误诊为肺癌的肺结核CT表现分析

目的分析误诊为肺癌的肺结核CT影像资料的原因。方法回顾性分析19例误诊为肺癌但经临床或病理确诊为肺结核患者的临床及CT资料。结果本组误诊病例按形态分3种类型:肺不张型2例,片状实变改变型2例,结节样或肿块样改变类型15例。19例中,轻度边缘强化9例,不均匀强化6例,均匀强化4例;增强前后平均CT值差小于26Hu16例,增强前后平均CT值差大于26Hu3例。结论老年患者及免疫力低下肺结核患者的影像表现呈多样性,临床上应综合分析各种征象及临床资料以减少肺结核的误诊。

The reasons of pulmonary tuberculous misdiagnosed as lung cancer on the CT appearances

Objective To analyze the reasons of pulmonary tuberculosis misdiagnosed as lung cancer on the CT appearances. Methods Clinical data and CT findings of 19 cases of pulmonary tuberculosis were performed CT plain scans, and CT enhanced scanning. All of the cases were conformed by clinical results or pathology. Results Among 19 patients, 15 cases were over 50 years old (84.2). The atypical CT appearances of pulmonary tuberculosis were induced by immunocompromised patients. The CT appearances of nodule or mass of pulmonary tuberculosis were found in 15 patients, while the CT appearances of patchy consolidation or atelectasis of pulmonary tuberculosis could be seen in 2 patients, with mediastinal and pulmonary hilar lymph nodes enlargement in 9 patients. 19 patients underwent contrast-enhanced CT scan, and the differences of CT values before and after contrast injection were more than 26HU in 2 patients . Conclusion The variable CT findings of pulmonary tuberculosis in the elderly or immunocompromised patients is the main reason of misdiagnosis, and improving understanding of comprehensive analysis of all imaging features and clinical data can reduce the CT misdiagnosis rate.