發(fā)布時(shí)間：2018-04-03 10:08

  本文選題：結(jié)節(jié)病　切入點(diǎn)：肺　出處：《中國(guó)全科醫(yī)學(xué)》2017年20期

【摘要】：目的分析肺結(jié)節(jié)病誤診的不典型CT表現(xiàn),提高對(duì)肺結(jié)節(jié)病的CT診斷水平。方法選取2012年1月—2015年8月首都醫(yī)科大學(xué)附屬北京朝陽(yáng)醫(yī)院24例CT誤診,后經(jīng)病理證實(shí),符合臨床診斷標(biāo)準(zhǔn)并進(jìn)行治療的肺結(jié)節(jié)病患者為研究對(duì)象,回顧性分析24例患者的臨床表現(xiàn)、實(shí)驗(yàn)室檢查資料及CT影像學(xué)資料。結(jié)果 24例肺結(jié)節(jié)病患者中,23例(95.8%)表現(xiàn)為不同程度肺部癥狀(咳嗽、咳痰,胸悶、氣促,胸痛);8例(33.3%)同時(shí)伴全身非特異性癥狀(發(fā)熱、乏力,體質(zhì)量下降);4例(16.7%)伴有肺外表現(xiàn)(皮膚結(jié)節(jié)性紅斑,雙髖關(guān)節(jié)痛,神經(jīng)性耳聾);1例(4.2%)無(wú)明顯臨床癥狀。紅細(xì)胞沉降率升高率為47.6%(10/21);C反應(yīng)蛋白升高率為52.3%(11/21);結(jié)核菌素試驗(yàn)(PPD)陽(yáng)性率為1/9;支氣管肺泡灌洗液(BALF)CD_4/CD_8比值升高率為8/18。CT表現(xiàn):淋巴結(jié)增大不典型表現(xiàn)12例(50.0%),其中縱隔伴單側(cè)肺門(mén)淋巴結(jié)增大5例(20.8%),單純縱隔淋巴結(jié)增大5例(20.8%),淋巴結(jié)未見(jiàn)增大2例(8.3%);淋巴結(jié)融合8例(33.3%)。肺內(nèi)不典型表現(xiàn):磨玻璃密度影10例(41.7%),粟粒樣結(jié)節(jié)影7例(29.2%),索條網(wǎng)狀陰影6例(25.0%),類(lèi)似樹(shù)芽征表現(xiàn)5例(20.8%),結(jié)節(jié)及團(tuán)塊影4例(16.7%);胸膜病變10例(41.7%),其中增厚、鈣化及胸腔積液2例(8.3%)。CT誤診的疾病包括:肺結(jié)核5例(20.8%)、淋巴瘤4例(16.7%)、肺間質(zhì)纖維化4例(16.7%)、肺部感染3例(12.6%)、縱隔占位2例(8.3%)、肺轉(zhuǎn)移瘤2例(8.3%)、肺癌2例(8.3%)、間質(zhì)性肺炎2例(8.3%)。結(jié)論肺結(jié)節(jié)病的不典型CT表現(xiàn)較多,不具有特征性,充分認(rèn)識(shí)肺結(jié)節(jié)病的不典型CT表現(xiàn)并結(jié)合臨床綜合分析,對(duì)疾病的診斷及治療有重要的指導(dǎo)意義。
[Abstract]:Objective to analyze the atypical CT findings of pulmonary sarcoidosis and to improve the CT diagnosis of pulmonary sarcoidosis.Methods from January 2012 to August 2015, 24 patients with pulmonary sarcoidosis, who were misdiagnosed by CT and confirmed by pathology, met the criteria of clinical diagnosis and were treated.The clinical manifestations, laboratory data and CT imaging data of 24 patients were analyzed retrospectively.Results among the 24 patients with pulmonary sarcoidosis, 23 cases presented with pulmonary symptoms (cough, expectoration, chest tightness, shortness of breath, chest pain in 8 cases) and non-specific symptoms of the whole body (fever, fatigue).There were no obvious clinical symptoms (erythema erythema, pain of double hip joint, neurogenic deafness in 1 case).綰㈢粏鑳?yōu)娌夐檷鐜囧崌楂樼巼湄?fù)47.6%(10/21);C鍙嶅簲铔嬬櫧鍗囬珮鐜囦負(fù)52.3%(11/21);緇撴牳鑿岀礌璇曢獙(PPD)闃蟲(chóng)，

本文編號(hào)：1704734