Honda Y
Department of Respirology, NTT Sapporo Hospital, Japan.
Kekkaku. 1999 Jun;74(6):519-21.
Many studies have indicated the pitfalls in detecting abnormalities on chest radiography, although radiography of the chest has been used for the screening of peripheral lung cancer. Recently, mass screening with a spiral computed tomography scanner has been performed for the detection of small peripheral lung cancers, and it has been clarified that spiral CT was superior to chest radiography in the screening and detection of peripheral lung cancer. However, there have been only a few reports on pulmonary tuberculosis that was detected by chest CT. We report a case of active pulmonary tuberculosis detected by chest CT, and invisible on plain chest radiography. 39 year old female consulted our hospital, because chest radiography at mass screening for lung cancer showed an abnormal shadow in the left upper lung field. Chest CT revealed a high density nodule with calcification compatible with old tuberculosis. However, there was another 20 mm x 10 mm sized nodule in right S9b that was invisible on plain chest radiography. The nodule had a clear margin with satellite lesion that characterize active pulmonary tuberculosis. Bronchial lavage was performed by bronchofiberscopy, and Mycobacterium tuberculosis was isolated from lavage fluid. The nodular shadow disappeared after the treatment with isoniazid and rifampicin for 9 months.
尽管胸部X线摄影已用于周围型肺癌的筛查，但许多研究表明其在检测异常方面存在缺陷。最近，已采用螺旋计算机断层扫描仪进行大规模筛查以检测小的周围型肺癌，并且已经明确螺旋CT在周围型肺癌的筛查和检测方面优于胸部X线摄影。然而，关于胸部CT检测出肺结核的报道却很少。我们报告一例经胸部CT检测出的活动性肺结核病例，而胸部平片未见异常。一名39岁女性因肺癌大规模筛查时胸部X线摄影显示左上肺野有异常阴影而前来我院就诊。胸部CT显示一个高密度结节伴钙化，符合陈旧性肺结核表现。然而，右肺S9b区还有一个20mm×10mm大小的结节，胸部平片未见。该结节边界清晰，有卫星灶，具有活动性肺结核的特征。通过纤维支气管镜进行支气管灌洗，从灌洗液中分离出结核分枝杆菌。经异烟肼和利福平治疗9个月后，结节阴影消失。
