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支气管源性囊肿是前肠畸形的一种,是由于在胚胎发育过程中,肺实质的细胞和(或)肺芽脱落导致的肺先天性发育畸形[1]。支气管源性囊肿最常发生于纵隔,也可发生于肺内、颈部及腹部[2],当其发生在肺内时表现多样,需要与肺内多种疾病相鉴别[3]。我们回顾性分析了经组织病理学检查结果证实的46例肺内支气管源性囊肿患者的影像学资料,探讨其CT影像学特征及CT对其的鉴别诊断价值。
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46例肺内支气管源性囊肿患者中,单发42例、多发4例(3例位于同侧肺的不同肺叶,1例位于双肺)。位于右肺上叶、中叶、下叶的病变数量分别为10个、7个、11个;位于左肺上叶、下叶的病变数量分别为10个、12个。46例支气管源性囊肿患者的CT表现与组织病理学检查结果见表1。
类别 含液囊肿
(n=16)含气囊肿
(n=10)蜂窝及肿块样
囊肿(n=20)单发/多发(例) 15/1 9/1 18/2 单肺/双肺(例) 16/0 9/1 20/0 病灶位置(个) 双肺上叶 7 2 11 右肺中叶 2 1 4 双肺下叶 8 8 7 形态(例) 圆形或类圆形 11 10 6 不规则形 5 0 14 周围肺改变(例) 小索条 4 0 20 肺不张及实变 2 3 20 肺透过度增高 3 0 15 增强CT表现(例) 无强化 3 0 0 囊肿壁强化 9 0 0 肿块、结节强化 0 0 19 组织病理学检查(个) 支气管源性囊肿无合并症 9 10 1 曲霉菌感染 3 0 9 其他感染 2 1 7 结核 2 0 4 类癌 0 0 1 表 1 46例支气管源性囊肿患者的CT表现及组织病理学检查结果
Table 1. CT findings and histopathological examination results of 46 patients with bronchogenic cyst
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16例患者CT表现为含液囊肿(球形灶),其中15例为单发,1例合并同侧肺含气囊肿。在CT横断面上,11例呈圆形或类圆形,5例呈不规则形(3例呈分叶状,2例呈葫芦状);在CT冠状面或斜冠状面上重建显示,长轴或近似长轴平行于支气管的血管束病变最大径为2~7 cm,边界较清晰,囊肿壁大多较薄且均匀,仅3例囊肿壁可见钙化,囊肿内密度较均匀,CT值为5~64 HU。12例CT表现为单纯含液囊肿(图1A),4例CT表现为线状分隔的多房含液囊肿。
图 1 不同类型支气管源性囊肿患者的CT表现及组织病理学检查图 A为单纯含液囊肿患者(男性,46岁)的横断面纵隔窗CT平扫图,显示右肺下叶类圆形低密度囊肿,边缘较清晰,密度较均匀;B为单纯含气囊肿患者(女性,52岁)的冠状面肺窗CT平扫图,显示右肺上叶巨大支气管囊肿,囊肿壁较薄且光滑,外缘可见少许肺实变;C为蜂窝及肿块样囊肿患者(男性,49岁)的横断面肺窗CT平扫图,显示左肺上叶不规则肿块,密度不均匀,可见含气影,前部见裂隙样空洞;D为囊肿壁结节患者(女性,48岁)的横断面肺窗CT平扫图,显示右肺下叶含气囊肿样影,囊肿壁厚度不均匀,内壁可见圆形结节;E为蜂窝及肿块样囊肿患者(与C为同一例患者)的术后组织病理学检查图(过碘酸雪夫染色,×400),显示曲霉菌球的类圆形断面,菌丝粗细均匀,为支气管源性囊肿合并曲霉菌感染;F为囊肿壁结节患者(与D为同一例患者)的术后组织病理学检查图(苏木精-伊红染色,×40),显示类癌细胞核染色体呈多发的细颗粒状,为支气管源性肿合并类癌。CT为计算机体层摄影术
Figure 1. CT findings and histopathological examination images of different types of bronchogenic cyst
16例含液囊肿患者中有12例同时行增强CT检查发现,9例含液囊肿患者的内容物未见强化,囊肿壁呈轻、中度强化;3例线状分隔的多房含液囊肿患者的内线状分隔显示更为清晰。
以上患者的CT合并表现:4例囊肿周围可见小索条影;3例囊肿周围可见肺透过度增高;2例较大囊肿周围可见条带状肺不张及实变,邻近肺叶容积受压变小并可见肺叶间胸膜移位。术后组织病理学检查结果证实,本组患者支气管源性囊肿病灶无合并症9个;合并曲霉菌感染3个、结核2个、其他感染2个。
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10例患者CT表现为含气囊肿,其中9例为单发,1例为双肺下叶各有1个含气囊肿,均呈圆形或类圆形,最大径为2~10 cm(图1B)。囊肿的内壁光滑,囊肿壁较薄(< 2 mm),仅1例患者囊肿壁可见点状钙化。
以上患者的CT合并表现:3例较大囊肿周围可见条带状肺不张及实变,邻近肺叶间胸膜移位。术后组织病理学检查结果证实,本组患者支气管源性囊肿病灶无合并症10个,仅1个病灶合并囊肿壁感染及囊肿周围肺感染。
