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[非免疫功能低下患者的肺结核。当前的放射学特征]

[Pulmonary tuberculosis in non-immunocompromised patients. Current radiologic features].

作者信息

Polverosi R, Zanellato E, Zanlungo P

机构信息

Servizio di Radiologia, Ospedale di Montebelluna, Treviso.

出版信息

Radiol Med. 1995 Jun;89(6):769-75.

PMID:7644726
Abstract

Sixty-four non-immunocompromised and adult patients with proved tuberculosis were examined. Twenty-three of them had bacteriologic confirmation with sputum examination, 7 with biopsy, 8 with bronchoscopy and bronchial lavage, 3 with pleural effusion examination and 3 with specific ex-juvantibus therapy. Fifteen patients had positive Mantoux skin tests. Thirty-nine patients had primary and 25 postprimary tuberculosis. All patients underwent chest radiography and 37 underwent also CT scans of the chest. The radiographic findings in primary tuberculosis were: 33 parenchymal consolidation patterns (in 24 patients), more frequent in the upper (20/33) than in the lower (13/33) lobes, with cavitations in 16 cases; 2 miliary patterns; 4 atelectasis cases; 4 intrathoracic adenopathies and 11 pleural effusions. The radiographic findings in postprimary tuberculosis were: 32 parenchymal consolidation patterns (in 19 patients), more frequent in the upper (27/32) than in the lower (5/32) lobes, with cavitations in 7 cases; 2 tuberculomas; 1 miliary pattern; 1 atelectasis; 5 pleural effusions and 1 pericardial effusion. Thus, we can conclude that in our series both primary and postprimary tuberculosis appear mostly as upper lobe consolidation, with cavitations especially in the primary form, often with pleural effusion and sometimes with intrathoracic adenopathies. Primary tuberculosis is most frequent in adult men. Finally, lower lobe consolidations or less typical radiographic patterns are observed, e.g., atelectasis, adenopathies or pleural effusion with no parenchymal changes, which can mimic other diseases and thus delay the diagnosis.

摘要

对64例确诊为结核病的非免疫功能低下成年患者进行了检查。其中23例经痰检获得细菌学确诊,7例经活检确诊,8例经支气管镜检查及支气管灌洗确诊,3例经胸腔积液检查确诊,3例经特效辅助治疗确诊。15例患者结核菌素皮肤试验呈阳性。39例患者为原发性结核病,25例为继发性结核病。所有患者均接受了胸部X线检查,37例还接受了胸部CT扫描。原发性结核病的影像学表现为:33例实变影(24例患者),上叶(20/33)比下叶(13/33)更常见,16例有空洞形成;2例粟粒样影;4例肺不张;4例胸内淋巴结肿大和11例胸腔积液。继发性结核病的影像学表现为:32例实变影(19例患者),上叶(27/32)比下叶(5/32)更常见,7例有空洞形成;2例结核瘤;1例粟粒样影;1例肺不张;5例胸腔积液和1例心包积液。因此,我们可以得出结论,在我们的研究系列中,原发性和继发性结核病大多表现为上叶实变,空洞尤其在原发性结核病中常见,常伴有胸腔积液,有时伴有胸内淋巴结肿大。原发性结核病在成年男性中最为常见。最后,观察到下叶实变或不太典型的影像学表现,如肺不张、淋巴结肿大或无实质改变的胸腔积液,这些表现可模仿其他疾病,从而延误诊断。

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