孤立结节型肺隐球菌病与肺癌的CT鉴别诊断.pdf

中华临床医师杂志( 电子版)2014 年9 月第8 卷第17 期 Chin J Clinicians(Electronic Edition),September 1,2014,Vol.8,No.17 ²3083 ² ²临床论著² 孤立结节型肺隐球菌病与肺癌的 CT 鉴别诊断 毛海霞 韩砆石 杨洋 孙希文 【摘要】 目的 对照分析肺内经病理证实的 33 例孤立结节型肺隐球菌病与 31 例肺癌的 CT 表现，探讨其鉴别诊断关键，以提高诊断正确率。方法 肺隐球菌病的 CT 表现复杂多样，尤其孤 立结节型难与肺癌鉴别，我们将被误诊为肺癌的33 例孤立结节型肺隐球菌病挑选出来与CT 表现类 似的 31 例肺癌进行比较，分析其影像特征，总结二者的 CT 鉴别诊断关键。结果 33 例肺隐球菌 病：左肺6 例、右肺27 例，上叶 15 例、下叶18 例，胸膜下26 例，分叶征4 例、毛刺征7 例、支 气管充气征28 例、晕征 11 例、支气管穿过征22 例；31 例肺癌：左肺 13 例、右肺18 例，上叶21 例、中叶2 例、下叶8 例，胸膜下14 例，分叶征20 例、毛刺征20 例、支气管充气征 10 例、晕征 3 例、支气管穿过征11 例。结论 孤立结节型肺隐球菌病与肺癌难以鉴别，但分叶、毛刺、支气管 充气征或穿过征、晕征对于其鉴别诊断可提供一定的参考意义，在临床工作中应结合患者的临床表 现及其他资料综合分析，配合支气管镜、穿刺活检等其他的检查方法，以做出正确诊断，减少误诊 的发生。 【关键词】 隐球菌病； 肺肿瘤； 体层摄影术，X 线计算机； 诊断，鉴别 Differential diagnosis of isolated nodule of pulmonary cryptococcosis and lung cancer by CT Mao Haixia, Han Fushi, Yang Yang, Sun Xiwen. Department of Radiology, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China Corresponding author: Sun Xiwen, Email: xiwensunfeike@126.com 【Abstract 】 Objective To compare and analyze CT characteristics of isolated nodule of 33 cases of pulmonary cryptococcosis and 31 cases of lung cancer, which were confirmed by biopsy, to study the key in their differential diagnosis and to improve their diagnostic accuracy. Methods The CT manifestations of pulmonary cryptococcosis were complicated, and especially the isolated nodule of pulmonary cryptococcosis was difficult to be identified from the isolated nodule of lung cancer. Isolated nodule of 33 cases of pulmonary cryptococcosis misdiagnosed as lung cancer were selected out to compare with isolated nodule of 31 cases of the lung cancer which had the similar CT manifestations in order to analyze the characteristics of the images and summarize the key of the differential diagnosis of them on CT. Results Out of the 33