoscopic features by Chung's Classification. The change of bronchoscopic findings during treatment in each subtype of EBTB was evaluated prospectively. Follow-up bronchoscopy was done each month until there was no subsequent change in endobronchiat lesion, and every 3 months thereafter, and at the end of treatment. Chest CT and PFT were performed in 26 and 68 patients respectively, at initial bronchoscopy. RESULTS: Twenty-two of the 34 cases of actively caseating EBTB changed into the fibrostenotic type, and the other 12 healed without sequelae. Seven of the 11 cases of oedematous-hyperaemic EBTB changed into the fibrostenotic type, and the other four healed. Nine of the 11 cases of granular EBTB, six cases of non-specific bronchitic EBTB, and two cases of ulcerative EBTB resolved completely. However, the other two cases of granular EBTB changed into the fibrostenotic type. Seven cases of fibrostenotic EBTB did not improve despite antituberculosis chemotherapy. These various changes in bronchoscopic findings occurred within 3 months of treatment. In 10 cases of tumorous EBTB, seven progressed to the fibrostenotic type. In addition, new lesions appeared in two cases, and the size of the initial lesions increased in another two cases, even at 6 months after treatment. On chest CT findings of 26 EBTB patients, the length of bronchial involvement was measured from 10 to 55 mm. Bronchial stricture was noticed in 25 cases and the range of narrowing was from total occlusion to near normal, and there was wide variation in bronchial stricture even within same subtype of EBTB. The dominant feature of PFT in EBTB at the diagnosis was restrictive pattern. CONCLUSION: The therapeutic outcome of each subtype of EBTB can be predicted by follow-up bronchoscopy during the initial 3 months, with the exception of the tumorous type. In tumorous EBTB, the evolution of the lesions during treatment is very complicated, and bronchial stenosis may develop at a later time. Chest CT was useful in measuring the length of involved bronchus and degree of stricture in EBTB. PFT may be useful in differential diagnosis and follow up of EBTB.     

Normal bronchi on high resolution CT]

The delineation of normal bronchi was evaluated by high resolution CT. Under the usual conditions for lung survey, with window width of 1500, window level -650, and slice thickness 10 mm, using high spatial frequency algorithm, the subsegmental bronchi were delineated in 77% of total branches. Sub-subsegmental bronchi were delineated in 8% of branches. Under thin slice high resolution CT, with slice thickness of 1.5 mm and slice interval 10 mm, subsegmental bronchi were delineated in 89% of branches, and sub-subsegmental bronchi were delineated in 35% of branches. In two of the cases in which almost the whole lungs were studied on continuous slice images with thin slice high resolution CT, sub-sub-subsegmental bronchi could be easily delineated, except in for the lingular segment. High resolution CT is very useful for the interpretation of normal pulmonary structures and for diagnosis of bronchial lesions.     

Sialyl Lewis X-i (SLX) in the bronchoalveolar lavage fluid from patients with lung cancer]

The measurement of serum SLX is thought to be a useful aid in the diagnosis of malignant diseases, particularly adenocarcinoma of the lung. In the present investigation, we measured and compared SLX values in BALF from affected and normal bronchi, obtained from 83 patients. They consisted of 64 males and 19 females, with mean age of 60 years, consisting of 8 normal controls, 19 cases of benign lung disease, and 56 cases of primary lung cancer. SLX value in BALF from normal bronchi was significantly higher in patients with lung cancer than in normal controls, but there was no significant difference in SLX value between lung cancer and benign lung disease. On the other hand, SLX value from affected bronchi was significantly higher in patients with lung cancer than in normal controls and patients with benign lung disease. The rate of elevated SLX in BALF from affected bronchi was significantly higher in patients with lung cancer than in those with benign lung disease. These results suggest that measurement of SLX levels in BALF from affected bronchi may be a useful method for differential diagnosis of primary lung cancer.     

支气管内膜结核90例临床分析

目的探索支气管内膜结核（ＥＢＴＢ）的临床特征及早期确诊手段。方法分析９０例经纤维支气管镜（纤支镜）确诊的ＥＢＴＢ患者的临床表现、胸部Ｘ线（ＣＴ）、纤支镜检查结果。结果９０例中主要症状包括：咳嗽７５例,发热２７例,咯血２４例,胸痛１８例,气促１１例,消瘦７例。气道阻塞症状少,仅２例出现喘息。７例的Ｘ线表现正常,只有２例的ＣＴ检查结果提示ＥＢＴＢ。纤支镜检查示３８％的病例有炎症浸润型病变,９％有增殖型病变,２６％有狭窄闭塞型病变,１７％有溃疡型病变,１１％大致正常。５６例痰涂片行抗酸染色者中８例阳性,８６例行纤支镜刷片检查者中７３例阳性,５６例行活组织检查者中１７例证实为结核。结论ＥＢＴＢ缺乏特异性临床表现,胸部Ｘ线表现正常不能排除ＥＢＴＢ,ＣＴ诊断价值不高,确诊主要依靠纤支镜检查。对不明原因低热和呼吸道症状经积极治疗无效者,应怀疑ＥＢＴＢ而及时行纤支镜检查。行镜下常规刷检找抗酸杆菌和（或）组织活检阳性率高,且简便快捷,值得推广。