不典型肺结核的影像表现及误诊分析

目的 分析不典型肺结核误诊的原因及影像表现。方法 收集我院自2001年以来106例肺结核误诊病例，其中，男64例，女42例，年龄12～72岁，平均年龄27.5岁。全部病例均行CT平扫检查，81例有胸部X线片，由3位放射医师逐例回顾分析影像资料，找出误诊原因。结果 经手术病理或活检等证实，在106例肺结核患者中，被误诊为肺癌29例，肺炎40例，肺脓肿9例，肺结核合并肺癌12例，支气管扩张症6例，结节病2例，韦格纳肉芽肿病2例，转移瘤3例，淋巴瘤2例，以及肺段隔离症1例。误诊病例中表现为结节或肿块病灶42例，呈节段实变型或肺叶实变型阴影27例，支气管内膜结核11例，肺门或纵隔肿块14例，粟粒结节状或多发结核瘤5例。结论 肺结核影像表现不典型，在诊断中过分依赖某单一征象而忽视临床表现等为误诊的主要原因。

Imaging findings and misdiagnostic causes of atypical pulmonary tuberculosis

Objective To analyze the imaging findings and misdiagnostic causes of atypical pulmonary tuberculosis.Methods Since 2001 year,a hundred and six in-patients (64 men,42 women;aged 12-72 years,mean age,27.5 years)with clinically misdiagnosed pulmonary tuberculosis were collected in our hospital.All patients initially underwent CT plain scans of the chest.81 patients underwent additional chest radiography.Imaging data in all patients were retrospectively analyzed by three radiologists to find out the misdiagmostic causes.Results Surgery,pathology,fibro bronchoscopic biopsy or clinically antituberculotic therapy demonstrated that there were 29 lung cancer,40 pneumonia,9 lung abscess,12 pulmonary tuberulosis associated with lung cancer,6 bronchiectasis,2 sarcoidosis,2 Wegner's granulomatosis,3 metastatic tumor,2 lymphoma,and l pulmonary sequestration in 106 cases of misdiagnostic pulmonary tuberculosis.Among all patients,nodular or mass-like lesions were found in 42,segmental or lobular solid shadows in 27,bronchointimal tuberculosis in ll,hilar or medistinal masses in 14,and miliary nodular or multiple tuberculoma in 5.Conclusion During the diagnosis of pulmonary tuberculosis,atypical imaging fimdings,overestimating some sign and underestimating clinical manfestation are important causes which led up to the misdiagnosis.