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肺癌性淋巴管炎的HRCT表现与病理基础
引用本文:金震滨,张涛.肺癌性淋巴管炎的HRCT表现与病理基础[J].CT理论与应用研究,2021,30(3):387-394.
作者姓名:金震滨  张涛
作者单位:南通大学附属南通第三人民医院影像科, 江苏 南通 226001
摘    要:目的:总结肺癌性淋巴管炎(PLC)的HRCT表现。资料与方法:回顾性分析本院2013年10月至2018年6月共29例经病理证实的PLC的HRCT表现,29例均行HRCT平扫和增强扫描。结果:29例PLC患者中,男性17例,女性12例,年龄30~79岁,平均年龄58岁。累及单侧肺16例(55%),且右肺发病率大于左肺,两肺13例(45%),局限性分布22例(76%),弥漫性非对称性分布7例(24%),29例均可见肺纹理不规则增多、增粗、紊乱和边缘欠清(中轴间质增厚),其中21例在异常的肺纹理中夹杂有多个微小结节影;小叶间隔不规则增厚25例,10例呈小的结节状增厚(周围间质增厚);5例见胸膜下条状影(周围间质增厚);4例见细网格状影(小叶内间质增厚);胸膜不规则增厚伴多发微小结节18例;肺门和(或)纵隔淋巴结肿大14例;胸腔积液(右侧胸腔积液较左侧多)10例;心包少量积液4例。结论:PLC在HRCT多表现肺内间质局限性或弥漫性非对称性增厚,伴多发微小间质结节、胸膜轻度增厚伴多发微小结节、肺内磨玻璃影及小结节影、肺门和(或)纵隔淋巴结肿大,HRCT具有较高的诊断价值。 

关 键 词:肺癌性淋巴管炎    体层摄影    X线计算机
收稿时间:2020-11-26

HRCT Manifestations and Pathological Basis of Pulmonary Lymphangitic Carcinomatosis
JIN Zhenbing,ZHANG Tao.HRCT Manifestations and Pathological Basis of Pulmonary Lymphangitic Carcinomatosis[J].Computerized Tomography Theory and Applications,2021,30(3):387-394.
Authors:JIN Zhenbing  ZHANG Tao
Affiliation:Department of Radiology, the Third Hospital Affiliated of Nantong University, Nantong 226001, China
Abstract:Objective: To summarize the HRCT manifestations of pulmonary lymphangitic carcinomatosis(PLC). Materials and Methods: The HRCT manifestations of 29 cases of PLC confirmed by pathology from October 2013 to June 2018 were analyzed retrospectively. All 29 cases underwent plain and enhanced HRCT scanning. Results: Among 29 patients with PLC, 17 patients were male and 12 patients were female, Age 30 to 79, the average age was 58 years old. Unilateral lung involvement was found in 16 cases(55%), and the incidence rate in the right lung was larger than that in the left lung. Bilateral lung involvement was found in 13 cases(45%) in two lungs. Localized distribution was found in 22 cases(76%), and diffuse asymmetrical distribution was found in 7 cases(24%). In 29 cases, irregular increase, thickening, disorder and unclear margin of lung texture(thickening of axial interstitium) were found, including 21 cases with multiple tiny nodule shadows in abnormal lung texture; 25 cases with irregular thickening of interlobular septum were found, 10 cases with small nodule like thickening(thickening of peripheral interstitium) were found; 5 cases with streaky shadow under pleura(thickening of peripheral interstitium) were found; There were 18 cases of irregular pleural thickening with multiple micro nodules, 14 cases of hilar and/or mediastinal lymphadenopathy, 10 cases of pleural effusion(more on the right side than on the left side), and 4 cases of pericardial effusion. Conclusion: In HRCT, PLC often shows the local or diffuse asymmetric thickening of pulmonary interstitium with multiple micro interstitial nodules, mild thickening of pleura with multiple micro nodules, ground glass shadow and small nodule shadow in the lung, hilar and/or mediastinal lymph nodes enlargement. HRCT has a high diagnostic value. 
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