腮腺结核病的CT表现

目的分析腮腺结核病的CT征象,提高对该病的认识与诊断水平。方法搜集2009年8月-2012年12月期间经手术病理及实验室检查证实的腮腺结核病患者9例,回顾性分析其CT表现并与病理检查结果对照。结果 9例患者均单侧发病,其中左侧7例,右侧2例。腮腺淋巴结结核病8例,均位于浅叶,3例单发,5例多发,共30枚病灶,直径约0.5~4.5 cm;平扫呈均匀稍低密度,增强后呈中等密度均匀实性强化25枚,环状强化4枚,花边状强化1枚,其中6例临近颈阔肌、皮下脂肪及皮肤不同程度增厚,6例伴颈部淋巴结增大。腮腺实质结核病1例,为弥漫性实质受累,累及深浅叶,平扫呈不均匀稍低密度,内见斑片状低密度影及结节状钙化灶,增强后整个腮腺实质弥漫性强化,局部见不规则液化、坏死,临近颈阔肌及脂肪层稍肿胀,不伴颈部淋巴结增大。结论腮腺结核病的CT征象与其病理改变密切相关,对于单侧腮腺浅叶占位病变,呈均匀实性强化、环状强化或花边状强化,临近颈阔肌、皮肤及皮下脂肪层增厚,伴颈部淋巴结增大,应考虑到腮腺淋巴结结核病的诊断。

The CT Features of Parotid Tuberculosis

Objective To analyze the CT features of parotid tuberculosis, in order to increase the cognition and diagnostic level of the disease. Methods Nine cases of parotid tuberculosis confirmed by pathology and laboratory examinations between August 2009 and December 2012 were collected retrospectively, and we analyzed their CT features which were then compared with pathological findings. Results All the 9 cases involved unilateral parotid, among which 7 were on the left side and 2 on the right side. Eight cases were parotid lymph node tuberculosis located in parotid superficial lobe, including 3 cases of single lesion and 5 cases of multiple lesions. There were 30 lesions in total with diameters ranging from 0.5 cm to 4.5 cm, presenting slightly lower density on CT scan. Twenty-five lesions were moderate homogeneous enhancement; four lesions were ring-like enhancement; and one lesion was lace-like enhancement. Six cases of parotid lymph node tuberculosis had thickened platysma, and subcutaneous fat and skin were at different levels. Six cases in the group were accompanied with enlargement of cervical lymph nodes. One case of parotid gland essence tuberculosis involved its superficial and deep lobe diffusely presenting heterogeneous slightly low density, in which we could see some patchy low density and nodular calcification. All the parotid gland essence presented diffuse enhancement with irregular liquefactive necrosis, mildly swelling of adjacent platysma and fat, without enlargement of cervical lymph node. Conclusions CT signs of parotid tuberculosis are closely related to its pathologic changes. For the lesions in unilateral parotid superficial lobe, we should consider the diagnosis of parotid lymph node tuberculosis with the signs of homogeneous enhancement, thickness of close platysma, subcutaneous fat and skin, and enlargement of cervical lymph node.