超声对肺周边局限性炎性病变的诊断价值

目的　为了提高超声对良性炎性病变声像图的鉴别诊断率。方法　根据高分辨率超声能显示的病灶形状、回声类型、病灶内细支气管及相关所见、与肺组织的边界清晰度、病灶表面形态（含局部脏胸膜）、胸膜肥厚或粘连以及后方回声的观察等７项指标， 分析了经手术或病理等确诊的４２例局灶性肺炎实变及球形炎性包块（脓疡、结核瘤、炎瘤）的声像图特征及病理意义。结果　发现病灶呈楔型或与肺交界部呈直边形， 病灶内见小支气管呈弥漫散在分布的不连续小等号状、星状或短线状等特征性图像对局灶性肺炎实变有较高的诊断价值。而病灶呈类圆形或肿块形、周边见强回声包膜对炎性肿块的诊断有重要的参考价值， 其内常可见支气管相或强回声斑点； 肺脓疡多见粗大的气体相， 结核瘤多见钙化强回声伴声影。另有２７例行超声引导细针穿刺组织学及细胞学检查，诊断率分别为４８％ 、６３％ ， 两种方法互补诊断率达８５％ 。结论　炎性病灶声像图分析有助提高超声鉴别诊断率； 超声随诊为炎性病变疗效判断提供依据； 超声引导穿刺活检安全有效， 多数患者可获适宜治疗并避免不必要的手术。

The value of ultrasonography and ultrasonically guided biopsy applied in peripheral pulmonary benign lesions

Objective To study the value of ultrasonographical diagnosis of peripheral pulmonary benign lesions(PPBL).Methods The sonographical data of 42 patients with pathologically proven PPBL (i.e. focal pneumonia, abscess, tuberculoma, and inflammatory pseudotumor)were collected. With comparison to pathological findings, we analyzed seven aspects of sonographical appearances of the lesion, which were shape, echo type, bronchiole or air phase, margin, relationship with surrounding lung and pleura, and posterior echo change.Results The focal pneumonia was diagnosed with high confidence when the lesion presented with wage like morphology, straight linear edge, and bronchiole or air phase inside focus. The inflammatory mass or tumor like disease was considered reliably if the lesion had round shape and capsular structure with high echogeneity. in 27 cases who had ultrasonicall yguided aspiration and biopsy (USAB), accuracy of 48% and 63% were obtained, respectively; however, a higher 85% with combination of both methods. Conclusions The ultrasonography and USAB help to successfully diagnose PPBL and select effective therapies.