原发肺真菌性肉芽肿的CT表现

目的 探讨原发肺真菌性肉芽肿的CT表现。方法 回顾性分析经手术病理证实的21例原发肺真菌性肉芽肿患者的影像及临床资料。21例均接受CT平扫,17例接受增强扫描。结果 CT表现呈单发结节或肿块17例,多发4例(12个结节或肿块),共计29个病灶,均分布于肺叶外周带;24个病灶(24/29,82.76%)与胸膜紧密相邻,其中11个(11/29,37.93%)与胸膜呈宽基底相连。病灶呈软组织密度,1个病灶内部可见小片状低密度影,空洞、空气新月征各见于1个病灶,未见钙化、脂肪及空气支气管征。20个病灶边缘模糊,3个见分叶,16个见毛刺征,11个伴卫星灶。17例增强扫描中,6例病灶呈明显强化,其余为轻-中度强化。纵隔内未见明显肿大淋巴结。结论 原发肺真菌性肉芽肿CT表现具有一定特征性,结合临床排除其他病变,可做出诊断。

CT manifestations of primary pulmonary fungal granuloma

Objective To investigate the CT findings of primary pulmonary fungal granuloma. Methods CT findings of 21 patients with pathologically confirmed pulmonary fungal granuloma were retrospectively analyzed. All 21 patients underwent plain CT, 17 underwent contrast enhanced CT examination. Results Solitary nodule or mass was found in 17 cases, while multiple lesions were found in 4 cases. Totally 29 lesions were found in all 21 cases, located in peripheral area of lung, among which 82.76% (24/29) closely correlated with pleural membrane, 37.93% (11/29) connected to the pleural membrane with wide base. On plain CT, the lesions showed soft tissue density, no punctate calcification nor fat was observed. Cavity and air crescent sign was noticed in 1 lesion, respectively, while lobulation was found in 3, spiculation in 16, satellite in 11 and ill-defined in 20 lesions. On contrast enhanced CT of 17 cases, 6 lesions enhanced significantly, the others enhanced slightly to moderately. No lymphadenhypertrophy in the mediastinal septum was observed. Conclusion CT appearances of primary pulmonary fungal granuloma have some characteristics. Combination of CT and clinical findings contributes to the diagnosis.