论文部分内容阅读
目的：探讨支气管血管束异常对于肺弥漫性病变的鉴别诊断价值。材料与方法：７２例肺弥漫性病变中，经病理证实１５例，其余５７例均经临床证实。其中肺弥漫性间质性病变３３例，肺弥漫性实质性病变５例，支气管病变１４例，播散性病变２０例。全部病例均做了胸部ＣＴ常规扫描，少数病例同时做了ＨＲＣＴ扫描，每例均由两位主任医师共同观察。结果：支气管血管束异常征象：（１）支气管血管束变细，主要见于肺弥漫性间质性病变和慢性支气管炎。（２）支气管血管束增粗，主要见于肺间质性病变及播散性病变，结节病与癌性淋巴管炎多呈串珠状增粗。（３）支气管血管束显示率增加，主要见于毛细支气管炎及播散性病变。结论：支气管血管束异常是肺弥漫性病变的ＣＴ征象，占８０％，支气管血管束异常无特异性，但呈串珠状增粗多见于结节病及癌性淋巴管炎。特发性肺间质纤维化及慢性支气管炎伴弥漫性间质性病变时，参考横膈位置具有鉴别诊断价值，前者横膈位置正常或升高，后者横膈位置低平。支气管血管束从正常演变到异常，表示病变的发展。
Objective: To investigate the differential diagnosis value of bronchovascular bundle abnormalities for diffuse lung lesions. MATERIALS AND METHODS: Of the 72 patients with diffuse lung disease, 15 were confirmed by pathology and the remaining 57 were clinically confirmed. Among them, 33 cases were diffuse pulmonary interstitial lesions, 5 cases were diffuse pulmonary substantive lesions, 14 cases were bronchogenic lesions and 20 were disseminated lesions. All cases were done chest CT scan, a few cases at the same time did a HRCT scan, each case by two chief physicians observed. Results: Abnormal signs of bronchovascular bundles: (1) bronchovascular bundles become thinner, mainly found in diffuse interstitial lung disease and chronic bronchitis. (2) thickening of bronchovascular bundles, mainly seen in interstitial lung disease and disseminated lesions, sarcoidosis and lymphangitis, mostly beaded thick. (3) increase in the rate of bronchovascular bundles, mainly seen in bronchiolitis and disseminated lesions. CONCLUSION: Bronchovascular bundle abnormalities are CT signs of diffuse pulmonary lesions, accounting for 80%. The abnormalities of bronchovascular bundles are nonspecific, but beaded thickening is more common in sarcoidosis and cancerous lymphangitis. Idiopathic pulmonary fibrosis and chronic bronchitis with diffuse interstitial lesions, the location of the reference diaphragmatic differential diagnosis, the former diaphragm position normal or elevated, the latter diaphragm position low flat. Bronchovascular bundle evolves from normal to abnormal, indicating the development of the lesion.