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目的探讨易误诊为肺癌的肺结核球的CT所见,以提高影像学诊断水平,避免误诊。方法回顾性分析山西省肺瘤医院术前经CT检查诊断为肺癌,并经手术病理证实的33例肺结核球患者的影像学特点。结果33例患者33处病灶均表现为结节或团块影;病灶直径为0.9~5.7cm,平均(3.04±0.15)cm。发生于双肺上叶及下叶背段25例;病灶内部发生空洞7例(21.2%,7/33),钙化10例(30.3%,10/33);病变边缘多发小毛刺8例(24.2%,8/33),长索条影10例(30.3%,10/33);同一肺野内可见卫星灶8例(24.2%,8/33),其他肺野可见钙化及粒状影4例(12.1%,4/33);胸腔积液1例(3.0%,1/33)。病变CT增强扫描表现:28例行增强扫描,其中不均匀强化占35.7%(10/28),蜂窝状强化占32.1%(9/28);28例中17例行CT平扫加增强扫描,强化部分CT值较平扫增加值为7~58HU,平均(24.1±1.8)HU。结论肺结核球CT及临床表现多样,蜂窝状强化、长索条影、卫星病灶有助于判断,同时要结合临床及实验室检查综合判断,才能降低不典型肺结核球的误诊。
Objective To investigate CT findings of tuberculosis balls that are easily misdiagnosed as lung cancer in order to improve the diagnostic level of imaging and avoid misdiagnosis. Methods The imaging features of 33 patients with pulmonary tuberculosis confirmed by surgery and pathology were retrospectively analyzed in Shanxi Province. Results All the 33 lesions showed nodules or masses in 33 cases. The diameter of the lesions was 0.9-5.7 cm, with an average of 3.04 ± 0.15 cm. (21.2%, 7/33), calcification in 10 cases (30.3%, 10/33), multiple burr on the margins of the lesion in 8 cases (24.2 %, 8/33). There were 10 long strips (30.3%, 10/33) in the same field; 8 (24.2%, 8/33) 12.1%, 4/33); pleural effusion in 1 case (3.0%, 1/33). Lesions CT enhanced scan performance: 28 cases of enhanced scanning, of which 35.7% (10/28), honeycomb-like enhancement accounted for 32.1% (9/28); 28 cases of 17 cases of CT scan and enhanced scanning, CT value of the enhancement part of the average increase of 7 ~ 58HU, an average of (24.1 ± 1.8) HU. Conclusion CT and clinical manifestations of pulmonary tuberculosis, honeycomb-like enhancement, long cable shadow, satellite lesions help to judge, combined with clinical and laboratory tests to determine the combined judgment, can reduce the misdiagnosis of atypical tuberculosis ball.