肺炎性假瘤的CT诊断与误诊分析

目的：探讨肺炎性假瘤的CT征象和CT鉴别诊断，减少误诊率。方法：回顾分析20例经手术病理证实的肺炎性假瘤的CT表现。结果：CT诊断正确者6例，误诊为肺癌8例，结核瘤5例，球型肺炎1例，虽然CT对炎性假瘤的诊断有一定局限性，但肿块对于肺的外周，有垂直于胸膜的刀切样边缘，局限性胸膜增厚、尖角征、平直征，肿块与邻近胸壁之间有低密度影及均匀强化等征象，对肺炎性假瘤的诊断具有意义。结论：全面分析CT征象，并结合肺内感染病史能提高肺炎性假瘤诊断的正确率。     

肺炎性假瘤的X线与CT诊断

肺炎性假瘤本质是增生性炎症，由多种细胞组成并有纤维化，增生的组织形成肿瘤样团块，在X线或CT常表现为孤立球形或肿块阴影。临床上需与肺癌、肺结核球等肺内肿块阴影疾病相鉴别，本文就肺炎性假瘤的X线与CT表现分析．旨在提高该病的诊断符合率。     

周围型肺癌、结核球、炎性假瘤的CT诊断及鉴别

目的：探讨周围型肺癌、结核球、炎性假瘤的CT表现及其诊断。方法：分析5例肺炎性假瘤、3例结核球、31例周围型肺癌CT征象：结果：全部病例均表现为胸膜下肺内孤立性肿块或结节，其中浅分叶征13例，典型的胸膜凹陷征8例，细短毛刺征8例，边缘显示棘突、尖角、锯齿状4例，空泡征7例，偏心性空洞2例．早期明显强化13例，强化均匀12例，3例不均匀强化。肺门纵膈淋巴结肿大13例。结论：对肺内孤立性肿块或结节的CT表现特征认识不够准确。过分强调某些征象的特异性而缺乏综合分析，是造成误诊的主要原因：对于CT表现不典型的病例，全面细致的分析和穿刺活检都是必要的。     

肺炎性假瘤的X线诊断

目的：提高X线对肺炎性假瘤的诊断水平。方法：对临床与X线检查资抖较全并经手术病理证实的31例肺炎性假瘤进行回顾性分析。结果：31例肺炎性假瘤中X线诊断正确者仅5例，占16％；误诊为肺癌12例，占39％；良性病变10例，占32％；结核瘤3例，占10％；错构瘤1例，占3％。总误诊26例，占84％。结论：肺炎性假瘤X线表现以肺部“肺尖征”为较特征性改变。对诊断确有困难者，经皮穿剌行病理细胞学检查有助于明确诊断。     

肺炎性假瘤的CT诊断

目的　加深对肺炎性假瘤CT表现特点的认识 ,以提高其CT诊断水平。方法　由 3名有经验的放射学医师按双盲法对48例经手术病理证实的肺炎性假瘤进行回顾性分析 ,然后共同讨论并达成一致意见。结果　在 48例肺炎性假瘤中 ,CT诊断正确者仅 9例 ( 18.7% ) ,其余被误诊为肺癌 2 1例 ( 5 3 .8% ) ,结核瘤 11例 ( 2 2 .9% ) ,良性病变 5例 ( 10 .4% ) ,错构瘤 2例 ( 4 .2 % )。虽然CT对肺炎性假瘤的诊断有一定的局限性 ,但肿块位于肺的外周、局限性胸膜增厚粘连、病灶边缘多发性空泡征、病灶下缘散在结节征、桃尖征、平直征及均匀强化等征象 ,对肺炎性假瘤的CT诊断具有重要意义。结论　全面综合地分析肺炎性假瘤的CT表现特征 ,并结合患者肺内感染病史对提高本病的CT诊断尤为必要。CT检查对于肺炎性假瘤的正确诊断与鉴别诊断是很有帮助的     

