胸部放线菌病的CT表现并文献复习

目的探讨胸部放线菌病的CT表现，提高临床医师对该病的影像学诊断水平。方法回顾性分析广东省人民医院1995年1月至2008年3月确诊的4例胸部放线菌病病例并复习国内外相关文献。结果4例患者，分别通过CT引导下经皮肺穿刺活检（2例）和支气管镜下活检（2例）获得组织病理学诊断为胸部放线菌病。根据临床资料和影像学特征，此4例患者中1例为支气管放线菌病，3例为肺放线菌病。3例肺放线菌病患者cT表现存在共同的特征：软组织密度影，病灶多发（3例）；可见支气管扩张（2例）；增强扫描病灶环形强化，肿块中见大片低密度坏死，坏死区多发虫蚀样空洞（3例）；邻近胸膜增厚（3例），纵膈和肺门淋巴结肿大（3例）。结论肺放线菌病的典型CT表现为慢性节段性有空泡的肺部实变影，实变区域中有低密度区，周围组织强化，邻近胸膜增厚，纵膈和肺门淋巴结肿大。该病临床少见，容易误诊造成不必要的外科手术。

CT findings and rolated literature review of thoracic actinomycosis

Objective To characterize computed tomographic(CT) findings of thoracic actinomycosis. Meth-ods Chest CT scans obtained in 4 patients with histopathologically proved thoracic actinomycosis in the Guangdong Provincial People's Hospital from January 1995 to March 2008 were retrospectively analyzed and the related literatures were reviewed. Results Four cases was confirmed by CT-guided fine needle aspiration(2 cases) and biopsy with bronchoscope (2 cases). According to clinical data and imaging features, one was diagnosed as bronchial actinomycosis, three were diagnosed as pulmonary actinomycosis. The CT features of those three cases demonstrated the existence of common characteristics: soft tissue density mass, multiple lesions (three cases); visible bronchiectasis (two cases); contrast-enhanced CT image shows segmental consolidation containing central areas; cases), mediastinal and hilar lymphadenectasis (3 cases). Conclusion The typical CT feature of parenchymal aetinomycosis is chronic segmental air-space consolidation containing necrotic low-attenuation areas with frequent cavity formation, adjacent pleural thickening, mediastinal and hilar lymphadenectasis. Thoracic actinomycosis is a kind of relative infrequent disease and easily misdiagnosed.