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目的认识肺腺癌经支气管播散肺转移的 CT 表现和规律。方法回顾性分析15例经病理证实为腺癌或细支气管肺泡癌经支气管肺转移患者的 CT 表现,重点关注病变的发展特点。结果15例肺癌患者在 CT 上原发病灶均为实变型肺癌,在同侧或对侧肺内出现多发性、与支气管分布有明确相关的病灶,胸膜不受累。在初诊的 CT 上表现为小叶中心性结节5例、树芽征7例、腺泡结节2例、磨玻璃影10例和实变13例,其中5例仅有小叶中心结节(单一型),10例为多种形态病变共存(复合型),曾全部被误诊为结核或炎症,经抗结核或抗炎治疗无效。在平均4个月的 CT 随访中,单一型转移者进展缓慢,结节融合形成边界相对清晰的实变影;初诊为复合型的病变恶化较快。结论肺腺癌经支气管转移的 CT 表现有一定规律,但诊断仍须结合临床及实验室检查,以区别于结核和炎性反应。
Objective To understand the CT findings and regularities of bronchial lung metastasis from lung adenocarcinoma. Methods A retrospective analysis of 15 cases of pathologically confirmed adenocarcinoma or bronchioloalveolar carcinoma in patients with bronchial lung metastases CT performance, with a focus on the development of lesions. Results All the 15 cases of lung cancer were all solid tumors in the primary lesions of CT. Multiple lesions were found in the ipsilateral or contralateral lung with definite correlation with the bronchus. The pleura was not affected. In newly diagnosed CT, there were 5 cases of centrilobular nodules, 7 cases of spondylolisthesis, 2 cases of acinar nodules, 10 cases of ground glass opacification and 13 cases of solidification, of which 5 cases had only centrilobular nodules Type), 10 cases of multiple morphological coexistence (complex type), had all been misdiagnosed as tuberculosis or inflammation, anti-TB or anti-inflammatory treatment ineffective. In an average of 4 months of CT follow-up, single-type transfer of slow progress, the nodules to form a relatively clear border consolidation consolidation shadow; first diagnosis of complex lesions worse. Conclusion The CT findings of bronchoalveolar metastasis of lung adenocarcinoma have certain rules, but the diagnosis still need to be combined with clinical and laboratory tests to distinguish tuberculosis and inflammatory reaction.