论文部分内容阅读
目的进一步认识老年肺结核的X线、CT特征,分析总结误诊原因。方法抽取60例经手术、临床及病理确诊的老年不典型肺结核的完整资料,男32例,女28例,年龄60~80岁,平均67岁。均摄胸部正位片,48例摄胸部侧位片,23例行CT检查,13例行增强CT,14例行支气管镜检查,12例穿刺活检确诊。采用双盲法读片,总结X线及CT表现,分析其误诊原因。结果60例不典型肺结核中结节肿块型14例,其中边缘光滑者11例,浅分叶者3例,支气管内膜结核12例,节段实变及肺叶型各6例,空洞型6例,下肺叶结核5例,多发结核瘤4例,粟粒结节状结核3例,肺不张型结核2例。共误诊22例,其中误诊为肺癌12例,炎症4例,转移癌2例,肺泡癌1例,肺不张2例,炎性假瘤1例。结论老年肺结核具有症状不典型,病灶部位形态不典型,以及影像表现多样等特点。影像科医师过分依赖某些征象的诊断价值,影像检查不全面或忽视临床等为主要误诊原因。
Objective To further understand the X-ray and CT features of elderly pulmonary tuberculosis and analyze the causes of misdiagnosis. Methods The complete data of 60 cases of atypical pulmonary tuberculosis diagnosed by operation, clinic and pathology were collected from our hospital. There were 32 males and 28 females, aged from 60 to 80 years, with an average of 67 years. Thoracic radiographs were taken in 48 cases, lateral CT in 48 cases, CT in 23 cases, enhanced CT in 13 cases, bronchoscopy in 14 cases and biopsy in 12 cases. Using double-blind reading, summarize the X-ray and CT findings, analyze the causes of misdiagnosis. Results Of the 60 cases of atypical pulmonary tuberculosis, 14 were nodular masses, of which 11 were smooth margin, 3 were shallow lobe, 12 were endobronchial tuberculosis, 6 were segment consolidation and lobar type, 6 were cavitary , 5 cases of pulmonary tuberculosis, 4 cases of multiple tuberculosis, 3 cases of miliary nodular tuberculosis, 2 cases of atelectasis-type tuberculosis. A total of 22 cases were misdiagnosed, of which 12 cases were misdiagnosed as lung cancer, 4 cases of inflammation, 2 cases of metastatic carcinoma, 1 case of alveolar carcinoma, 2 cases of atelectasis and 1 inflammatory pseudotumor. Conclusion Elderly pulmonary tuberculosis has atypical symptoms, atypical lesions, and diverse images. Imaging physicians over-reliance on the diagnostic value of some signs, imaging is not comprehensive or ignore the clinical cause of the main misdiagnosis.