肺炎性假瘤的CT诊断（附18例分析）

肺炎性假瘤并不少见，它是一种非特异性炎症引起的慢性增生肿块，其CT表现，临床表现与肺内其他肿瘤样病变有许多相似之处，因而易误诊。本文收集我院经手术病理证实的18例肺炎性假瘤病例进行回顾性分析，以探讨CT对本病的诊断价值。     

肺炎性肿块CT表现的探讨

肺炎性假瘤、限局性机化性肺炎及限局性化脓性肺炎CT检查均可表现为结节或肿块,其临床与CT表现不完全相同,且与肺癌、肺结核鉴别有一定困难.本文回顾性分析了34例肺炎性肿块的临床与CT表现,旨在提高对于肺炎性肿块CT表现的认识及其与肺癌及其他良性肺结节的鉴别.     

肺炎性假瘤的CT表现(附19例报告)

肺炎性假瘤是较少见的肺内炎性增生性病变 ,占肺良性肿块的第二位 ,仅次于结核球[1] 。其影像表现易与良性肿瘤、结核球和肺癌等混淆 ,在肺周围性肿块的鉴别诊断中有重要意义。为提高认识 ,现将笔者搜集的 19例肺炎性假瘤的ＣＴ表现作一总结。材料与方法收集 1990年～ 1996年经手术病理证实的肺炎性假瘤共 19例 (华西医科大学附一院 18例 ,成都铁路局中心医院 1例 )。年龄 39～ 73岁 ,平均 53.1岁 ,50～ 6 0岁 13例 ,占 6 8%。男 18例 ,女 1例。无症状体检发现4例 ,咳嗽 9例 ,痰中带血 7例 ,少、中量咯血 2例 ,胸痛3例 ,发热 3例。发现肿块…     

肺炎性假瘤CT诊断分析

肺炎性假瘤为肺内良性肿瘤样病变,是非特异性炎症所致的一种慢性炎性增生性肿块.其临床表现错综复杂,影像学有多种不典型征象,常与肺内其他肿块性病变相似,特别与周围型支气管肺癌鉴别困难.本文搜集经CT检查、手术及随访证实的炎性假瘤27例作回顾性分析,以探讨X线与CT对肺炎性假瘤的诊断价值.     

高分辨螺旋CT增强扫描诊断肺内孤立小结节

目的 :评价高分辨螺旋CT增强扫描诊断肺内孤立小结节的价值。材料和方法 :直径小于 3cm的肺内孤立小结节患者 40例 ,其中周围性肺癌 2 9例 ,转移瘤 1例 ,肺炎性肿块 5例 ,结核瘤 2例 ,肺错构瘤、肺囊肿及肺血管瘤各 1例。40例患者先行常规CT扫描 ,发现病变后局部行高分辨螺旋CT扫描 ,仍不能定性诊断时行高分辨螺旋CT增强扫描。 40例病例均行前瞻性对比研究。结果 :高分辨螺旋CT增强扫描诊断肺内孤立性小结节的正确率为 81% ,肺内恶性结节大多均匀增强且增强CT值大于 2 0Hu ,平均增强CT值为 3 6Hu。良性结节多周边增强且增强CT值小于 10Hu。结论 :高分辨螺旋CT增强扫描有助于肺内孤立性小结节定性诊断 ,同时强调必须结合病变的基本形态特征综合考虑。     

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.     

肺隔离症的多层螺旋CT诊断

目的：探讨肺隔离症的多层螺旋CT（MSCT）征象,以提高对该疾病的认识及临床诊断。方法回顾性分析经手术及病理证实的肺隔离症患者13例,包括临床表现,多层螺旋CT扫描资料,并复习文献;所有患者均行胸部平扫及双期增强容积扫描。结果13例肺隔离症患者中,12例为叶内型,1例为叶外型。12例叶内型均位于肺下叶内后基底段,9例位于左下肺,3例位于右下肺;1例叶外型位于左膈与下叶之间。13例中1例为增多增粗的异常血管结构,4例为实质性肿块,5例为囊实性肿块,3例为囊性肿块。6例病灶周围可见局限性肺气肿,4例病灶周围见渗出性阴影。13例隔离肺的供血动脉均发自体动脉。结论肺隔离症CT征象典型,容积扫描能对其作出准确诊断,并能为外科手术治疗提供重要参考,多层螺旋CT可以作为诊断肺隔离症的首选方法。     

