Kobashi Y, Niki Y, Kawane H, Matsushima T
Department of Internal Medicine, Kawasaki Medical School, Okayama Prefecture, Japan.
Kekkaku. 1996 Apr;71(4):311-6.
Four cases of pulmonary tuberculosis resembling pulmonary abscess radiographically were reviewed from their clinical features, chest X-ray and chest CT, and the mechanism of formation of so-called niveau-like shadows was discussed. Only one case showed a newly formed tuberculous cavity with air fluid level on chest X-ray, however, even in this case, the possibility of the infection with tubercle bacilli of an emphysematous bulla of the lung could not be completely excluded as several bulla were found on chest CT. The remaining three cases showed a slightly different mechanism of the formation of niveau-like shadows. Namely, mycobacterium tuberculosis spread into an existed bulla and a tubercle bacilli infected bulla was formed. Regarding the clinical features, no remarkable findings were detected and we could find no differences with common tuberculosis. Based on these experiences, the presence of pulmonary tuberculosis resembling the shadow of pulmonary abscess should be emphasized.
回顾了4例影像学表现类似肺脓肿的肺结核病例，从其临床特征、胸部X线和胸部CT进行分析，并探讨了所谓的“水平样”阴影的形成机制。仅1例胸部X线显示有新形成的伴有气液平面的结核空洞，然而，即便在该病例中，由于胸部CT发现有多个肺大疱，也不能完全排除肺大疱感染结核杆菌的可能性。其余3例“水平样”阴影的形成机制略有不同。即结核分枝杆菌播散至已有的肺大疱内，形成结核杆菌感染的肺大疱。关于临床特征，未发现明显异常，且与普通肺结核无差异。基于这些经验，应重视存在类似肺脓肿阴影的肺结核。
