不典型肺错构瘤的CT表现及误诊分析

摘要

Objective ToanalyzetheCTimagingfeaturesofatypicalpulmonaryhamartomas,soastounderstandthecausesof misdiagnosisandimprovetheaccuracyofdiagnosis.Methods 18caseswithatypicalpulmonaryhamartomasconfirmedbypathology inourhospitalwerecollectedretrospectively,including9 malesand9females.18caseswereexaminedbychestCTscans,among which,2caseswithplainscans,and16caseswithenhancedscans.TheresultsofCTimagingwereanalyzedbytwoassociatechief radiologistswithdoubleblindmethod,observingthelesionlocation,size,edge,border,density,enhancementfeatures,theremaining lungtissue,theageofonset,history,andclinicalmanifestations.Results Inall18cases,3caseswereendotracheallesion,ofwhich1 casewasinleftmainbronchus,theothertwowereinrightmiddleandupperbronchusrespectively,showingcalcificationdensityand subsequentatelectasis;15caseswereperipherallesions,including7casespresentingrightpulmonarynodulesand8casespresenting leftpulmonarynodules.Allperipheralcasesweresolitarypulmonarynoduleswithoutcalcificationandfatdensity.Thediameterof nodulesrangedfrom0.3cmto2.1cm.5casesshowedsmoothroundisolatednodulesand10casesshowedshallowlobulatednodules. In16casesofenhancedscan,1lesionshowedremarkableenhancement,6lesionsshowedslightlyenhancement,and9lesionsshowed nosignificantenhancement.Conclusion PulmonaryhamartomaislackofcharacteristicofCTimaging,whichisthemainreasonof misdiagnosis.Recognizingitsdiverseimageperformancesincludingshallowlobulation,roughedge,remarkableenhancementandetc. helpsusavoidmisdiagnosis.%目的 分析不典型肺错构瘤的影像表现,了解误诊原因并提高诊断的正确率.方法 回顾性分析经病理证实的18例CT误诊的不典型肺错构瘤影像学征象并进行双盲分析,观察病灶部位、大小、边缘、边界、密度、强化特点,其余肺组织情况以及患者发病年龄、病史、临床表现等.结果 共选取肺错构瘤患者18例,其中男9例,女9例.所有18例患者均行胸部CT扫描,其中平扫2例,增强扫描16例.18例肺错构瘤病例中,气管内病变3例,其中左主支气管1例,右中及右上支气管各1例,后2例病灶内可见钙化密度且继发相应肺段不张;周围型病变15例,其中右肺结节7例,左肺结节8例,所有周围型病例均为单发且均未见钙化及脂肪密度.病变直径0.3~2.1cm.其中光滑圆形孤立结节5例,浅分叶10例.16例增强扫描中,1例表现为明显强化,轻中度强化6例,无明显强化9例.结论 肺错构瘤CT表现缺乏特征性,是导致误诊的主要原因.了解其多样化的影像表现,包括边缘浅分叶、边缘毛糙、异常强化等,有助于减少误诊.