非典型性老年人肺结核X线、CT诊断与病理分析

目的：提高对非典型性老年人肺结核X线、CT诊断的再认识,以减少误诊。方法：对116例非典型性老年人肺结核病例资料较完整地进行综合分析并总结。结果：肺不张17例,X线表现为肺叶或肺段实变、肺体积缩小,误诊为肺癌9例;CT表现呈三角形或＂V＂形,尖端指向肺门的软组织阴影,误诊为肺癌6例。肿块型12例,X线表现肿块有分叶,周边见少许斑点状钙化,8例伴肺门增大者误诊为肺癌;CT表现为肿块边缘光滑,有分叶及短毛刺,肿块中心呈斑片状钙化,误诊为肺癌。干酪性肺炎52例,X线、CT表现为肺叶或肺段大片实变,其内密度不均。混合型35例,X线、CT表现为渗出、增殖、纤维条索状,结核瘤呈多形性,肺叶内1～2 mm粟粒性结节。结论：综合分析X线、CT及支气管镜检病理表现对于减少误诊具有重要的价值。

X-ray,CT Diagnosis and Pathological Analysis of Atypical Pulmonary Tuberculosis in the Elderly

Objective To raise the re-awareness of X-ray and CT diagnosis in elderly people with atypical pulmonary tuberculosis with a view to reduce misdiagnosis.Methods A comprehensive analysis was thoroughly conducted on the data of 116 cases of elderly patients with pulmonary tuberculosis and relevant conclusions were drawn.Results Among the 17 cases of atelectasis,9 ones with pulmonary lobe or segment consolidation and lung volume astrophia shown by X-ray were misdiagnosed as lung cancer and 6 ones with a triangle or V-shape with tip pointing to the soft tissue shadow in hilus pulmonis shown by CT images were misdiagnosed as lung cancer.Among the 12 cases of mass-type,8 cases accompanied by increased hilar with lobulation in the mass and a few spots of calcification around the mass shown by X-ray were misdiagnosed as lung cancer and the cases with sharp edges,lobulation,and short-burr in the mass and patchy calcification in the center of the mass shown by CT images were diagnosed as lung cancer.There were 52 cases of caseous pneumonia with a large consolidation in pulmonary lobe or segment and nonuniform internal density shown by X-ray and CT images.While 35 cases were admixture with exudation,proliferation,fibrous cord-like change,pleomorphic tuberculoma and 1～2mm military nodules in pulmonary lobe shown by X-ray and CT images.Conclusion A comprehensive analysis of X ray,CT and bronchoscopy pathological manifestations is of great value for reducing misdiagnosis.