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20例患者CT表现为蜂窝及肿块样囊肿,其中18例为单发,2例位于同侧肺的不同肺叶。6例CT表现为大小不等的圆形或类圆形小囊腔,部分小囊腔内可见气液平面,其中3例囊腔内合并曲霉菌感染,2例偏心空洞内可见曲霉菌球及新月形裂隙(图1C、E)。14例CT表现为不规则形,其中2例不规则囊腔,分叶状、囊肿壁厚度不均匀(其中1例囊肿壁可见钙化),此2例囊肿壁均可见结节影(其中1例结节为曲霉菌,另1例为类癌结节)(图1D、F);12例表现为不规则软组织影,与周围分界不清,内部密度不均匀,其中3例表现为分叶状。
20例蜂窝及肿块样囊肿患者中19例行增强CT检查结果显示,病变内肿块及结节可见不同程度强化。增强后气液平面、液体成分分界更为清晰;3例分叶状实性肿块呈明显不均匀强化,术后组织病理学检查结果证实合并感染、局部坏死;1例呈明显强化的结节,术后组织病理学检查结果证实为类癌。
以上患者的CT合并表现:20例支气管源性囊肿患者的囊肿周围均可见小索条和肺不张及实变,其中15例合并有肺透过度增高、3例合并肺裂不全。经术后组织病理学检查结果证实,本组患者支气管源性囊肿病灶无合并症1例,合并曲霉菌感染9个、结核4个、其他感染7个、类癌1个。
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46例患者均行外科手术,术后组织病理学检查结果证实,囊肿内病灶合并曲霉菌感染12个,其他感染10个,结核6个;囊肿内发现肿瘤病灶1个(类癌),表现为不规则囊肿壁的结节影,结节较光滑(图1D)。
成人肺内支气管源性囊肿的CT表现
CT findings of intrapulmonary bronchogenic cyst in adults
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摘要:
目的 分析成人肺内支气管源性囊肿的CT表现特点。 方法 回顾性分析2014年2月至2019年12月于天津市胸科医院经组织病理学检查结果证实为肺内支气管源性囊肿的46例患者的影像学资料,其中男性25例、女性21例,年龄23~74(48.3±8.1)岁。所有患者均行CT平扫检查,其中31例患者同时行增强CT检查。根据CT表现特点分析患者肺内病变的部位、数量、周围的肺组织改变及合并症等。 结果 46例患者中,42例为单发、4例为多发(3例位于同侧肺的不同肺叶,1例位于双肺)。所有患者中CT表现为含液囊肿的有16例、含气囊肿10例、蜂窝及肿块样囊肿20例。囊肿周围肺改变以小索条、肺透过度增高、肺不张及实变为主,分别有24例、18例、25例。术后组织病理学检查结果证实支气管源性囊肿病灶无合并症20个、合并曲霉菌感染12个、其他感染10个、结核6个、肿瘤(类癌)1个。 结论 CT图像所示的成人肺内支气管源性囊肿的含液、含气囊肿具有圆形或类圆形形态,其内为单纯液体或气体,具有一定的鉴别诊断价值。当形成蜂窝及肿块样囊肿时,需要与肺结核、肺癌等相鉴别。 -
关键词:
- 支气管源性囊肿 /
- 肺疾病 /
- 体层摄影术,X线计算机
Abstract:Objective To analyze the CT features of intrapulmonary bronchiogenic cyst in adults. Methods Imaging data of 46 patients (25 males, 21 females, 23–74 (48.3±8.1) years old) with intrapulmonary bronchiogenic cyst confirmed by histopathological examination results in Tianjin Chest Hospital from February 2014 to December 2019 were analyzed retrospectively. All patients underwent CT examination, 31 of whom underwent contrast-enhanced CT examination. According to the CT features, the location and number of intrapulmonary lesions, the changes in surrounding lung tissue, and the complications were analyzed. Results Among the 46 patients, 42 cases were single and 4 cases were multiple (3 cases were located in different lobes of the ipsilateral lung, and 1 cases was located in both lungs). Among all