球形肺炎的CT诊断与鉴别诊断(附32例分析)

目的：探讨球形肺炎的影像学特点,以便与其它球形病灶特别是周围型肺癌鉴别。方法：搜集32例经临床证实的球形肺炎患者的临床检查资料,进行回顾性分析。结果：32例球形肺炎的主要表现：（1）病变两侧缘垂直于胸膜呈刀切样平直边缘,病变呈方形,是球形肺炎的特征。（2）病变局部及周围胸膜肥厚;病变所属支气管非狭窄性均匀增厚;肺门侧血管增多、增粗、扭曲,但无僵直及牵拉;病变非胸膜侧浅淡小片状高密度等支持球形肺炎诊断。（3）抗炎治疗后病变疏散或明显缩小支持球形肺炎,提示可以继续抗炎治疗。（4）纵隔、肺门无明显淋巴结肿大,趋向支持肺炎诊断。（5）“晕征”、支气管充气征和病灶内“肺泡征”,不能过分强调其诊断价值。结论：CT检查是球形肺炎诊断和鉴别诊断的有效方法。

CT diagnosis and differential diagnosis of spherical pneumonia

Objective To evaluate the imaging features of spherical pneumonia(SP)and to differentiate it from other spherical lesions,particularly from pulmonary carcinoma.Method 32 cases of SP clinically proved were analyzed retrospectively.Results The main CT findings were as follows:(1) Bilateral margins of the lesions were perpendicular to pleura with a straight cut-edge presenting a square sign.(2) The following manifestations strongly meaned SP:adjacent pleural thickness;symmetrical bronchial wall thickness without bronchial stenosis;hilar blood vessel proliferation,enlargement and kink but not rigidity;small patches of slight high density around lesions apart from pleura.(3)Shrink of lesions after anti-inflammatory therapy inclined to SP.(4) There were not mediastinal and hilar lymph enlargememt.(5) "halosign","bronchiologram" and "vacuole"were not special to SP.Conclusion CT examination is a effective way of diagnosis and differentiation to SP.