老年Ⅲ期尘肺与结节状大阴影继发性肺结核的高分辨率CT鉴别诊断

Differential diagnosis of stage Ⅲ pneumoconiosis and secondary tuberculosis with large nodular shadow using high resolution CT in the elderly

摘要:

目的 分析老年Ⅲ期尘肺与结节状大阴影继发性肺结核的高分辨率CT(HRCT)鉴别诊断要点,提高老年Ⅲ期尘肺诊断准确率。方法 回顾性分析老年Ⅲ期尘肺患者43例和老年结节状大阴影肺结核患者55例,对2组患者的一般资料及影像征象进行比较。应用SPSS 22.0软件进行统计学分析。结果 2组患者临床表现中性别、咯血、胸痛、喘憋、呼吸困难等5个因素组间差异有统计学意义(P＜0.05)。2组患者CT征象中大阴影发生在双肺上叶、左肺上叶、大阴影内钙化、空洞、大阴影周边肺气肿、肺内粟粒影、支气管扩张、肺门淋巴结肿大、肺门淋巴结钙化及纵隔淋巴结钙化等10个因素组间差异有统计学意义(P＜0.05)。结论 老年Ⅲ期尘肺患者的HRCT具有一定的特征性,结合其临床表现可提高其诊断准确率。

Abstract:

Objective To analyze the key points of differential diagnosis between stage Ⅲ pneumoconiosis and secondary tuberculosis with large nodular shadow using high-resolution CT (HRCT) in the elderly with a view to improving the diagnostic accuracy of stage Ⅲ pneumoconiosis in the elderly. Methods A retrospective analysis was made of 43 cases of stage Ⅲ pneumoconiosis and 55 cases of secondary tuberculosis with large nodular shadow in the elderly. The two groups were compared in their general information and imaging characteristics. Statistical analysis was performed using SPSS statistics 22.0. Results As for clinical manifestations, there were significant differences between the two groups in five factors:gender, hemoptysis, chest pain, wheeze, and dyspnea(P＜0.05). As for CT features, there were significant differences between the two groups in 10 factors:bilateral upper lobes, upper left lobe, calcification in the big shadow, cavity, emphysema around the big shadow, miliary shadow in the lung, bronchiectasis, hilar lymph node enlargement,hilar lymph node calcification and calcification of mediastinal lymph nodes(P＜0.05). Conclusions HRCT shows specificity of some degree for stage Ⅲ pneumoconiosis in the elderly, which can improve the diagnostic accuracy if combined with the clinical manifestations.