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目的探讨高分辨率CT(HRCT)在肺泡蛋白沉积症(PAP)中的诊断价值。方法回顾我院2011年2月至2013年12月收治的7例PAP患者,所有患者均经病理诊断证实,进行常规胸片检查后,采用多层螺旋CT扫描仪进行肺部检查,首先行普通胸部平扫,之后行HRCT扫描,比较患者2种检查结果的影像学改变。结果胸部X线示,2例以肺门为中心呈“蝶翼”状片影,类似肺泡性肺水肿;2例两下肺广泛大片状阴影,类似肺部炎症;2例为左中上肺淡薄均匀的云雾状磨玻璃影;1例为两肺广泛分布的磨玻璃影及小结节状阴影。行HRCT检查后,在4例行普通CT检查呈大片状磨玻璃密度影的患者中,3例表现为两肺较淡的斑片状磨玻璃影,不呈叶段分布;1例表现为磨玻璃影,与正常肺组织间分界清楚,边缘可成角或呈弧形,如“地图样”改变;在其余3例普通CT表现为粟粒样结节影的患者中,2例HRCT表现为两肺磨玻璃影与小叶间隔增厚交织成“铺路石样”改变,其中1例可见蜂房征,1例肺泡实变融合成密度较高的斑片状实变阴影,并在肺泡实变区可见空气支气管征。结论 HRCT表现较普通CT更能清楚地显示PAP的特征性变化,可为PAP的影像学诊断提供一定的价值。
Objective To investigate the diagnostic value of high resolution CT (HRCT) in pulmonary alveolar proteinosis (PAP). Methods A retrospective study of 7 patients with PAP in our hospital from February 2011 to December 2013 was performed. All patients were confirmed by pathological diagnosis. After routine chest radiography, multi-slice spiral CT scanner was used for lung examination. First, Chest scan, followed by HRCT scan, comparing the two patients the results of the imaging changes. Results Chest X-ray showed that 2 cases had hilar central lesion as “wing-like” shadow, which was similar to alveolar pulmonary edema. There were 2 cases with extensive massive shadow on both lungs, similar to pulmonary inflammation; 2 cases were left In the light of the lungs uniform thin cloud ground glass; 1 case of extensive distribution of both lungs ground glass and nodular shadow. After HRCT examination, among the 4 patients who undergone large-scale ground-glass opacities in CT examination, 3 showed lighter patchy ground-glass opacities in both lungs without leaf segment distribution. One case showed as Ground glass shadow, with clear boundaries between normal lung tissue, the edge can be angular or arc, such as “map ” change in the other three cases of common CT showed miliary nodules, 2 cases of HRCT The performance of the two lung mill glass and interlobular septa thickening interweaved into a “paving stone-like” changes, including 1 case of hives sign, 1 case of alveolar consolidation into high density patchy shadows, and in Alveolar consolidation zone visible air bronchial sign. Conclusion HRCT can clearly show the characteristic changes of PAP more clearly than ordinary CT, which can provide certain value for the imaging diagnosis of PAP.