不典型肺结节病的CT表现误诊分析

发布时间：2018-04-03 10:08

  本文选题：结节病　切入点：肺　出处：《中国全科医学》2017年20期

【摘要】：目的分析肺结节病误诊的不典型CT表现,提高对肺结节病的CT诊断水平。方法选取2012年1月—2015年8月首都医科大学附属北京朝阳医院24例CT误诊,后经病理证实,符合临床诊断标准并进行治疗的肺结节病患者为研究对象,回顾性分析24例患者的临床表现、实验室检查资料及CT影像学资料。结果 24例肺结节病患者中,23例(95.8%)表现为不同程度肺部症状(咳嗽、咳痰,胸闷、气促,胸痛);8例(33.3%)同时伴全身非特异性症状(发热、乏力,体质量下降);4例(16.7%)伴有肺外表现(皮肤结节性红斑,双髋关节痛,神经性耳聋);1例(4.2%)无明显临床症状。红细胞沉降率升高率为47.6%(10/21);C反应蛋白升高率为52.3%(11/21);结核菌素试验(PPD)阳性率为1/9;支气管肺泡灌洗液(BALF)CD_4/CD_8比值升高率为8/18。CT表现:淋巴结增大不典型表现12例(50.0%),其中纵隔伴单侧肺门淋巴结增大5例(20.8%),单纯纵隔淋巴结增大5例(20.8%),淋巴结未见增大2例(8.3%);淋巴结融合8例(33.3%)。肺内不典型表现:磨玻璃密度影10例(41.7%),粟粒样结节影7例(29.2%),索条网状阴影6例(25.0%),类似树芽征表现5例(20.8%),结节及团块影4例(16.7%);胸膜病变10例(41.7%),其中增厚、钙化及胸腔积液2例(8.3%)。CT误诊的疾病包括:肺结核5例(20.8%)、淋巴瘤4例(16.7%)、肺间质纤维化4例(16.7%)、肺部感染3例(12.6%)、纵隔占位2例(8.3%)、肺转移瘤2例(8.3%)、肺癌2例(8.3%)、间质性肺炎2例(8.3%)。结论肺结节病的不典型CT表现较多,不具有特征性,充分认识肺结节病的不典型CT表现并结合临床综合分析,对疾病的诊断及治疗有重要的指导意义。
[Abstract]:Objective to analyze the atypical CT findings of pulmonary sarcoidosis and to improve the CT diagnosis of pulmonary sarcoidosis.Methods from January 2012 to August 2015, 24 patients with pulmonary sarcoidosis, who were misdiagnosed by CT and confirmed by pathology, met the criteria of clinical diagnosis and were treated.The clinical manifestations, laboratory data and CT imaging data of 24 patients were analyzed retrospectively.Results among the 24 patients with pulmonary sarcoidosis, 23 cases presented with pulmonary symptoms (cough, expectoration, chest tightness, shortness of breath, chest pain in 8 cases) and non-specific symptoms of the whole body (fever, fatigue).There were no obvious clinical symptoms (erythema erythema, pain of double hip joint, neurogenic deafness in 1 case).绾㈢粏鑳炴矇闄嶇巼鍗囬珮鐜囦负47.6%(10/21);C鍙嶅簲铔嬬櫧鍗囬珮鐜囦负52.3%(11/21);缁撴牳鑿岀礌璇曢獙(PPD)闃虫，

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