以反晕征为主要CT表现的继发性肺结核影像特征分析

目的探讨以反晕征为主要CT表现的继发性肺结核的影像学特征,以提高对此类不典型肺结核的诊断水平。方法搜集经临床证实的以反晕征为主要CT表现的继发性肺结核患者12例,结合相关文献,对其影像学和临床资料进行回顾性分析和总结。结果共发现反晕征病灶97个:上叶63个(以尖、后段为主),下叶背段19个,其余肺叶、肺段15个;1例单发,其余11例多发。CT或HRCT表现:12例均见反晕征,呈类圆形、边界较清,内见结节、树芽征,外环不光滑。病灶周围可见卫星灶和其他间质性改变,包括:小叶内网格状阴影(12/12)、微结节(12/12)、树芽征(10/12)、小叶间隔增厚(7/12)、细支气管壁增厚(6/12)和磨玻璃样密度影(5/12)。伴随征象:空洞1例(痰菌阳性),胸腔积液2例,实变3例,胸膜受累3例,钙化4例。结论以反晕征为主要CT表现的继发性肺结核患者影像学具有一定特征性,结合临床资料,可对其诊断和鉴别诊断提供一定帮助。

Aanlysis the Imaging Features of Secondary Pulmonary Tuberculosis with Reversed Halo Sign as the Main CT Manifestation

Objective To investigate the imaging features of secondary pulmonary tuberculosis with the main CT manifestations of reversed halo sign in order to improve the diagnostic ability of such atypical tuberculosis.Methods 12 clinically confirmed secondary pulmonary tuberculosis patients with the main CT manifestation of reversed halo sign were collected.Combined with relevant literature,the imaging and clinical data were retrospectively analyzed and summarized.Results(1)general situation:a total of 97 reversed halo sign lesions were found:63 in the upper lobe(mainly in the apical and posterior segment),19 in the dorsal segment of the lower lobe,and 15 in the remaining lobes and segments of the lung;One case was single,and the other 11 cases were multiple.(2)the CT or HRCT manifestations:①12 cases showed reversed halo sign with round shape and clear boundary,nodules and tree-in-buds can be seen in it,and the outer ring was not smooth.②satellite focus and other interstitial changes were observed around the lesion,including:intralobular reticulation(12/12),micronodules(12/12),tree-in-bud(10/12),interlobular septal thickening(7/12),bronchiole wall thickening(6/12)and ground-glass opacity(5/12).③accompanying signs:1 case with cavity(sputum positive),2 cases with pleural effusion,3 cases with consolidation,3 cases with pleural involvement and 4 cases with calcification.Conclusion The imaging features of secondary pulmonary tuberculosis with the main CT features of reversed halo sign have certain characteristics.And combined with clinical data,it can provide some help for its diagnosis and differential diagnosis.