Blandino A, Gaeta M, Scribano E, Pandolfo I
Instituto di Radiologia, Università di Messina.
Radiol Med. 1996 Oct;92(4):381-5.
The angiogram sign in chest CT is the demonstration of normally enhanced pulmonary branches within hypoattenuating lung parenchyma consolidation. In a retrospective review of the chest CT exams performed in a 2-year period, we identified the angiogram sign in 10 patients with lung consolidation; the diagnosis was central lung tumor with obstructive pneumonia in 4 patients, bronchioloalveolar carcinoma in 2 patients, postirradiation fibrosis in 1 patient, tuberculous pneumonia in 1 patient, lung lymphoma in 1 patient and metastasis from pancreatic tumor in 1 patient. The diagnosis was made with cytology and/or surgical specimen in 9 patients and with clinical-radiologic follow-up in 1 patient. The density, air and mucous bronchogram and the volume loss in the consolidated lung were also considered. The consolidated lung density was < 30 HU in 5 patients-one bronchioloalveolar carcinoma, one metastasis from pancreatic carcinoma and 3 obstructive pneumonia cases-, while it was > 30 HU in the extant 5 patients. The air bronchogram sign was observed in 4 cases-one bronchioloalveolar carcinoma, one metastasis, one postirradiation fibrosis and one lung lymphoma-, while a mucous bronchogram was observed in 3 patients with obstructive pneumonia. Lung volume was reduced only in 2 patients-one obstructive pneumonia and one postirradiation fibrosis. In our opinion, the CT angiogram sign must be considered a poorly specific sign, because it can be found in many pathologic processes, both benign and malignant. If associated with the other features of lung consolidation, the CT angiogram sign can help diagnose, together with clinical findings and the patient's history, the pathologic condition. Particularly, the angiogram sign within a hypoattenuated lung consolidation area can be found in obstructive pneumonia, while the angiogram sign within a hypoattenuated consolidation with an air bronchogram probably indicates a mucinous carcinoma with lipidic growth.
胸部CT血管造影征是指在肺实质低密度实变区内显示正常强化的肺分支。在对两年内进行的胸部CT检查进行回顾性分析时，我们在10例肺实变患者中发现了血管造影征；诊断结果为：4例中央型肺肿瘤伴阻塞性肺炎，2例细支气管肺泡癌，1例放疗后纤维化，1例结核性肺炎，1例肺淋巴瘤，1例胰腺肿瘤转移。9例患者通过细胞学检查和/或手术标本确诊，1例通过临床-影像学随访确诊。还考虑了实变肺的密度、空气支气管造影和黏液支气管造影以及肺容积减少情况。5例患者的实变肺密度<30 HU（1例细支气管肺泡癌、1例胰腺癌转移和3例阻塞性肺炎），其余5例患者的实变肺密度>30 HU。4例患者观察到空气支气管造影征（1例细支气管肺泡癌、1例转移瘤、1例放疗后纤维化和1例肺淋巴瘤），3例阻塞性肺炎患者观察到黏液支气管造影。仅2例患者出现肺容积减少（1例阻塞性肺炎和1例放疗后纤维化）。我们认为，CT血管造影征必须被视为一种特异性较差的征象，因为它可在许多良性和恶性病理过程中出现。如果与肺实变的其他特征相关，CT血管造影征可与临床表现和患者病史一起帮助诊断病理状况。特别是，在低密度肺实变区内的血管造影征可见于阻塞性肺炎，而在伴有空气支气管造影的低密度实变区内的血管造影征可能提示黏液腺癌伴脂质生长。
