Kim H Y, Song K S, Goo J M, Lee J S, Lee K S, Lim T H
Department of Radiology, Ewha Women's University Mokdong Hospital, Seoul, Korea.
Radiographics. 2001 Jul-Aug;21(4):839-58; discussion 859-60. doi: 10.1148/radiographics.21.4.g01jl06839.
Pulmonary tuberculosis is caused by Mycobacterium tuberculosis when droplet nuclei laden with bacilli are inhaled. In accordance with the virulence of the organism and the defenses of the host, tuberculosis can occur in the lungs and in extrapulmonary organs. A variety of sequelae and complications can occur in the pulmonary and extrapulmonary portions of the thorax in treated or untreated patients. These can be categorized as follows: (a) parenchymal lesions, which include tuberculoma, thin-walled cavity, cicatrization, end-stage lung destruction, aspergilloma, and bronchogenic carcinoma; (b) airway lesions, which include bronchiectasis, tracheobronchial stenosis, and broncholithiasis; (c) vascular lesions, which include pulmonary or bronchial arteritis and thrombosis, bronchial artery dilatation, and Rasmussen aneurysm; (d) mediastinal lesions, which include lymph node calcification and extranodal extension, esophagomediastinal or esophagobronchial fistula, constrictive pericarditis, and fibrosing mediastinitis; (e) pleural lesions, which include chronic empyema, fibrothorax, bronchopleural fistula, and pneumothorax; and (f) chest wall lesions, which include rib tuberculosis, tuberculous spondylitis, and malignancy associated with chronic empyema. These varieties of radiologic manifestations can mimic other disease entities. Therefore, recognition and understanding of the radiologic manifestations of the thoracic sequelae and complications of tuberculosis are important to facilitate diagnosis.
当吸入携带杆菌的飞沫核时,肺结核由结核分枝杆菌引起。根据病原体的毒力和宿主的防御能力,结核病可发生在肺部和肺外器官。在接受治疗或未接受治疗的患者中,胸部的肺内和肺外部分可出现多种后遗症和并发症。这些可分类如下:(a) 实质病变,包括结核瘤、薄壁空洞、瘢痕形成、终末期肺破坏、曲菌球和支气管源性癌;(b) 气道病变,包括支气管扩张、气管支气管狭窄和支气管结石症;(c) 血管病变,包括肺或支气管动脉炎和血栓形成、支气管动脉扩张和拉斯姆森动脉瘤;(d) 纵隔病变,包括淋巴结钙化和结外扩展、食管纵隔或食管支气管瘘、缩窄性心包炎和纤维性纵隔炎;(e) 胸膜病变,包括慢性脓胸、纤维胸、支气管胸膜瘘和气胸;以及(f) 胸壁病变,包括肋骨结核、结核性脊柱炎和与慢性脓胸相关的恶性肿瘤。这些各种放射学表现可模仿其他疾病实体。因此,认识和理解结核病胸部后遗症和并发症的放射学表现对于促进诊断很重要。