肺部孤立团块伴空洞的CT诊断及鉴别诊断

目的 观察肺部孤立团块伴空洞(肺癌、肺结核、肺脓肿)的CT特征.方法 回顾分析经病理及临床证实的肺癌、肺结核及肺脓肿伴空洞各40例,分析记录病变及周围相关病变特点.结果 分叶:肺癌35例(87.50%),肺结核及肺脓肿仅分别2和3例.毛刺:肺癌29例(短毛刺占93.10%),肺结核23例,肺脓肿4例,均为长毛刺.内壁:肺癌空洞不光整29例,肺结核及肺脓肿分别2和6例.卫星灶:肺癌及脓肿周围以片絮为主,肺结核除片絮外,结节及分支线状影发生率100%.肺癌卫星灶于病变远端占87.50%,肺结核和肺脓肿卫星灶不限于远端;近端支气管壁:6例肺癌近端支气管壁不规则增厚及软组织密度影,肺结核及肺脓肿近端支气管壁均匀增厚,无软组织影;增强后扫描,肺癌及脓肿全部强化,肺结核仅3例环形包膜强化,其余无强化.以上征象差异均具有统计学意义.结论 肺癌、肺结核及肺脓肿伴空洞具有各自影像特征,CT(包括薄层及HRCT)扫描对其鉴别诊断具有重要价值.

CT diagnosis and differential diagnosis of pulmonarysolitary mass with cavity

Objective To observe the CT features of solitary cancer, tuberculosis and abscess nodules with cavity. Methods The cavities of lung cancer, tuberculosis and lung abscess confirmed by histopathology and clinical study were retrospectively analyzed. CT findings and surrounding pulmonary parenchyma of these lesions were recorded. Results Notch: 35 cases in lung cancer (87.50%), 2 in tuberculosis and 3 in abscess; spiculation: 29 in lung cancer (short speculation 93.10%), 23 in tuberculosis and 4 in abscess; irregularity of internal wall: 29 in lung cancer, 2 in tuberculosis and 6 in abscess; satellite lesions: cotton-piece-shape centered surrounding the lung cancer and tuberculosis, while alveolar consolidation and tree-in-bud (100%) centered in abscess; 87.5% of the lesions located in the distance of the lung cancer; bronchial wall near the heart: the bronchial wall thickening (irregularity) as well as soft tissue mass in 6 cases with lung cancer, the bronchial wall thickening and regularity in 11 tuberculosis and 24 abscess. On contrast-enhanced CT scan, enhancement of all lung cancer and the abscess, ring enhancement in 3 tuberculosis lesions, and the other tuberculosis had no enhancement. All the different values had statistical significance. Conclusion Some CT features are significantly useful for differential diagnosis of solitary cavitary nodules.