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胸部 CT 常见和不常见的 Wegener 肉芽肿表现:影像学-病理学相关性。

Common and uncommon manifestations of Wegener granulomatosis at chest CT: radiologic-pathologic correlation.

机构信息

Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Founders 202, Boston, MA 02114, USA.

出版信息

Radiographics. 2012 Jan-Feb;32(1):51-69. doi: 10.1148/rg.321115060.

Abstract

Wegener granulomatosis is an uncommon necrotizing vasculitis that classically manifests as a clinical triad consisting of upper and lower airway involvement and glomerulonephritis. Other less frequently involved organ systems include the central and peripheral nervous system and large joints. The diagnosis is based on a combination of clinical and laboratory findings. Because thoracic involvement often predominates, chest radiographic findings are often the first to suggest the diagnosis. However, chest computed tomography (CT) has superior sensitivity and specificity for evaluation of the airways, lung parenchyma, and mediastinum, particularly with the use of multiplanar reformatted and three-dimensional images. Common pulmonary radiologic findings include waxing and waning nodules, masses, ground-glass opacities, and consolidation. Airway involvement is usually characterized by circumferential tracheobronchial thickening, which can be smooth or nodular. Pleural effusions are the most common manifestation of pleural disease and can result from primary involvement or be secondary to renal failure. Mediastinal lymphadenopathy is a nonspecific finding and is usually reactive. Uncommon thoracic radiologic manifestations include involvement of the heart and great vessels. CT is the imaging modality of choice for diagnosis, surveillance, and follow-up in patients with Wegener granulomatosis.

摘要

韦格纳肉芽肿病是一种罕见的坏死性血管炎,经典表现为上、下呼吸道受累和肾小球肾炎三联征。其他较少受累的器官系统包括中枢和外周神经系统以及大关节。诊断基于临床和实验室发现的综合判断。由于胸部受累往往更为突出,胸部 X 线摄影结果通常是首先提示诊断的依据。然而,胸部计算机断层扫描(CT)在评估气道、肺实质和纵隔方面具有更高的敏感性和特异性,特别是在使用多平面重建和三维图像时。常见的肺部放射学表现包括时消时现的结节、肿块、磨玻璃影和实变。气道受累通常表现为气管支气管环状增厚,可呈光滑或结节状。胸腔积液是胸膜疾病最常见的表现,可由原发性受累或肾衰竭引起。纵隔淋巴结肿大是一种非特异性表现,通常为反应性的。罕见的胸部放射学表现包括心脏和大血管受累。CT 是韦格纳肉芽肿病患者诊断、监测和随访的首选影像学方法。

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