弥漫性泛细支气管炎的HRCT诊断.docVIP

弥漫性泛细支气管炎的HRCT诊断 【摘要】 　　目的　提高对弥漫性泛细支气管炎(DPB)的CT表现的认识, 探讨CT对DPB的诊断和鉴别诊断价值。方法 回顾性分析2003年6月-2007年12月本院收治的DPB 51例, 其中病理活检确诊3例, 临床诊断48例。结果　1. 胸部CT征象: ①弥漫性细粟粒样影伴树芽征, 无融合趋势,占88.24%; ②小(细)支气管扩张, 表现为小气道支气管“双轨征”和环状透光影, 部分病例可见支气管壁增厚, 占66.67%; ③炎性斑片影, 多为小斑片影, 占52.94%。2. 副鼻窦CT检查时多有慢性副鼻窦炎表现, 本组病例占73.33%。结论　CT是DPB诊断中必要手段, 高分辨率CT(HRCT)是最佳显示方法, 副鼻窦CT检查可为鉴别诊断提供佐证。 【关键词】 弥漫性泛细支气管炎 高分辨率CT 副鼻窦炎 　　CT Diagnosis and differentiation of diffuse panbronchiolitis 　　YOU Zheng-qian, ZHU Xiao-hua, MA Jun, JIANG Shen, PEN Gang, YU Dong, SUN Chun-yi, JIE Bing, YOU Xiao-fang 　　(Department of Radiology, The Shanghai Pneumology Hospital, Shanghai 200433, China) 　　【Abstract】 Objective To evaluate HRCT manifestations of diffuse panbronchiolitis (DPB) and the diagnosis. Methods fourty-three patients collected from June 2003 to December 2007 were retrospectively analyzed including pathologically diagnosis(n=3 cases), clinical-diagnosis (n=48 cases) (refer to Japanese secondary revised diagnostic criteria). Resultes 1.The CT appearances of DPB were as follow: ① Diffuse miliary pulmonary signs accompanied by tree-in-bud sign(88.24%), with fusion tendency; ② Small airway bronchiectasis(66.67%), such as the bronchiolar double track sign and small crico-lucency signs with bronchial wall thickening; ③ Small inflammatory patching signs(52.94%). 2. Chronic paranasal rhinitis(73.33%) by CT examination of accessory nasal cavity. Conclusion HRCT is an indispensable method for diagnosing DPB. CT examination of accessory nasal cavity may provide significant diagnotic evidence. 　　【Key words】 Diffuse panbronchiolitis; High resulation computed tpmography (HRCT); Nasosinusitis 　　弥漫性泛细支气管炎(diffuse panbronchiolitis, DPB) 是累及两肺细支气管和呼吸性细支气管壁全层的慢性炎症, 影像学表现缺乏特异性, 与多种肺部疾病有相似之处, 易于误漏诊。本文收集2003-2007年本院收治的DPB病例48例, 分析其CT特征、临床表现和实验室检查结果, 以期提高对本病的认识和诊断能力。 　　1　资料与方法 　　1.1　一般资料　收集自2003年6月-2007年12月本院诊断的DPB病例51例, 其中临床诊断48例, 病理确诊3例(胸腔镜开胸活检2例, TBLB活检1例)。男性24例, 女性27例; 年龄16岁~83岁, 平均52.83岁; 病史13天~41年, 平均10.24年。 　　1.2　临床资料　所有病例就诊时均有咳嗽、咳痰、气促;