Tanaka Hiroshi, Yamada Yuichi, Ito Eiji
Third Department of Internal Medicine, Sapporo Medical University School of Medicine, Hokkaido, Japan.
Kekkaku. 2009 Aug;84(8):585-90.
Radiological imaging is one of the important clues for diagnosis of pulmonary mycobacterial infection. Differential diagnosis of pulmonary tuberculosis and nontuberculous mycobacterial infection is following; bacterial pneumonia, bronchopneumonia, mycoplasma pneumonia, pulmonary fungal infection, diffuse panbronchiolitis, sinobronchial syndrome, sarcoidosis, Wegener's granulomatosis, bronchiolealveolar carcinoma, pulmonary malignant lymphoma, and pneumoconiosis. Characteristic findings of bronchial tuberculosis are chronic productive cough with no radiological finding, lobar atelectasis, or mucoid impaction of bronchi. Radiologic findings of pulmonary mycobacterial infection are multiple infiltration, centri-lobular nodules which sometime adhere, cavity, and solitary nodule, however, these findings mimic bacterial pneumonia and bronchopneumonia especially in case of immunosuppressive patients. Pulmonary tuberculosis predominantly appears in upper lobe and the top of lower lobe of S6. Nontuberous mycobacterium pulmonary infection predominantly affects middle lobe and lingual lobe, accompanying with bronchial wall thickness and bronchiectasis. It is difficult to diagnose pulmonary mycobacterial infection using pulmonary imaging alone, therefore bacterial examination from sputum or bronchoalveolar lavage fluid should be necessary.
放射影像学检查是诊断肺部分枝杆菌感染的重要线索之一。肺结核与非结核分枝杆菌感染的鉴别诊断如下：细菌性肺炎、支气管肺炎、支原体肺炎、肺部真菌感染、弥漫性泛细支气管炎、鼻窦支气管综合征、结节病、韦格纳肉芽肿、细支气管肺泡癌、肺恶性淋巴瘤和尘肺。支气管结核的特征性表现为慢性咳痰而无放射学表现、肺叶不张或支气管黏液嵌塞。肺部分枝杆菌感染的放射学表现为多发浸润、有时相互粘连的小叶中心结节、空洞和孤立结节，然而，这些表现与细菌性肺炎和支气管肺炎相似，尤其是在免疫抑制患者中。肺结核主要出现在上叶和S6下叶的顶部。非结核分枝杆菌肺部感染主要累及中叶和舌叶，伴有支气管壁增厚和支气管扩张。仅通过肺部影像学检查很难诊断肺部分枝杆菌感染，因此有必要对痰液或支气管肺泡灌洗液进行细菌学检查。