patients, 16 cases with fluid-containing cysts, 10 cases with balloon-like cysts, and 20 cases had honeycomb and mass-like cysts. The main lung changes around the cysts were small cord (24 cases), excessive increase of pulmonary permeability (18 cases), and atelectasis and consolidation (25 cases). Postoperative histopathological examination results confirmed that there were 20 bronchogenic cyst lesions without complications, 12 lesions with aspergillus infection, 10 lesions with other infections, 6 lesions with tuberculosis, and 1 lesion with tumor (carcinoid). Conclusions Fluid-containing and gas-containing cysts shown in CT images of the adults intrapulmonary bronchiogenic cyst had round or quasi-circular shapes, which were simple liquid or gas and had a certain value of differential diagnosis. When honeycomb and mass-like cysts form, they need to be distinguished from pulmonary tuberculosis and lung cancer. -
Key words:
- Bronchogenic cyst /
- Lung diseases /
- Tomography, X-ray computed
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图 1 不同类型支气管源性囊肿患者的CT表现及组织病理学检查图 A为单纯含液囊肿患者(男性,46岁)的横断面纵隔窗CT平扫图,显示右肺下叶类圆形低密度囊肿,边缘较清晰,密度较均匀;B为单纯含气囊肿患者(女性,52岁)的冠状面肺窗CT平扫图,显示右肺上叶巨大支气管囊肿,囊肿壁较薄且光滑,外缘可见少许肺实变;C为蜂窝及肿块样囊肿患者(男性,49岁)的横断面肺窗CT平扫图,显示左肺上叶不规则肿块,密度不均匀,可见含气影,前部见裂隙样空洞;D为囊肿壁结节患者(女性,48岁)的横断面肺窗CT平扫图,显示右肺下叶含气囊肿样影,囊肿壁厚度不均匀,内壁可见圆形结节;E为蜂窝及肿块样囊肿患者(与C为同一例患者)的术后组织病理学检查图(过碘酸雪夫染色,×400),显示曲霉菌球的类圆形断面,菌丝粗细均匀,为支气管源性囊肿合并曲霉菌感染;F为囊肿壁结节患者(与D为同一例患者)的术后组织病理学检查图(苏木精-伊红染色,×40),显示类癌细胞核染色体呈多发的细颗粒状,为支气管源性肿合并类癌。CT为计算机体层摄影术
Figure 1. CT findings and histopathological examination images of different types of bronchogenic cyst
表 1 46例支气管源性囊肿患者的CT表现及组织病理学检查结果
Table 1. CT findings and histopathological examination results of 46 patients with bronchogenic cyst
类别 含液囊肿
(n=16)含气囊肿
(n=10)蜂窝及肿块样
囊肿(n=20)单发/多发(例) 15/1 9/1 18/2 单肺/双肺(例) 16/0 9/1 20/0 病灶位置(个) 双肺上叶 7 2 11 右肺中叶 2 1 4 双肺下叶 8 8 7 形态(例) 圆形或类圆形 11 10 6 不规则形 5 0 14 周围肺改变(例) 小索条 4 0 20 肺不张及实变 2 3 20 肺透过度增高 3 0 15 增强CT表现(例) 无强化 3 0 0 囊肿壁强化 9 0 0 肿块、结节强化 0 0 19 组织病理学检查(个) 支气管源性囊肿无合并症 9 10 1 曲霉菌感染 3 0 9 其他感染 2 1 7 结核 2 0 4 类癌 0 0 1 -
[1] 胡浩, 彭俊红, 吴恩福. 支气管源性囊肿的CT诊断与误诊分析[J]. 临床放射学杂志, 2017, 36(1): 65−68. DOI: 10.13437/j.cnki.jcr.2017.01.018.
