Atypical HRCT manifestations of pulmonary sarcoidosis
Atypical HRCT manifestations of pulmonary sarcoidosis
复制标题
DOI：
10.1007/s11547-017-0830-y
复制
发表时间：
2018-03-01
影响因子：
8.9
通讯作者：
Miele, Vittorio
中科院分区：
文献类型：
--
作者：
Cozzi, Diletta;Bargagli, Elena;Miele, Vittorio
目的总结2016年肺结节病HRCT表现不典型病例的诊断与鉴别诊断经验，以帮助临床医师更好地诊断结节病。材料与方法回顾性分析47例肺结节病HRCT表现。所有患者均经组织病理学证实。29例（61.7%）为典型肺型，18例（38.3%）为不典型肺型。后者由三位经验丰富的胸部疾病放射科医师进行评估，以确定影像学上的主要表现形式。（38.3%）不典型结节病，观察到以下实质模式：四名患者（22.2%）有间质纤维化改变，3例患者（16.6%）为网状结构，小叶间隔增厚，2例（11.1%）小气道受累伴镶嵌性低血症，2例患者（11.1%）胸膜受累（气胸和胸膜斑块），1例患者（5.5%）伴纤维囊性变，1有晕轮征者占5.5%，（5.5%）伴有弥漫性双侧磨玻璃样阴影，孤立性肺肿块占5.5%;此外，本发明还涉及一种用于该方法，三名患者（16.6%）结论与讨论CT检查中发现的不典型肺部改变易与其他肺部疾病相混淆，即使是最有经验的放射科医生也面临着挑战。在我们的经验中，研究中评估的非典型肺结节病模式的病例与文献中描述的类似病例在淋巴结和非典型实质受累方面一致。所有的非典型特征的工作应提醒放射科医生考虑结节病之间可能的鉴别诊断，始终相关的结果，计算机断层扫描检查与适当的临床实验室评估。
Purpose To present our experience of cases of pulmonary sarcoidosis with atypical HRCT patterns found during 2016 focusing on the differential diagnosis to contribute to the difficult role of the radiologist in the disease identification and to help the clinicians to reach the diagnosis.Materials and methods The HRCT examinations of 47 patients with sarcoidosis were studied retrospectively. All patients had a histopathological confirm of the disease. 29 (61.7%) show a typical pulmonary pattern and 18 (38.3%) an atypical pattern. The latter were evaluated by three experienced radiologists dedicated to thoracic disease to radiologically define the predominant pattern of presentation.Results In the 18 patients (38.3%) with atypical sarcoidosis, the following parenchymal patterns were observed: four patients (22.2%) had interstitial fibrotic alterations, three patients (16.6%) with reticular pattern with inter-intralobular septal thickening, two patients (11.1%) with small-airway involvement with mosaic oligoemia, two patients (11.1%) with pleural involvement (pneumothorax and pleural plaques), one patient (5.5%) with fibrocystic changes, 1 (5.5%) with halo-sign, 1 (5.5%) with diffuse bilateral ground-glass opacities, and 1 (5.5%) with isolated lung mass; in addition, three patients (16.6%) with atypical lymph node pattern were also found.Conclusions and Discussion The atypical pulmonary alterations found in CT examination can be confused with other lung diseases and they are always a challenge even for the most experienced radiologist. In our experience, cases with atypical pulmonary sarcoidosis patterns evaluated in the study are consistent with similar cases described in the literature, both in lymph node and atypical parenchymal involvement. All the atypical characteristics of the work should alert the radiologist to consider sarcoidosis among the possible differential diagnoses, always correlating the results of the computed tomography examination with appropriate clinical-laboratory evaluations.