摘要
目的 探讨局灶性机化性肺炎(FOP)的CT征象,总结CT误诊原因和防范措施。方法 回顾性分析2009年5月—2021年10月48例经手术病理检查或肺穿刺活检证实FOP的CT影像学资料。结果 本组48例有吸烟史29例,肺癌病史6例,肺结核病史5例,肺炎病史4例,余4例无明确既往史;其中37例首诊CT误诊,误诊为肺癌22例、肺炎性假瘤10例、肺结核5例;另11例无症状或症状较轻者均未误诊。肺部CT表现为孤立性结节或肿块影,其内部结构疏松,常见空气支气管征,血管无受侵犯表现,空洞内侧壁光滑无附壁结节,周边呈长毛刺改变。本组均经病理检查证实为FOP,其中30例行肺穿刺活检、12例行手术病理检查、6例行胸腔镜活检,确诊后临床均以足量、系统、规范的糖皮质激素治疗获得良好疗效,所有病例随访预后较好。结论 FOP缺乏特异性的临床表现,CT征象有一定特征性,对本病有极为重要的诊断和鉴别价值,确诊依赖病理检查。
Objective To explore the CT signs of focal organizing pneumonia(FOP),and to summarize the causes of CT misdiagnosis and preventive measures.Methods The CT imaging data of 48 patients with FOP confirmed by surgical pathological examination or lung biopsy from May 2009 to October 2021 were retrospectively analyzed.Results Twenty-nine of the 48 patients in this group had a history of smoking,6 had a history of lung cancer,5 had a history of pulmonary tuberculosis,4 had a history of pneumonia,and the remaining 4 had no clear past history.Among them,37 were misdiagnosed by CT at initial diagnosis,and they were misdiagnosed as lung cancer(n=22),pulmonary pseudotumor(n=10),and pulmonary tuberculosis(n=5);the other 11 cases of asymptomatic or mild symptoms were not misdiagnosed.Lung CT showed a solitary nodule or mass shadow,with loose internal structure,common air-containing bronchus sign,no invasion of blood vessels,smooth inner wall of the cavity without mural nodules,and burr-like changes around the nodule.All patients in this group were confirmed to be FOP by pathological examination.Among them,30 patients underwent lung puncture biopsy,12 patients underwent surgical pathological examination,and 6 patients underwent thoracoscopy biopsy.The curative effect and the prognosis of all cases were favorable.Conclusion FOP lacks specific clinical manifestations,and CT signs have certain characteristics,which have extremely important diagnostic and differential value for the disease.The diagnosis depends on pathological examination.
作者
陈亚晗
秦杨
曹倩
万钰磊
徐莹
李鸿波
CHEN Ya-han;QIN Yang;CAO Qian;WAN Yu-lei;XU Ying;LI Hong-bo(Department of Radiology,the Sixth Hospital of Wuhan Affiliated of Jianghan University,Wuhan 430015,China)
出处
《临床误诊误治》
CAS
2022年第8期8-12,共5页
Clinical Misdiagnosis & Mistherapy
关键词
局灶性机化性肺炎
误诊
肺炎性假瘤
肺肿瘤
结核
肺
体层摄影术
螺旋计算机
Focal organizing pneumonia
Misdiagnosis
Pulmonary inflammatory pseudotumor
Lung neoplasms
Tuberculosis,pulmonary
Tomography,spiral computed
