非黄型结节病21例临床分析

目的 提高对非典型结节病的认识,方法 回顾性分析了２１例非典型结节病的临床资料,所有病例以病理检查证实。结果 不典型结节病影像学可表现为：１）肺内病变;有孤立结节影,肺不张,单侧,双侧肺实变,双肺栗粒样结节。（２）单纯纵隔淋巴结变;有纵隔肿物,纵隔淋巴结肿大和单侧肺门淋巴结肿大,纵隔单纯淋巴结肿大。（３）胸膜病变;有液,气胸,胸膜增厚。（４）肺门病变：有单侧肺门淋巴 肿大和纵隔淋巴 肿大,双侧肺门     

老年前期及老年人胸部结节病的CT表现

目的：总结老年前期及老年胸部结节病患者的CT表现。方法：回顾性分析25例确诊的老年前期及老年胸部结节病患者的CT图像。结果：9例CT呈典型表现，16例CT呈不典型表现，其中纵隔和一侧肺门淋巴结肿大者3例（3／25），无肺门淋巴结肿大的单纯纵隔淋巴结肿在者7例（7／25），无纵隔淋巴结肿大的单侧肺门淋巴肿大者1例（1／25），仅有肺部改变而无胸部淋巴结肿大者5例（5／25）。后者在首诊时全部误诊。结论：老年人胸部结节病的CT表现多不典型，认识此种表现在诊断中很重要。     

肺结节病误诊原因分析

目的提高对肺结节病的认识和诊断符合率,减少误诊。方法对2002年2月～2010年2月经病理确诊为肺结节病22例患者的临床资料进行回顾性分析。结果22例患者年龄36～69岁,平均41岁,女性18例,男性4例,临床表现不典型,胸部CT表现为肺门（双侧为主）,纵隔淋巴结肿大,易误诊为肺结核或肿瘤,22例均行病理学检查确诊。结论肺结节病明确诊断需要结合临床表现,影像学,纤维支气管镜,纵隔镜／胸腔镜,皮肤黏膜、淋巴结活检进行病理检查。     

肺结节病的影像学表现

结节病多累及肺部，主要靠影像学诊断及判断预后，本综述了结节病的胸片表现，并对其进行分期，对典型和非典型的胸片进行分析。胸部ＣＴ扫描提高纵隔及肺门淋巴结肿大的检出率，是发现结节病患肺实变的敏感方法。     

32例结节病临床分析

目的探讨结节病的临床特点及诊断方法。方法对32例经组织病理学确诊的结节病患者的临床资料进行分析。结果平均发病年龄40.3岁,女性多于男性;呼吸系统症状主要表现为咳嗽、胸闷、气促;肺外表现主要为周围淋巴结肿大、发热、皮肤结节;X线胸片及胸部CT提示双侧肺门肿大27例,单侧肺门肿大3例,纵隔淋巴结肿大28例;血清血管紧张素转化酶(SACE)敏感性68.8%;各种活检方法中,纵隔镜淋巴结活检及外科电视胸腔镜下肺活检阳性率最高。结论结节病临床表现多样而无特异性,尽可能行组织病理学检查明确诊断。     

肺结节病的影像学表现

结节病多累及肺部,主要靠影像学诊断及判断预后,本文综述了结节病的胸片表现,并对其进行分期,对典型和非典型的胸片进行分析。胸部CT扫描提高纵隔及肺门淋巴结肿大的检出率,是发现结节病患者肺实变的敏感方法。     

以胸膜广泛侵犯为表现的结节病一例并文献复习

<正>结节病因其最常累及肺及淋巴系统,在肺部最常表现为肺门淋巴结肿大和肺纤维化,故在内科学上被列为间质性肺疾病的范畴~([1])。结节病Ⅱ期表现为双肺门淋巴结肿大及肺内病变时鉴别诊断困难,尤其是与结核病的鉴别。结节病虽属于多系统受累的疾病,但胸膜累及并出现双侧胸腔积液并不常见。现将我科经胸腔镜诊断表现为胸膜广泛累及的1例结节病报道如下,以提高临床医师对于该病的认识。临床资料患者,女性,63岁。主因咳嗽6个月、气短1个月入院。     

198例结节病的诊断方法及其要点分析

目的 了解结节病的临床特征、影像学改变和病理资料，以探讨其诊断方法。方法回顾分析我院自1980年来经病理确诊的198例结节病患者的临床资料。结果 结节病有以下临床特征。(1)以中青年患者为主：平均年龄35．1岁；(2)女性多于男性：女125例(63．1％)，男73例(36．9％)；(3)病程长：平均病程6．1个月；(4)分期：0期3例，Ⅰ期86例，Ⅱ期91例，Ⅲ期18例；(5)呼吸道症状轻，肺外以浅表淋巴结肿大，皮肤结节和眼部受累，有35．4％体检发现，64．6％因咳嗽、胸闷、发热、胸痛等；(6)胸部X线、CT检查显示：肺门、纵隔淋巴结肿大伴或不伴两肺病变；(7)纵隔镜淋巴结活检应用价值最高，浅表淋巴结，皮下结节，支气管黏膜及经气管镜肺活检值得临床推广。结论 结节病易误诊，误诊率39．9％。有上述胸部X线、CT检查特征时，均应警惕本病可能，尽可能作组织病理学检查明确诊断，严防漏诊和误诊。     