Hu H, Peng JH, Wu EF. CT diagnostic and misdiagnosis analysis of bronchogenic cysts[J]. J Clin Radiol, 2017, 36(1): 65−68. DOI: 10.13437/j.cnki.jcr.2017.01.018.[2] Santos I, Barros J, Lopes T, et al. Bronchogenic cyst of the neck in an elder patient: a case report[J/OL]. Int J Surg Case Rep, 2019, 64: 128−132[2020-12-29]. https://www.ncbi.nlm.nih.gov/pmc/journals/1424. DOI: 10.1016/j.ijscr.2019.10.013. [3] Hermelijn SM, Elders BBLJ, Ciet P, et al. A clinical guideline for structured assessment of CT-imaging in congenital lung abnormalities[J]. Paediatr Respir Rev, 2021, 37: 80−88. DOI: 10.1016/j.prrv.2019.12.004. [4] Cardinale L, Ardissone F, Cataldi A, et al. Bronchogenic cysts in the adult: diagnostic criteria derived from the correct use of standard radiography and computed tomography[J]. Radiol Med, 2008, 113(3): 385−394. DOI: 10.1007/s11547-008-0255-8. [5] Le HM, Validire P, Mayeur D, et al. Intrapulmonary bronchogenic cysts[J]. Rev Mal Respir, 2016, 33(7): 622−625. DOI: 10.1016/j.rmr.2015.11.011. [6] 陈爱萍, 王德杭, 俞同福. 先天性支气管囊肿的影像诊断[J]. 放射学实践, 2016, 31(5): 397−401. DOI: 10.13609/j.cnki.1000-0313.2016.05.003.
Chen AP, Wang DH, Yu TF. Imaging diagnosis of congenital bronchial cyst[J]. Radiol Pract, 2016, 31(5): 397−401. DOI: 10.13609/j.cnki.1000-0313.2016.05.003.[7] Bayfield N, Stamp N, Laycock A, et al. Large air-filled intrapulmonary bronchogenic cyst associated with tension pneumothorax during air travel[J/OL]. BMJ Case Rep, 2019, 12(3): e228032[2020-12-29]. https://casereports.bmj.com/content/12/3/e228032#. DOI: 10.1136/bcr-2018-228032. [8] Chen F, Marx S, Zhang CC, et al. Intramedullary bronchogenic cyst in the foramen magnum region accompanied with syringomyelia: a case report and literature review[J]. Medicine (Baltimore), 2019, 98(5): e14353. DOI: 10.1097/MD.0000000000014353. [9] Taira N, Kawasaki H, Atsumi E, et al. Mucoepidermoid carcinoma of arising from a bronchogenic cyst of the diaphragm[J]. Ann Thorac Cardiovasc Surg, 2018, 24(5): 247−250. DOI: 10.5761/atcs.cr.17-00131. [10] Abdalla A, Seedahmed E, Patel P, et al. Role of endobronchial ultrasound scan in the diagnosis and management of intrapulmonary bronchogenic cyst misdiagnosed by low-dose CT scan of the chest as lung mass[J/OL]. BMJ Case Rep, 2017, 2017: bcr2016218411[2020-12-29]. https://casereports.bmj.com/content/2017/bcr-2016-218411. DOI: 10.1136/bcr-2016-218411. [11] Kim HJ, Shin KE, Park JS, et al. Intralobar pulmonary sequestration with cystic degeneration mimicking a bronchogenic cyst in an elderly patient: a case report and literature review[J]. Medicine (Baltimore), 2020, 99(9): e19347. DOI: 10.1097/MD.0000000000019347. [12] Choo JY, Hwang J, Lee JH, et al. Bronchopulmonary foregut malformation presenting as extralobar pulmonary sequestration associated with a bronchogenic cyst: an unusual clinical and radiological feature in an adolescent patient[J]. J Thorac Dis, 2017, 9(7): E632−E635. DOI: 10.21037/jtd.2017.06.101. [13] Tang SJ, Tang SJ, Zhong C, et al. Lung carcinoma mimicking bronchopulmonary cyst in a 22-year-old man[J]. Heart Lung Circ, 2019, 28(10): e143−e144. DOI: 10.1016/j.hlc.2019.04.021. [14] Byers JT, Gertz HE, French SW, et al. Case report: retroperitoneal bronchogenic cyst as a diagnostic dilemma after colon cancer diagnosis[J]. Exp Mol Pathol, 2018, 104(2): 158−160. DOI: 10.1016/j.yexmp.2018.02.002. [15] Ota Y, Watanabe T, Takahashi K, et al. Bronchogenic cyst removal via thoracoscopic surgery in the prone position: a case report and literature review[J/OL]. Int J Surg Case Rep, 2019, 60: 204−208[2020-12-29]. https://www.sciencedirect.com/science/article/pii/S2210261219303128?via%3Dihub. DOI: 10.1016/j.ijscr.2019.05.064.