肺内淋巴结的HRCT特征分析
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摘要
目的探讨肺内淋巴结(IPLNs)的高分辨率CT(HRCT)特征,提高对该病的认识和诊断正确率。方法回顾性分析经手术病理证实的IPLNs患者58例,术前均行胸部HRCT检查,分析内容包括结节的大小、密度、形态、边缘、位置、分布、与胸膜的关系等。病理切片观察结节中心成分及周边结构特点。结果 58例患者共68个结节,大小约(7.03±1.73)mm,全部位于气管隆突水平以下,大部分位于胸膜下区(88.2%),形态不规则(85.3%),除1例表现为磨玻璃密度外,其余均为实性结节。结节边缘可见特征性的细线样影,常规CT多仅发现0~1条(85.3%),HRCT多可发现2条及以上(91.2%),60个结节(88.2%)均发现至少1条线样影与胸膜相连。病理证实淋巴结内均有炭末沉着,边缘细线样结构为增粗的小叶间隔。结论 IPLNs是较少见的肺内良性结节,影像表现具有一定特点。HRCT能准确地发现特征性的细线样影,对于诊断具有重要价值。
Objective To investigate the high resolution computed tomography( HRCT) features of intrapulmonary lymph nodes( IPLNs),and to improve the diagnostic accuracy. Methods Fifty-eight cases of IPLNs confirmed by pathology received HRCT chest scanning examinations. The size,density,shape,border,location,distribution,and relationship with pleura were analyzed retrospectively. Microscopic examination included center components and surrounding structures of nodules. Results Sixty-eight IPLNs with median size of( 7. 03 ± 1. 73) mm were located below the level of the carina,frequently in the subpleural region( 88. 2%),irregular in shape( 85. 3%). Most of the IPLNs were solid in texture but occasionally present with a ground-glass appearance. For general CT scans and HRCT scans,none or one( 85. 3%) and two or more( 91. 2%) linear opacities extending from the nodules can be identified,respectively. In Sixty nodules( 88. 2%),we found at least one linear opacity connected to the pleura. Histologically,carbon powder was observed within the IPLNs.Linear opacities on the CT scans were correlated with the thickened interlobular septa under microscopy. Conclusion IPLNs are rare benign pulmonary nodules possessing radiologic features. HRCT scan that revealed typical linear opacities can play an important role in the diagnosis of IPLNs.
Objective To investigate the high resolution computed tomography( HRCT) features of intrapulmonary lymph nodes( IPLNs),and to improve the diagnostic accuracy. Methods Fifty-eight cases of IPLNs confirmed by pathology received HRCT chest scanning examinations. The size,density,shape,border,location,distribution,and relationship with pleura were analyzed retrospectively. Microscopic examination included center components and surrounding structures of nodules. Results Sixty-eight IPLNs with median size of( 7. 03 ± 1. 73) mm were located below the level of the carina,frequently in the subpleural region( 88. 2%),irregular in shape( 85. 3%). Most of the IPLNs were solid in texture but occasionally present with a ground-glass appearance. For general CT scans and HRCT scans,none or one( 85. 3%) and two or more( 91. 2%) linear opacities extending from the nodules can be identified,respectively. In Sixty nodules( 88. 2%),we found at least one linear opacity connected to the pleura. Histologically,carbon powder was observed within the IPLNs.Linear opacities on the CT scans were correlated with the thickened interlobular septa under microscopy. Conclusion IPLNs are rare benign pulmonary nodules possessing radiologic features. HRCT scan that revealed typical linear opacities can play an important role in the diagnosis of IPLNs.
引文
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5杨洋,陈燕清,江森,等.肺内淋巴结的多层螺旋CT征象分析[J].中华放射学杂志,2012,46:654-656.
6 Ishikawa H,Koizumi N,Morita T,et al.Ultrasmall intrapulmonary lymph node:usual high-resolution computed tomographic findings with histopathologic correlation[J].J Comput Assist Tomogr,2007,31:409-413.
7 Takenaka M,Uramoto H,Shimokawa H,et al.Discriminative features of thin-slice computed tomography for peripheral intrapulmonary lymph nodes[J].Asian Journal of Surgery,2013,36:69-73.
8 Tanaka O,Kiryu T,Iwata H,et al.Intrapulmonary lymph node mimicking a pulmonary metastasis associated with adenocarcinoma on high resolution computed tomography(HR-CT)findings[J].European Journal of Radiology Extra,2005,56:7-9.
9 Hyodo T,Kanazawa S,Dendo S,et al.Intrapulmonary lymph nodes:thin-section CT findings,pathological findings,and CT differential diagnosis from pulmonary metastatic nodules[J].Acta Med Okayama,2004,58:235-240.
10罗凤莲,王亮,李玉伟.最大径2cm以下肺小结节诊断中超高分辨率薄层CT的应用[J].实用医学杂志,2015,31:604-606.
2 Trapnell DH.Recognition and incidence of intrapulmonary lymph nodes[J].Thorax,1964,19:44-50.
3隋锡朝,李运,王煦,等.肺内淋巴结的临床和影像学特点[J].中华胸心血管外科杂志,2012,28:271-273.
4 Shaham D,Vazquez M,Bogot NR,et al.CT features of intrapulmonary lymph nodes confirmed by cytology[J].Clinical Imaging,2010,34:185-190.
5杨洋,陈燕清,江森,等.肺内淋巴结的多层螺旋CT征象分析[J].中华放射学杂志,2012,46:654-656.
6 Ishikawa H,Koizumi N,Morita T,et al.Ultrasmall intrapulmonary lymph node:usual high-resolution computed tomographic findings with histopathologic correlation[J].J Comput Assist Tomogr,2007,31:409-413.
7 Takenaka M,Uramoto H,Shimokawa H,et al.Discriminative features of thin-slice computed tomography for peripheral intrapulmonary lymph nodes[J].Asian Journal of Surgery,2013,36:69-73.
8 Tanaka O,Kiryu T,Iwata H,et al.Intrapulmonary lymph node mimicking a pulmonary metastasis associated with adenocarcinoma on high resolution computed tomography(HR-CT)findings[J].European Journal of Radiology Extra,2005,56:7-9.
9 Hyodo T,Kanazawa S,Dendo S,et al.Intrapulmonary lymph nodes:thin-section CT findings,pathological findings,and CT differential diagnosis from pulmonary metastatic nodules[J].Acta Med Okayama,2004,58:235-240.
10罗凤莲,王亮,李玉伟.最大径2cm以下肺小结节诊断中超高分辨率薄层CT的应用[J].实用医学杂志,2015,31:604-606.