球形肺炎影像学诊断和鉴别诊断.docVIP

球形肺炎的影像学诊断与鉴别诊断 作者；杨玉娥，郝敬明，胡春艾，赵宝忠，师毅冰，夏平 ［摘要］? 目的? 探讨球形肺炎的影像学特点，以便与其他球形病灶，特别是周围型肺癌做出鉴别诊断。方法? 搜集32例经临床证实的球形肺炎的临床和CT、X线平片检查资料，进行回顾性分析。结果? 32例球形肺炎的主要表现：（1）病变两侧缘垂直于胸膜呈刀切样平直边缘，病变呈方形，是球形肺炎的特征；（2）病变局部及周围胸膜肥厚；病变所属支气管非狭窄性均匀增厚；肺门侧血管增多、增粗、扭曲，但无僵直及牵拉；病变非胸膜侧浅淡小片状高密度等强烈支持球形肺炎诊断；（3）抗炎治疗后病变疏散或明显缩小支持球形肺炎，提示可以继续抗炎治疗；（4）纵隔、肺门无明显淋巴结肿大，趋向支持肺炎诊断；（5）晕征、支气管充气征、病灶内肺泡征，不能过分强调其诊断价值。首诊平片显示病变的病例，平片可作为经济、简便有效的随诊方法。结论? CT检查是球形肺炎诊断和鉴别诊断的有效方法。??? ??? ［关键词］? 肺炎；体层摄影术，X线计算机；诊断，鉴别??? ??? Imaging and differential diagnosis of spherical pneumonia:a report of 32 cases??????? ［Abstract］? Objective? To evaluate the imaging features of spherical pneumonia （SP）and to differentiate it from other spherical lesions，particularly in pulmonary carcinoma.Methods? 32 cases of SP clinically proved were analyzed retrospectively.Results? The CT findings were as follows:（1）Bilateral margins of the lesions were perpendicular to pleura with a straight cutedge presenting a square sign.（2）Following manifestations strongly means SP:adjacent pleural thickness；symmetrical bronchial wall thickness without bronchial stenosis；intensified vascular markings but not hardening；small patches of slight high density around lesions apart from pleura （3）Reduce of lesions after antiinflammatory therapy was inclined to SP.（4）There were not mediastinal and hilar lymph enlargememt.（5）“Halosign”，“bronchiologram”，“vacuole” were not special to SP.Conclusion? CT exam is a effective way of diagnosis and differentiation to SP.??? ??? ［Key words］? pneumonia；tomography，X-ray computed；diagnosis，differentiation??? ??? 球形肺炎作为一种特殊类型的肺部炎症，被认为是误诊率较高的病变。笔者继1996年及1999年报告［1，2］后又搜集近年资料完整的病例，再行进一步分析、讨论，以进一步提高对本病的认识和诊断水平。??? ??? 1? 资料与方法??? ??? 1.1? 一般资料? 1987年6月～2004年12月就诊于我院的32例患者，男25例，女7例，年龄35～68岁，其中35～40岁5例，41～60岁23例，61～72岁4例，平均52.4岁。无临床症状12例，占38％，咳嗽13例，占41％，痰中带血丝7例，占22％，脓痰4例，胸痛10例，发热8例。实验室检查：白细胞增高（10×109/L）6例，血沉20 mm/1 h 5例，痰菌培养12例，阳性5例，其中肺炎球菌2例，肺炎克雷伯杆菌、肺炎链球菌、大肠杆菌各1例。痰查癌细胞21例，抗酸染色18例均阴性。纤维支气管镜检查13例，10例为病灶段支气管腔黏膜充血、水肿或脓性分泌物，未见肿瘤直接或间接征象。经皮肺穿