CT引导胸穿肺活检对纤支镜阴性的肺部肿块诊断价值

目的：评价CT引导下经胸穿肺活检对纤维支气管镜检查阴性的肺部肿块患的诊断价值。方法：搜集290例肺部肿块患接受CT引导下经胸穿肺活检，其中43例患曾接受过纤维支气管镜检查，又检查结果为阴性，回顾性分析了该43例患的病理结果、肿块大小和穿刺并发症情况。结果：发现恶性26例(腺癌11例、鳞癌8例、支气管肺泡癌3例、未分化癌和腺鳞癌各2例)；良性4例(结核2例、结节病1例、炎性假瘤1例)；仍有13例未能明确结果，该13例中有6例因诊断或治疗的原因行手术治疗，发现5例为恶性(鳞癌2例、未分化癌1例、小细胞癌1例、腺癌1例)，1例为良性病变(结核)。结论：CT引导下经胸穿肺活检对纤维支气管镜检查阴性的肺部肿块患有很高的临床价值，它的明确诊断率与部位关系不大，而与肿块的大小正相关。     

肺炎性假瘤的X线、CT表现研究(附30例报告)

目的:探讨肺炎性假瘤的X线、CT表现及其特征。方法:对30例经手术病理证实肺的炎性假瘤病人进行胸部X线片、CT扫描,对其影像学特征进行了分析研究。结果:假瘤稳定阶段时,多数肿块包膜完整,边界光滑呈球形。病灶急性阶段时,灶周有炎性浸润,无包膜形成,病灶多呈团块状。肿块内空洞坏死,胸膜粘连,长毛刺等征像,对假瘤诊断具有重要意义。结论:全面分析假瘤的影像学特征,重视病人肺内感染病史,提高本病诊断的准确率是可能的。     

周围型肺癌阻塞性病变的CT表现(附18例分析)

目的:确定深呼吸时相CT扫描对周围型肺癌诊断敏感性。材料与方法:18例周围型肺癌(13例经病理证实,5例由其它方法证实)和12例良性肺肿块对照者(炎性假瘤和结核球等)均经常规CT扫描,除2例炎性假瘤患者外,其余所有病人并经肿块部位及其上下一层的深呼吸时相CT扫描。结果:周围型肺癌深呼吸时相CT扫描所见的阻塞性病变计有4例肺不张,12例阻塞性肺炎(按其帮位进而可分为远离肿块的和邻近肿块的阻塞性肺炎),1例阻塞性肺气肿,以及1例肺静脉癌栓。周围型肺癌的这些CT表现,在良性肺肿块对照者中不复被看到。结论:深呼吸时相CT扫描所见的远离肿块的阻塞性肺炎及肿块外侧的阻塞性肺气肿,可被看作是周围型肺癌的特有表现而且是其早期诊断的依据。     

Prevalence of air bronchograms in small peripheral carcinomas of the lung on thin-section CT: comparison with benign tumors

