Beigelman C, Chartrand-Lefebvre C, Jouveshomme S, Brauner M
Service de Radiologie Centrale, Hôpital Pitié-Salpêtrière, Paris.
Rev Mal Respir. 1998 Apr;15(2):151-7.
Chest X-Ray is the most accurate method of imaging for infectious diseases in an immunocompetent patient. Computed tomography (CT) may be useful in certain circumstances, particularly in case of atypical findings at the time of diagnosis or in case of complications. CT helps to detect and perform a complete study of the lesions, some aspects being very suggestive of a diagnosis, as in post-primary active tuberculosis. CT may also detect an unknown underlying etiology. Multiplanar reformations with helical CT can be useful for example in case of empyema. In case of non tuberculous bacterial infections, CT is mainly recommended when abscess and empyema are difficult to differentiate or in case of pleural complications with possible percutaneous treatment. In case of tuberculosis, CT may be indicated when clinical and chest X-Ray findings are discordant, in case of mediastinal adenopathies, when reactivation is suspected or in case of complications as hemoptysis. A baseline CT examination could be proposed at the end of a specific treatment to facilitate the diagnosis of reactivation tuberculosis. A nontuberculous mycobacterial infection should finally be suspected in front of peculiar CT findings.
胸部X线检查是免疫功能正常患者感染性疾病最准确的影像学检查方法。计算机断层扫描（CT）在某些情况下可能有用，特别是在诊断时出现非典型表现或出现并发症的情况下。CT有助于检测病变并对其进行全面评估，某些方面对诊断具有很强的提示作用，如继发性活动性肺结核。CT还可以发现未知的潜在病因。例如，螺旋CT的多平面重建在脓胸的情况下可能有用。对于非结核分枝杆菌感染，主要在脓肿和脓胸难以鉴别或存在可能需要经皮治疗的胸膜并发症时推荐使用CT。对于结核病，当临床和胸部X线检查结果不一致、存在纵隔淋巴结肿大、怀疑复发或出现咯血等并发症时，可能需要进行CT检查。在特定治疗结束时，可以建议进行基线CT检查，以利于复发性结核病的诊断。在出现特殊的CT表现时，最终应怀疑非结核分枝杆菌感染。