61例胸内结节病的诊断分析

６１例胸内结节病的诊断分析山东省胸科医院（２５００１３）王进鸿章橘山东省地方病防治研究所丛树玲自１９８３年以来，我院遇到６１例胸内结节病患者，现分析如下。资料分析：６１例患者均因肺门淋巴结、纵隔淋巴结肿大和（或）肺部病变就诊。男２１例，女４０例；年龄...     

应用纵隔镜检查术诊断纵隔淋巴结结核和结节病

目的寻找和探索一种区分良恶性纵隔淋巴结肿大,确诊纵隔淋巴结结核和结节病的有效方法。方法应用纵隔镜检查术对胸部ＣＴ或ＭＲＩ检查发现的纵隔淋巴结肿大、临床诊断不清疑为淋巴结结核或结节病者实施此检查,获取病理组织,做出明确诊断,以指导治疗。结果本组２５例患者接受纵隔镜检查,其中１６例被病理诊断为纵隔淋巴结结核,占６４％（其中增殖性结核１４例,占８８％;干酪性结核２例,占１２％）;８例诊为结节病,占３２％;１例难于确定为淋巴结结核或结节病,占４％。非典型的纵隔淋巴结结核与结节病在影像诊断上难于区别,而且在显微镜下也极易混淆。这两种疾病常与其他原因引起的纵隔淋巴结肿大（如恶性淋巴瘤、淋巴结转移性癌等）在影像检查中不易区分,极易误诊,造成误治。本组病例术前影像诊断及临床诊断大多考虑为恶性疾病,其中第一诊断为恶性疾病的占８４％（２１／２５）,有２例已在外院接受化疗。结论对于纵隔区域发现的肿大淋巴结,纵隔镜检查术是一种很有价值的确诊手段,治疗前应尽一切可能获取明确的病理诊断     

83例胸内结节病临床特征及诊断方法分析

目的:探讨胸内结节病的临床特征及诊断方法,尤其是支气管镜检查在胸内结节病诊断中的应用价值。方法:总结2000年3月至2009年7月在上海长海医院住院的83例胸内结节病患者的临床资料,分析其实验室检查及病理活组织检查(活检)方法的特点。结果:①患者症状具有多样性,胸部影像学检查是早期诊断的重要手段;②确诊依赖组织病理学检查;③经支气管镜活检及经纵隔镜淋巴结活检诊断阳性率较高。结论:结节病的临床表现无特异性,明确诊断需结合各项检查结果综合分析。对有肺门、纵隔淋巴结肿大的可疑病例,应尽可能做组织病理学检查以明确诊断。     

The features of cases of intrathoracic lymphomas

In this study, 18 patients who had been diagnosed as intrathoracic lymphoma between January 1999 and August 2001 had been evaluated retrospectively to guide the diagnostic approaches. 12 (66.6%) of the patients were male and 6 (33.4%) were female. The mean age was 46.47 +/- 17.31. The leading symptoms were disapnea, cough, weight loss and fever. The most frequently seen laboratory findings were decreased hemoglobin and hematocrit rates (72.2%) and increased Lactate Dehydrogenase levels (44.4%). Radiologically, 18 (100%) patients had mediastinal lymph node enlargement, 8 (44.4%) patients had bilateral and 6 (33.3%) had unilateral hilar enlargement, 3 (16.6%) patients had appearance of mass lesion, 1 (5.5%) had appearance of consolidation, 2 (11.1%) patients had atelectasis, 3 (16.6%) patients had appearance of pleural effusion. Histopathological diagnosis were undertaken with lymph node biopsies in 11(61.1%) patients, with bronchial biopsies in 2 (11.1%) patients, with pleural biopsy in 1 (5.5%) patient, with lymph node and bronchial biopsies in 3 (16.6%) patients, with lymph node and pleural biopsies in 1 (5.5%) patient. 11 (61.1%) patients were diagnosed as Hodgkin Disease (nine as nodular type, two as mixed cellular type). 7 (38.9%) patients were diagnosed as non Hodgkin Lymphoma. After taking diagnosis the patients were sent to medical oncology clinics for follow up and therapy. These findings showed that different locations of intrathoracic lymphomas could be seen with nodal or extranodal presentations so it must be taken into account in differential diagnosis of other pathological conditions.     

