Tang Shen-Jie, Xiao He-Ping, Chen Gang, Liu Yi-Dian, Fan Lin, Zhang Qing, Sun Hua, Gu Jin, Yao Lan
Shanghai Tuberculosis (Lung) Key Laboratory, Shanghai Pulmonary Hospital Affiliated to Tongji University, Shanghai 200433, China.
Zhonghua Jie He He Hu Xi Za Zhi. 2009 Apr;32(4):262-5.
To investigate the clinical, pathological and radiological characteristics of pleural tuberculoma, so as to improve the understanding of this disease.
We retrospectively analyzed the clinical, laboratory, pathological and radiological data of 83 cases of pleural tuberculoma diagnosed by pathology and(or) bacteriology in Shanghai Pulmonary Hospital Affiliated to Tongji University.
In the recruited 83 cases, there were 50 males and 33 females, aged from 7 to 85 years old, with a mean age of 37.8 years. Cough, fever and chest pain were common symptoms, but no significant symptoms were seen in 25 patients (31.3%). Some patients had positive physical signs, such as dullness to percussion and low breath sound. Pulmonary tuberculosis was also present in 36 patients (43.3%) with pleural tuberculoma. A history of tuberculous pleurisy was elicited in 80 patients, among whom 45 (56.3%) received delayed antituberculous treatment and 42 (52.5%) received nonstandard treatment. Forty-eight cases (60.0%) did not receive corticosteroids. Fifty-nine cases underwent CT-guided percutaneous biopsy, while 24 underwent thoracoscopic surgery, and tuberculosis was pathologically confirmed in 62 (74.7%). Pathological profiles included granuloma, coagulation or caseation necrosis, lymphocyte infiltration, epithelioid cells, inflammatory cells, histiocytes and scar tissue. Fifteen (18.1%) specimens from percutaneous biopsy were anti-fast smear positive, while Mycobacterium tuberculosis was obtained by culture in 21 (25.3%) cases. Chest X-ray showed that solitary lesions were seen in 68 cases, multiple foci in 15. The lesions of 46 cases (55.4%) occupied the lower right lobes. Round-like shadows were the most common signs, which were present in 63 cases (75.9%). CT examination demonstrated homogeneous density in 20, heterogeneous density in 40, calcification in 9, central attenuation in 34, and peripheral intensification in 28 cases.
Pleural tuberculoma is an important sequelae of tuberculous pleurisy. Understanding its clinical, pathological and radiological characteristics is helpful for the differential diagnosis of pleural and lung diseases.
探讨胸膜结核瘤的临床、病理及影像学特征，以提高对该疾病的认识。
回顾性分析同济大学附属上海市肺科医院经病理和（或）细菌学确诊的83例胸膜结核瘤患者的临床、实验室、病理及影像学资料。
纳入的83例患者中，男性50例，女性33例，年龄7～85岁，平均年龄37.8岁。咳嗽、发热及胸痛为常见症状，但25例患者（31.3%）无明显症状。部分患者有阳性体征，如叩诊浊音及呼吸音减弱。36例（43.3%）胸膜结核瘤患者合并肺结核。80例患者有结核性胸膜炎病史，其中45例（56.3%）接受了延迟抗结核治疗，42例（52.5%）接受了不规范治疗。48例（60.0%）未使用糖皮质激素。59例行CT引导下经皮穿刺活检，24例行胸腔镜手术，62例（74.7%）病理确诊为结核。病理表现包括肉芽肿、凝固性或干酪样坏死、淋巴细胞浸润、上皮样细胞、炎症细胞、组织细胞及瘢痕组织。15例（18.1%）经皮穿刺活检标本抗酸涂片阳性，21例（25.3%）培养出结核分枝杆菌。胸部X线显示，68例为孤立性病变，15例为多发病灶。46例（55.4%）病变位于右下叶。圆形阴影最为常见，共63例（75.9%）。CT检查显示，20例密度均匀，40例密度不均匀，9例有钙化，34例中心密度减低，28例周边强化。
胸膜结核瘤是结核性胸膜炎的重要后遗症。了解其临床、病理及影像学特征有助于胸膜及肺部疾病的鉴别诊断。
