癌症肿瘤学：误诊为肺癌的肺结核CT表现分析_精品.docVIP

误诊为肺癌的肺结核CT表现分析 耿兴东 田忠福 束长青 (江苏省扬中市中医院，江苏 镇江 212200） 【摘要】 目的 分析误诊为肺癌的肺结核CT影像学表现特点，总结误诊原因。 方法 搜集19例误诊病例，其均行CT平扫及增强，全部经临床或病理确诊。 结果 19例患者中，50岁以上者15例。CT表现为结节或肿块型15例，片状实变型和肺不张型各2例，纵隔及肺门淋巴结肿大9例。结论 老年人肺结核其影像表现呈多样性，易误诊为肺癌，应根据各种征像进行综合分析，避免误诊。 【关键词】 肺结核；肺肿瘤；误诊；体层摄影术，x线计算机； Analysis of pulmonary tuberculous misdiagnosed as lung cancer on CT Geng Xing-dong, Tian Zhong-fu, Shu Chang-qing. Traditional Chinese Hospital of Yangzhong City, Jiangsu Province. Zhenjiang, 212200, P.R.China 【Abstract】Objective To investigate the atypical CT appearances of pulmonary tuberculosis, and to analyze the causes of misdiagnosis. Methods 19 cases of pulmonary tuberculosis were performed CT plain scans , all of them were performed CT enhanced scanning . All of the cases were conformed by clinical results or pathology. Results The CT appearances of nodule or mass of pulmonary tuberculosis were misdiagnosed usually . The CT appearances of patchy consolidation or atelectasis of pulmonary tuberculosis could be seen unusually. Conclusion The main cause of misdiagnosis lies on the variable CT findings of pulmonary tuberculosis in the elderly. It is a guarantee to reduce CT misdiagnosis rate by means of improving understanding of comprehensive analysis of all imaging features . 【Key words】 Pulmonary tuberculosis; Lung neoplasms; Misdiagnosis ; Tomography, X-ray computed 近年来，肺结核和肺癌发病率呈上升趋势，而二者有咳嗽、咯血等相似的临床表现，同时，肺结核和肺癌CT征像的又有其多样性和重叠性，常给鉴别诊断带来一定困难，成为做出正确影像诊断难题。本人搜集2004年6月-2010年10月误诊为肺癌的肺结核共19例进行了回顾性研究，分析其影像表现及误诊原因。为临床鉴别肺结核或肺癌提供一些帮助，避免一些结核病人不必要的剖胸手术和肺切除，争取保留较好肺功能。 1 材料与方法 本组19例中，男13例，女6例，年龄41-81岁，平均56岁，50岁以上者15例。既往有结核病史者4例，伴糖尿病史7例。临床表现为咳嗽、咳痰18例，咯血14例，发热10例，胸痛6例，胸闷5例，消瘦7例。纤维支气管镜活检确诊6例，胸部穿刺活检确诊4例，手术病理确诊8例，痰菌检测阳性1例。 患者均经多排螺旋CT平扫及增强扫描，CT机型包括Siemense Sensation 64型 ，GE Hispeed CT/ipro ,扫描参数：100~120kV，120~130mA，扫描层厚为1mm或0.625mm,肺窗窗宽为1400~1600HU,窗位为-600HU，纵隔窗窗宽为400HU，窗位为40HU，重建层厚分别为7mm或5mm，依病灶情况薄层1mm或0.625mm回顾性重建。后处理技术主要包括多平面重建（MPR）和容积再现(VR), 增强扫描经高压注射器注