Despite improved techniques--such as bronchoscopy and percutaneous needle biopsy--to evaluate pulmonary nodules, there are still many cases in which surgical resection is necessary before carcinoma can be differentiated from benign lesions. The present study was undertaken to determine if the presence of an air bronchogram or air bronchiologram (patent visible bronchus or bronchiole) is useful in distinguishing small lung cancers from benign nodules. Thin-section chest CT scans were obtained in patients with 20 peripheral lung cancers less than 2 cm in diameter (18 adenocarcinomas, one squamous cell carcinoma, and one large cell carcinoma) and 20 small benign nodules (eight hamartomas, seven tuberculomas, two foci of aspergillosis, one focus of cryptococcosis, one chronic focal interstitial pneumonitis, and one plasma cell granuloma). The images were compared with regard to the patency of any bronchus or bronchiole within the lesions. After surgical resection, the specimens were inflated with agar and sectioned transversely to correlate gross morphology and low-power histologic sections with the CT appearance. An air bronchogram or air bronchiologram was seen in the tumors on 65% of CT scans and 70% of histologic sections. Benign nodules had a patent bronchus or bronchiole on CT scans and histologic sections in only one case (5%). These findings suggest that the presence of an air bronchogram in a lung nodule is a useful finding to help differentiate adenocarcinomas from benign lesions.     

CT of focal pulmonary masses in childhood.

Focal pulmonary masses in children encompass a spectrum of conditions including congenital lesions, inflammatory masses, hematomas, and benign and malignant tumors. Congenital masses include bronchial atresia, sequestration, cystic adenomatoid malformation, and pulmonary vascular anomalies. Inflammatory masses most commonly result from infection and include pulmonary abscess, granulomas, and postinflammatory pseudotumors. Blunt trauma can cause a hematoma, which decreases in size on serial radiographs. Pulmonary neoplasms may be benign such as papilloma, hamartoma, and bronchial carcinoid tumor (low-grade malignancy), or they may be malignant as in sarcoma, carcinoma, and pulmonary blastoma. Because computed tomography (CT) is the most sensitive technique in detecting and helping characterize parenchymal disease, it has become the procedure of choice for further investigation of lesions seen or suggested on plain chest radiographs. Understanding the CT appearance of these lesions can allow an accurate diagnosis and optimize management of the patient's condition.     

Radiological and clinical findings of pulmonary aspergillosis following solid organ transplant

AIM: To evaluate the radiological and clinical findings in patients with pulmonary aspergillosis after solid organ transplantation. MATERIALS AND METHODS: This study included 13 consecutive patients (five liver, four kidney, and four heart transplant; 10 male and three female; median age 54 years; range 13-63 years) with histologically confirmed pulmonary aspergillosis after solid organ transplantation at a tertiary referral hospital. Chest radiographs and computed tomography (CT) examinations performed for diagnosis were available in all patients. Radiological findings, such as lesion characteristics, location, and associated findings, were assessed retrospectively by two radiologists. The changes in radiological findings and clinical response after treatment were also assessed. Clinical findings, such as time of onset, initial symptoms, clinical course, and laboratory findings, were reviewed. RESULTS: The most common radiographic and CT findings were pulmonary nodules or masses (n=12). The number of nodules or masses was less than 10 in eight patients. Associated findings were surrounding ground-glass opacity (n=4), central low density (n=8), central air cavity (n=5), and air bronchogram (n=3). Follow-up radiographs and/or CT after treatment showed improvement in eight patients, persistence in two, and deterioration in three. The onset time of pulmonary aspergillosis was a median of 32 days (range 15-165 days). The most common symptom at diagnosis was fever (n=6). Ten of 13 patients did not have leucopaenia. There were two aspergillosis-associated deaths during the follow-up period. CONCLUSION: The most common radiological finding of pulmonary aspergillosis after solid organ transplantation is multiple nodules or masses, which commonly appear within 1 month following transplantation.     

肺炎性假瘤的HRCT诊断

目的 探讨肺炎性假瘤的CT表现.方法 21例经手术或病理证实的肺内直径小于2.0 cm炎性假瘤患者均经胸部高分辨力CT（RHCT）检查.其中,15例又经增强CT扫描.结果HRCT证实,21例病人中,浅分叶征见于6例,棘状突起5例,晕征8例,血管集束征5例.在接受增强扫描的15例中,增强后5例的病灶有轻度强化,而其余10例的病灶无明显强化,所有病例的病灶边缘均较光整.结论 HRCT对诊断肺内直径小于2.0 cm的炎性假瘤具有重要价值.而各种CT征象的综合分析有利于确诊.