摘要
目的研究 Kerley A 线的解剖、病理基础及其在弥漫性肺疾病中的鉴别诊断价值。方法煤工尘肺和煤尘接触者尸解肺标本28例,进行冠状面高分辨率 CT(HRCT)扫描、病理大切片和组织学切片制作及对照分析。同期搜集经病理或临床诊断为弥漫性肺病的患者176例进行 HRCT检查,并进行分析。结果 28例尸体肺标本的冠状面 HRCT 图像发现有 Kerley A 线17例。在大切片上观察有2种解剖基础:(1)小叶间隔线的串联组合,14例;(2)位于肺段和亚肺段之间不完整的纤维分隔,内含静脉和淋巴管,3例。组织病理检查所见:(1)间隔线内煤尘沉积和伴程度不等的纤维化;(2)间隔线内静脉血管壁增厚伴纤维化,扩张的静脉和淋巴管没有超过间隔线的轮廓;(3)间隔线内的水肿和炎性渗出。176例弥漫性肺病中发现 Kerley A线11例(6.3%),其中肺水肿5例、病毒性肺炎2例、癌性淋巴管炎2例、结节病1例、肺泡蛋白沉积症1例。结论在弥漫性肺病中,Kerley A线的数量少,难以识别,鉴别诊断价值有限。
Objective To study anatomic and pathological basis of Kerley＇s A line, and to evaluate the role of Kerley＇s A line in differential diagnosis of diffuse lung diseases（DLD）. Methods HRCT scans, gross specimen section（50-100μm thickness） and histologic section（5-8 μm thickness） were performed and analyzed comparatively on 28 dry lung specimens from the patients with coal worker＇s pneumoconiosis and occupational exposure history to coal dusts. At the same time, HRCT images of 176 patients with DLD were retrospectively reviewed for the detection of Kerley＇s A line. Results Kerley＇s A lines were seen in 17 of 28 lung specimens on coronal HRCT images. The anatomic basis of Kerley＇s A line represented the continuity of two or more thickened interlobular septa （14 cases） and incomplete fibrotic septa between segments or subsegments （ 3 cases）. Histologically, the linear opacities represented the deposits of coal dust, fibrosis, edema, inflammation, thickened vessel wall within interlobular septa. Kerley＇s A lines were present in 11 of 176 patients （6. 3% ） including interstitial pulmonary edema （5 cases）, viral pneumonia （2 cases）, lymphangitic carcinomatosis （2 cases ）, sarcoidosis （1 cases ） and pulmonary alveolar proteinosis （1 cases）. Conclusion Kerley＇s A line has a limited usefulness in the differential diagnosis of DLD because it is seen infrequently and not discernable.
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2007年第2期158-161,共4页
Chinese Journal of Radiology
