胸部结节病的影像诊断与鉴别诊断

    查期1，陆晔1，王宇鹏1，续晋铭2

    1.上海国际旅行卫生保健中心，上海 200335；2.上海杨浦区中心医院

    摘要：目的 分析胸部结节病的影像学特征及鉴别诊断方法，提高其影像诊断水平。方法回顾性的分析36例经确诊的胸部结节病的胸部平片及CT影像资料。结果X线胸片及胸部CT提示双侧肺门淋巴结增大27例（75%），无双侧肺门淋巴结肿大者为不典型胸部结节病，9例(25%)呈不典型表现；肺部异常表现在75%的病例都发现了微结节或结节，其他异常包括小叶间隔增厚15例（41.7%），纤维化表现12例（33.3%），磨玻璃影10例（27.8%），血管支气管集聚7例（19.4%），斑片或实变影5例（13.9%）。结论结节病临床表现多样而无特异性，容易引起误诊。CT检查能发现淋巴结肿大，又可显示肺内特征性改变，可提高诊断准确率。

    关键词：结节病；淋巴结增大；X线胸片；CT

    中图分类号：R56；R445　文献标识码：B

    Imaging and differential diagnosis ofpulmonary sarcoidosis

    ZHA Qi*，LU Ye，WANG Yu-peng，XU Jin-ming

    *Shanghai International Travel HealthcareCenter, Shanghai 200335 China

    Abstract:   Objective  To analyze the radiological features and differential diagnosis ofpulmonary sarcoidosis.  Methods   A total of 36patients with definite pulmonary sarcoidosis were retrospectivelyanalyzed by using X-ray chest films and CT scan. Results   X-ray and CT examination results showed 27cases with enlargement of lymph nodes in bilateral hilus pulmonisand 9 cases with atypical thoracic sarcoidosis. 75% of the caseswere micronodules or nodules, other abnormality included 15 cases(41.7%) of thickened interlobular septa，and 12 cases (33.3%) ofparenchymal fibrosis，10 cases (27.8%) of ground-glass opacity，7cases(19.4%) of central conglomeration of vessels and bronchioles,5 cases(13.9%) of patchy areas of alveolar consolidation. Conclusion   The clinical presentation of sarcoidosis isvaried and nonspecific and the diagnosis is easily mistaken. Butthere are some specific radiographic features of CT scan in findingenlarged lymph nodes, especially in finding pulmonaryinfiltrations．It is helpful to improve correct diagnostic rate.

    Key words:  Sarcoidosis；Enlargement of lymph nodes；X-ray chest films；ComputedTomography

    《中国国境卫生检疫杂志》6月刊