1 Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, 93 Ji-dong, Paldal-gu, Suwon, Kyeonggi-do 442-723, Republic of Korea.
AJR Am J Roentgenol. 2015 Jan;204(1):38-43. doi: 10.2214/AJR.14.12908.
The purpose of this study is to evaluate the prevalence and clinicoradiologic characteristics of pulmonary tuberculosis with lymphatic involvement.
A total of 126 adults with active tuberculosis who underwent CT were enrolled. A retrospective investigation of CT images focused on the presence of perilymphatic micronodules, as well as other CT features of active tuberculosis. We selected two groups of patients with micronodules according to distribution (perilymphatic vs centrilobular). We compared clinical and CT findings between the two groups.
Fifteen patients were excluded because of coexisting pulmonary disease. Among 111 patients, the prevalence of perilymphatic micronodules, galaxy or cluster signs, and interlobular septal thickening was 64 (58%), 18 (16%), and 30 (27%), respectively. Of 106 patients with micronodules, 37 and 40 were classified into the perilymphatic and centrilobular groups, respectively. Compared with the centrilobular group, the perilymphatic group had statistically significantly lower frequencies of positive acid-fast bacilli smears (32% vs 70%), consolidation (70% vs 98%), and cavitation (30% vs 60%). However, frequencies of interlobular septal thickening (41% vs 18%), galaxy or cluster signs (30% vs 0%), and pleural effusion (43% vs 20%) were statistically significantly higher in the perilymphatic group.
CT findings representing pulmonary perilymphatic involvement are relatively common in adults with tuberculosis. These findings may represent lymphatic spread of tuberculosis and provide an explanation for the unusual CT features of pulmonary tuberculosis mimicking sarcoidosis and the low detection of Mycobacterium tuberculosis in patients with micronodules.
本研究旨在评估肺淋巴管受累肺结核的患病率和临床影像学特征。
共纳入 126 例接受 CT 检查的活动性肺结核成人患者。对 CT 图像进行回顾性调查，重点关注肺淋巴管周围微结节的存在以及活动性肺结核的其他 CT 特征。我们根据分布情况（肺淋巴管周围与小叶中心）选择两组微结节患者。比较两组患者的临床和 CT 表现。
15 例患者因并存肺部疾病被排除在外。在 111 例患者中，肺淋巴管周围微结节、星系或聚类征和小叶间隔增厚的患病率分别为 64（58%）、18（16%）和 30（27%）。在 106 例有微结节的患者中，37 例和 40 例分别归入肺淋巴管周围和小叶中心组。与小叶中心组相比，肺淋巴管周围组阳性抗酸杆菌涂片（32%比 70%）、实变（70%比 98%）和空洞（30%比 60%）的频率显著较低。然而，肺淋巴管周围组的小叶间隔增厚（41%比 18%）、星系或聚类征（30%比 0%）和胸腔积液（43%比 20%）的频率显著较高。
在肺结核成人患者中，代表肺淋巴管受累的 CT 表现较为常见。这些表现可能代表结核分枝杆菌的淋巴播散，并为肺结核的不典型 CT 特征类似于结节病以及微结节患者中结核分枝杆菌检出率低提供解释。
