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目的探讨肺硬化性血管瘤(PSH)的CT表现,分析其误诊原因。方法回顾性分析25例经手术病理证实的PSH患者临床及CT资料,总结其CT特征,并对术前诊断错误病例进行分析总结。结果 25例PSH,术前CT正确诊断10例,误诊为肺癌6例、结核球1例、炎性假瘤1例、孤立性纤维瘤2例、炎性肌纤维母细胞瘤1例,另4例考虑良性病变,性质不明。肿瘤位于左肺17例,其中上叶9例、下叶8例;右肺8例,其中上叶3例、中叶5例;中央型8例,周围型17例。病灶大小0.8 cm×0.8 cm~4.8 cm×3.7 cm,平均约2.7 cm×2.3 cm。24例CT表现为圆形或类圆形结节或肿块,边界清楚,11例浅分叶;1例为不规则肿块,边界尚清。CT平扫密度均匀18例,7例密度不均匀;增强扫描7例不均匀强化,中央轻度强化区,边缘明显强化;18例均匀明显强化,净强化值30~80HU,平均52.3 HU。9例病灶内或边缘可见钙化。血管贴边征10例,空气新月征2例,尾征4例,肺动脉为主征3例,血管集中征2例,胸膜牵拉凹陷1例,长毛刺1例,棘状突起1例。结论 PSH表现具有一定CT特征(血管贴边征,空气新月征,尾征等),仔细多平面观察及增强扫描可以提高术前正确诊断率。
Objective To investigate the CT findings of pulmonary sclerosing hemangioma (PSH) and analyze the causes of misdiagnosis. Methods The clinical and CT data of 25 cases of PSH confirmed by surgery and pathology were retrospectively analyzed. The CT features were summarized and the cases of preoperative diagnosis were analyzed. Results 25 cases of PSH were correctly diagnosed by CT before operation, 6 cases were misdiagnosed as lung cancer, 1 was tuberculoma, 1 was inflammatory pseudotumor, 2 was solitary fibroma, 1 was inflammatory myofibroblastoma and 4 was other cases Consider benign lesions, the nature of unknown. The tumor was located in the left lung in 17 cases, including 9 cases of upper lobe, 8 cases of lower lobe; 8 cases of right lung, 3 cases of upper lobe and 5 cases of middle lobe; 8 cases of central type and 17 cases of peripheral type. The size of the lesion was 0.8 cm × 0.8 cm ~ 4.8 cm × 3.7 cm with an average of 2.7 cm × 2.3 cm. 24 cases of CT showed round or round nodules or mass, the border is clear, 11 cases of shallow lobes; 1 case of irregular mass, the boundary is clear. The CT scan density was uniform in 18 cases, and the density in 7 cases was non-uniform. In 7 cases, the enhancement scan was inhomogeneous and the central mild enhancement area was markedly enhanced. The edge of the CT scan was markedly enhanced. The net enhancement value was 30-80HU with an average of 52.3 HU. 9 cases of calcification within the edge or visible. Vascular stick sign in 10 cases, air crescent sign in 2 cases, tail emblem in 4 cases, pulmonary arterial sign in 3 cases, vascular focus in 2 cases, pleural retraction depression in 1 case, long burr in 1 case, spicular protrusion in 1 case. Conclusions PSH has some CT features (vascular sticking sign, air crescent sign, tail sign, etc.). Careful multiplanar observation and enhanced scanning can improve the correct diagnosis rate before operation.