7例影像学表现为弥漫肺间质性病变的肺结核报道及文献复习

目的:通过对7例高分辨CT(High Resolution Computed Tomography,HRCT)表现为弥漫肺间质性病变的肺结核患者的相关资料进行分析,结合相关文献,提高对该类肺结核的认识。方法:分析本院2012.2~2015.3确诊的7例HRCT表现为弥漫肺间质性病变的肺结核的临床症状、体征、影像学资料及痰抗酸杆菌、结核菌素纯蛋白衍生物(Purified Protein Derivative,PPD)试验、T细胞斑点试验(T-SPOT.TB)、抗结核抗体、血常规、血沉(Erythrocyte Sedimentation Rate,ESR)等实验室检查、病理检查等资料。结果:6例经2次以上痰涂片阳性确诊为肺结核,1例抗结核治疗有效诊断为肺结核;弥漫肺间质性病变的肺结核患者HRCT上间质性病变的范围与抗酸杆菌的检出及发热症状的出现有关联;与盗汗、乏力、咯血等结核中毒症状及PPD、结核抗体、ESR等指标无明显相关关系。结论:弥漫肺间质性病变也可为肺结核的一种特殊表现,极易误诊为其他间质病变。当患者临床表现及实验室检查无特殊发现时,需考虑肺结核的可能并进行结核病相关检查,尤其是抗酸杆菌及肺组织病理检查,以尽早明确诊断。

The Imaging Findings of Pulmonary Tuberculosis Mimicking Diffuse Interstitial Lesions: a Report of 7 Cases and Literature Review

ABSTRACT Objective: To analyze the relevant data of pulmonary tuberculosis mimicking diffuse interstitial lesions on chest high resolution computed tomography (HRCT) manifestations and review literature to improve the diagnosis rate of the atypical tuberculosis. Methods: Retrospectively analyzed the clinical data of 7 pulmonary tuberculosis mimicking diffuse interstitial lesions patients who were diagnosed in the Xiangya Hospital of Central South University during February 2012 to March 2015. The clinical, signs, radiological, laboratory examination such as acid fast bacilli, Purified Protein Derivative ( PPD), T-SPOT.TB, anti tuberculosis antibody, routine blood test and erythrocyte sedimentation rate (ESR) and pathological features of those patients were summarized. Results: 6 cases were diagnosed as pulmonary tuberculosis by 2 or more sputum smear positive cases, and 1 cases were diagnosed as tuberculosis by diagnostic anti tuberculosis; As for the Pulmonary tuberculosis patients with diffuse interstitial changes, the range of interstitial changes on CT imaging was positive correlated with the positive number of acid fast bacilli and fever symptoms, but have no apparent correlation with tuberculosis symptoms of night sweats, fatigue, hemoptysis and laboratory examination of PPD, anti tuberculosis antibody, ESR. Conclusion: The diffuse interstitial changes can be a special performance of pulmonary tuberculosis, and misdiagnosed as other interstitial lesions easily. When the clinical and laboratory examination have no special finds, it is necessary to consider the possibility of tuberculosis and conduct tuberculosis related examination, especially the acid fast bacilli and pathological examination of lung tissue, to clarify the diagnosis as early as possible.