Choi D, Lee K S, Suh G Y, Kim T S, Kwon O J, Rhee C H, Han J
Department of Radiology, Samsung Medical Center, College of Medicine, Sungkyunkwan University, Seoul, Korea.
J Comput Assist Tomogr. 1999 Jan-Feb;23(1):107-13. doi: 10.1097/00004728-199901000-00023.
The purpose of this work was to describe the radiologic findings of pulmonary tuberculosis in patients who presented with acute respiratory failure.
We included patients who had newly diagnosed active pulmonary tuberculosis and who presented with acute respiratory failure. Initial chest radiographic (n = 17) and high-resolution CT (n = 11) findings of each patient were analyzed retrospectively.
Of 1,010 patients with active pulmonary tuberculosis, 17 patients (1.7%) presented with acute respiratory failure. Nine (53%) of the 17 patients died. The most common initial chest radiographic findings were small nodular lesions (16/17; 94%), consolidation (13/17; 76%), and ground-glass opacity (12/17; 70%). Eleven (69%) of 16 nodular lesions, 9 of 13 (69%) consolidations, and 10 of 12 (83%) ground-glass opacities were bilateral. On HRCT (n = 11), miliary micronodular lesions were seen in 6 patients (55%), whereas bronchogenic spread of tuberculosis with disseminated centrilobular nodules and tree-in-bud appearance was seen in 5 patients (45%). Diffuse areas of ground-glass attenuation were seen in all six patients with miliary nodules and four of five patients with bronchogenic spread of tuberculosis.
Patients with pulmonary tuberculosis occasionally present with acute respiratory failure. In this condition, chest radiograph most commonly shows bilateral small nodular lesions mixed with consolidation or ground-glass opacity, whereas HRCT demonstrates findings of miliary or bronchogenic disseminated tuberculosis with diffuse areas of ground-glass attenuation.
本研究旨在描述出现急性呼吸衰竭的肺结核患者的影像学表现。
我们纳入了新诊断为活动性肺结核且出现急性呼吸衰竭的患者。对每位患者最初的胸部X线片（n = 17）和高分辨率CT（n = 11）检查结果进行回顾性分析。
在1010例活动性肺结核患者中，17例（1.7%）出现急性呼吸衰竭。这17例患者中有9例（53%）死亡。最常见的初始胸部X线片表现为小结节状病变（16/17；94%）、实变（13/17；76%）和磨玻璃影（12/17；70%）。16个结节状病变中有11个（69%）、13个实变中有9个（69%）、12个磨玻璃影中有10个（83%）为双侧性。在高分辨率CT（n = 11）检查中，6例（55%）可见粟粒状微小结节病变，5例（45%）可见伴有弥漫性小叶中心结节和树芽征的结核支气管播散。所有6例有粟粒结节的患者以及5例有结核支气管播散的患者中的4例均可见弥漫性磨玻璃样密度减低区。
肺结核患者偶尔会出现急性呼吸衰竭。在此情况下，胸部X线片最常见的表现是双侧小结节状病变，伴有实变或磨玻璃影，而高分辨率CT显示粟粒性或支气管播散性结核的表现以及弥漫性磨玻璃样密度减低区。
