肺结核球的CT表现

目的探讨肺结核球的CT表现及其鉴别诊断。方法选择40例经临床和病理证实的肺结核球及40例经手术病理证实的周围型肺癌,将其资料进行对比分析。结果结核球好发于背侧肺段;密度大多均匀,边界光整,部分病例可见粗长毛刺;病灶内部常见弥散小钙化点,靠近边缘的弧形钙化,钙化面积大于病灶的10%;薄、厚壁空洞内缘光整或裂隙状空洞;增强扫描病灶不强化或环状强化;病灶周围的卫星病灶及胸膜增厚;肺门、纵隔淋巴结钙化,不肿大。抗结核治疗后复查病变吸收慢或略吸收、不吸收。结论综合分析各种CT征象,结合临床资料其诊断准确率可提高;对一时不能确诊的病例,应做CT引导下穿刺检查。

CT Appearances of Pulmonary Tuberculomas

Objective To discuss and analyze the CT appearances and differential diagnosis of pulmonary tuberculomas. Methods 40 cases of pulmonary tuberculomas proved by surgery and pathology were included in the study and compared to 40 cases of peripheral-type bronchogenic carcinomas, which were also surgico-pathologically proved. Results Tuberculomas were most found in the posterior segments of the lung and exhibited well-demarcated lesions of homogeneous density. Some lesions also possessed characteristics like rough spiculation, minute calcification within the lesion and marginal calcification. Thick-walled, thin-walled or stellate cavities were also found. On contrast enhanced scans, tuberculomas showed little or ring enhancement. In addition, satelite lesions or pleural thickening were often found near the tuberculomas. Hilar and mediastinal lymph-nodes were calcified but not enlarged. Anti-tuberbulosis therapy often resulted in little or even no absorption.Conclusion More accurate diagnosis of pulmonary tuberculomas could be made after careful analysis of all CT signs and the clinical data. CT-guided needle biopsy could be used when the dignosis could not be made clearly.