先天性肺囊性腺瘤样畸形的影像特征及误诊分析
Radiological Characteristics and Misdiagnosis of Congenital Cystic Adeno-matoid Malformation of the Lung
焦振华 1刘连锋 1郭文文 2秦琛琛 1李天云3
作者信息
- 1. 712000 陕西咸阳,咸阳市中心医院影像中心
- 2. 712000 陕西咸阳,咸阳市中心医院病理科
- 3. 710032 西安,空军军医大学西京医院放射科
- 折叠
摘要
目的 探讨先天性肺囊性腺瘤样畸形(CCAM)的影像特征,并分析误诊原因,总结防范误诊措施.方法 回顾性分析2020 年5 月—2023 年11 月收治经手术和病理检查证实的CCAM 9 例的临床资料.结果 本组5 例主要表现为间断性咳嗽、咳痰、痰中带血、发热及气短等,3 例为住院期间常规查体发现肺部异常,1 例为常规体检发现肺部异常.术前首诊确诊2 例,误诊7 例.误诊为支气管源性肺囊肿3 例,肺脓肿、囊性支气管扩张伴感染、肺隔离征和先天性大叶性肺气肿各1 例.误诊时间8d～2 周.9 例CT检查4 例为大囊型,CT表现为占据胸腔的较大含气体或液体的囊腔,囊内见弯曲细线样分隔或气液平面;5 例为小囊型,CT表现为局限于一侧肺叶多发薄壁小囊,部分呈蜂窝状改变,部分见短小气液平面.9 例皆行单操作孔电视胸腔镜肺叶或肺段切除术,病理检查示4 例大囊型为Stocker Ⅰ型,5 例小囊型为Stocker Ⅱ型.9 例出院后随访0.5～1.0 年,均预后良好.结论 CCAM因病理分型不同而影像学特征各异,虽易误诊,但仍具有一定影像学特征,确诊需病理学检查.
Abstract
Objective To investigate the imaging features of congenital cystic adenomatoid malformation(CCAM)of lung,to analyze the causes of misdiagnosis,and to summarize the preventive measures.Methods The clinical data of 9 pa-tients with CCAM confirmed by surgery and pathological examination from May 2020 to November 2023 were retrospectively analyzed.Results The main manifestations of 5 patients in this group were intermittent cough,sputum,blood in sputum,fe-ver and shortness of breath,etc.Three patients were found abnormal lung by routine physical examination during hospitaliza-tion,and 1 patient was found abnormal lung by routine physical examination.Two patients were diagnosed and 7 patients were misdiagnosed,including 3 patients misdiagnosed with bronchogenic lung cyst,1 patient with pulmonary abscess,1 patient with cystic bronchiectasis with infection,1 patient with pulmonary isolation sign and 1 patient with congenital lobar emphyse-ma.Misdiagnosis lasted 8 d to 2 weeks.CT examination showed that 4 of the 9 patients had large cystic type.CT showed a large cystic cavity containing gas or liquid occupying the chest cavity,and there were curved thin line compartments or gas-liquid planes in the cystic cavity.In 5 patients with small cystic type,the CT findings showed multiple thin-walled sacs con-fined to one lobe of the lung,some of which were honeycomb-like,and some showed short gas-liquid plane.All 9 patients un-derwent single-port video-assisted thoracoscopic lobectomy or segmental resection,and the pathological examination showed Stocker type Ⅰ in 4 patients of large cystic type and Stocker type Ⅱ in 5 patients of small cystic type.All the 9 patients were followed up for 0.5-1.0 year after discharge,and the prognosis was good.Conclusion CCAM has different imaging features due to different pathological types.Although it is more likely to be misdiagnosed,it still has certain special imaging character-istics,and pathological examination is needed to confirm the diagnosis.
关键词
囊性腺瘤样畸形/肺/先天性/体层摄影术,螺旋计算机/病理检查/误诊/囊肿/肺脓肿Key words
Cystic adenomatoid malformation/Lung/Congenital/Tomography,spiral computed/Pathology examina-tion/Misdiagnosis/Cysts/Lung abscess引用本文复制引用
基金项目
陕西省自然科学基础研究计划(S2024-JC-QN-0640)
出版年
2024
国家科技期刊平台
NSTL
万方数据