胸内结节病60例临床分析

目的　探讨结节病的临床特点及诊断方法。方法　对 1992 - 0 1～ 2 0 0 3- 0 4期间上海市胸科医院住院的经病理证实的结节病患者 6 0例作一回顾性分析 ,总结临床特点并对不同的诊断方法进行评价。结果　结节病主要累及器官以肺门及纵隔淋巴结最常见。肺功能主要为限制性通气障碍及弥散功能下降。纤支镜支气管黏膜活检和经支气管镜肺活检 (TBLB)阳性率分别为 80 %和 77 8% ,浅表淋巴结和皮肤结节活检阳性率分别是87%和 87 5 %。结论　该病临床表现非特异性。外周淋巴结活检 ,纤支镜支气管黏膜活检 ,TBLB ,简便易行 ,阳性率高 ,创伤性小 ,对结节病的诊断有较高的临床实用价值。     

Computed tomographic scanning in sarcoidosis

Sarcoidosis is a granulomatous disease of unknown etiology that involves the lungs or intrathoracic lymph nodes in more than 90% of patients. The clinical spectrum of sarcoidosis is protean, but pulmonary manifestations often dominate. Chest radiographs are abnormal in 90 to 95% of patients with sarcoidosis; the most characteristic feature is bilateral hilar lymphadenopathy (BHL), present in 50 to 80% of patients. Pulmonary parenchymal infiltrates are present in 25 to 50% of patients. In this article, we review the radiographic features of sarcoidosis (both typical and atypical), and the impact of chest radiographic stage on long-term prognosis. Computed tomographic (CT) scans are more sensitive than chest radiographs in delineating parenchymal, mediastinal, and hilar structures, and distinctive CT patterns may be virtually pathognomonic for sarcoidosis in some patients. Routine CT scan is not appropriate to diagnose or manage sarcoidosis, but CT may be invaluable in patients with atypical clinical or chest radiographic findings or specific complications of sarcoidosis (pulmonary or extrapulmonary), or to assess prognosis. High-resolution thin-section CT scans (HRCT) may be helpful in selected patients with stage II or III sarcoidosis to discriminate active inflammation from irreversible fibrosis. This article discusses the salient HRCT features of sarcoidosis, accuracy of CT in the differential diagnosis, and correlations of HRCT with disease extent and activity, pulmonary function, and lesion reversibility.     

肺结节病的临床研究

目的 提高对结节病的认识。方法 回顾分析经病理确诊的结节病21例患的临床资料。结果 胸部结节病多数有双侧肺门阴影对称性增大占（71％）。62．5％的患支气管肺泡灌洗液中CD4／CD8＞3．5。90．4％的患PPD为阴性。纤支镜支气管粘膜和肺活检及胸部小切口开胸肺活检病理确诊阳性率分别为80％和100％。结论 胸部X线,PPD及支气管肺泡灌洗液CD4／CD8检查对诊断结节病十分重要。经纤支镜支气管粘膜和肺活检和胸部小切口开胸肺活检简便易行,创伤小,阳性率高的方法,特别是后对疑难病例的确诊有重要的临床价值。     

A study on the problems of the radiologic manifestations in sarcoidosis

Unilateral hilar adenopathy, which is considered as an atypical manifestation of sarcoidosis, appeared only on the initial stage, and eventually became bilateral. The adenopathy may occur in all groups of the mediastinal lymph nodes. The roentgenological findings of the pulmonary parenchymal lesions include interstitial, alveolar, miliary and fibrous lesions. The alveolar involvement, and the pathological consideration of pseudoalveolar manifestations in X-ray film were discussed.     

CD8+ cell-dominant alveolitis in pulmonary sarcoidosis

A 55-year-old woman had bilateral hilar lymphadenopathy and retinouveitis. Microscopic examination of a biopsy specimen from a mediastinal lymph node revealed noncaseating epithelioid cell granulomas. Since granulomatous diseases of infectious origin and sarcoid reaction were reasonably excluded, she was diagnosed as having pulmonary sarcoidosis. Bronchoalveolar lavage findings were atypical in that the ratio of helper T cells to suppressor T cells (CD4/8 ratio) was 0.5 in two separate examinations, despite a moderately increased proportion of lymphocytes. Immunohistochemical examination of the lymph node also showed a predominancy of suppressor T cells. The inversion of the CD4/8 ratio suggests the presence of heterogeneity in the immunoregulatory mechanism in pulmonary sarcoidosis and may have a prognostic significance.     

结节病肺内、外影像学特征及肺外累及预测因素的初探

目的 总结结节病肺内、外影像学特征,结合患者临床资料探究结节病肺外累及的预测因素.方法 回顾性分析2012～2020年四川大学华西医院病理学明确诊断为结节病的103例住院患者临床、实验室及影像数据,观察及分析结节病肺内结节分布、纵隔淋巴结增大及肺外器官累及的影像表现,运用最小绝对收缩选择算子法(LASSO法)寻找其肺外...     

Posterior mediastinal sarcoidosis

We report two cases of enlargement of the posterior mediastinal lymph nodes due to sarcoidosis. Bilateral hilar enlargement, pulmonary parenchymal involvement, or extrathoracic manifestations of sarcoidosis were absent. A diagnostic thoracotomy had to be performed in both instances.