孤立结节型肺隐球菌病与肺癌的CT鉴别诊断

目的对照分析肺内经病理证实的33例孤立结节型肺隐球菌病与31例肺癌的CT表现,探讨其鉴别诊断关键,以提高诊断正确率。方法肺隐球菌病的CT表现复杂多样,尤其孤立结节型难与肺癌鉴别,我们将被误诊为肺癌的33例孤立结节型肺隐球菌病挑选出来与CT表现类似的31例肺癌进行比较,分析其影像特征,总结二者的CT鉴别诊断关键。结果 33例肺隐球菌病:左肺6例、右肺27例,上叶15例、下叶18例,胸膜下26例,分叶征4例、毛刺征7例、支气管充气征28例、晕征11例、支气管穿过征22例;31例肺癌:左肺13例、右肺18例,上叶21例、中叶2例、下叶8例,胸膜下14例,分叶征20例、毛刺征20例、支气管充气征10例、晕征3例、支气管穿过征11例。结论孤立结节型肺隐球菌病与肺癌难以鉴别,但分叶、毛刺、支气管充气征或穿过征、晕征对于其鉴别诊断可提供一定的参考意义,在临床工作中应结合患者的临床表现及其他资料综合分析,配合支气管镜、穿刺活检等其他的检查方法,以做出正确诊断,减少误诊的发生。

Differential diagnosis of isolated nodule of pulmonary cryptococcosis and lung cancer by CT

Objective To compare and analyze CT characteristics of isolated nodule of 33 cases of pulmonary cryptococcosis and 31 cases of lung cancer, which were confirmed by biopsy, to study the key in their differential diagnosis and to improve their diagnostic accuracy.Methods The CT manifestations of pulmonary cryptococcosis were complicated, and especially the isolated nodule of pulmonary cryptococcosis was difficult to be identified from the isolated nodule of lung cancer. Isolated nodule of 33 cases of pulmonary cryptococcosis misdiagnosed as lung cancer were selected out to compare withisolated nodule of 31 cases of the lung cancer which had the similar CT manifestations in order to analyze the characteristics of the images and summarize the key of the differential diagnosis of them on CT.Results Out ofthe 33 cases of pulmonary cryptococcosis, nodule in left lung was found in 6 patients, nodule in right lung was found in 27 patients, nodule in superior lobe was found in 15 patients, nodule in inferior lobe was found in 18 patients, subpleural nodule was found in 26 patients, lobulation was found in 4 patients, spiculation was found in 7 patients, air bronchogram was found in 28 patients, halo sign was found in 11 patients, bronchus through nodule was seen in 22 patients. Out of 31 cases of lung cancer, nodule in left lung was found in 13 patients, nodule in right lung was found in 18 patients, nodule in superior lobe was found in 21 patients, nodule in middle lobe was found in 2 patients, nodule in inferior lobe was found in 8 patients, subpleural nodule was found in 14 patients, lobulation was found in 20 patients, spiculation was found in 20 patients, air bronchogram was found in 10 patients, halo sign was found in 3 patients, bronchus through nodule was found in 11 patients.Conclusion It is difficult to identify isolated nodule of pulmonary cryptococcosis from isolated nodule of lung cancer, but lobulation, spiculation, air bronchogram or bronchus through nodule and halo sign can provide certain referential signi