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目的: 回顾性分析成人不典型肺结核的CT 表现, 探讨与其他同影性疾病的鉴别方法, 做到早诊断早治疗, 减低病人的治疗成本和思想负担。方法: 选择性收集病变不典型, CT 影像检查曾误诊或诊断困难的病例30 例做回顾性分析。所有病例均有最后治疗结果或术后病理结果证实。结果: 节段性阴影12 例, 局灶性斑片及斑点状影8 例, 散在少数小结节样影4 例, 多发结节并空洞影3 例, 肺内弥漫分布的粟粒结节影3 例, 肺内阴影伴有肺门淋巴结及纵隔淋巴结肿大者9 例以青壮年病人吸收较快, 病程较短, 以粟粒影和大片影表现者吸收最快。讨论: 对于不典型的成人肺结核, 不能片面的强调或突出某一方面征象, 年龄因素、临床症状、实验室检查如结核菌素试验( PPD) 、痰结核菌培养、抗结核抗体阳性在鉴别诊断中有着重要意义。进一步正确认识及探究病变的影像特点, 对于正确的诊断提供了强有力的理论根据。

英文摘要:

Objective: To study CT findings of adult atypical pulmonary tuberculosis( AAPT) and the analysis of differential diagnosis. Methods: 30 patients( male: 18, female: 12; aged from 30~ 76) with AAPT, who had been misdiagnosed or hard to diagnose by CT, were selected and their clinical data were retrospectively analysed. All the patients had the last therapeutic effects and were confirmed by postoperative pathological result. Results: Among the patients, there were 12 cases of segmental shadow, 8 of focal patching and mottling shadow, 4 of a few sporadic nodule- like shadow, 3 of multiple tubercle and cavitary shadow, 3 of miliary nodule shadow, and 9 of intrapulmonary shadow with enlargement of lymphatic gland of hilus pulmonis and mediastina. The younger of the patients were recovered more quickly and their time of therapy was much shorter, in which, miliary and large shadows disappeared most quickly. Conclusion: For AAPT, we shouldn?? t put undue emphasis on a certain sign for age factor, clinical symptoms, laboratory examinations( such as PPD test, tuberculosis sputum culture and antituberculosis ant-i body positive) are very important in differential diagnosis. So early diagnosis and treatment can reduce the therapeutic cost and ideological burden of patients with AAPT.

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