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CT可确定平片无法显示的肺部病变、发现隐蔽的空洞，特别是隐匿于胸腔积液中的空洞、发现支气管狭窄及支气管阻塞和息肉状的、充填于支气管内的引起肺不张的支气管结核。CT在原发性肺结核的诊断中发挥着重要的作用，对于肺门和纵隔淋巴结的增大也易于发现。CT对早期的粟粒样阴影显示优于普通平片，因此当疑为粟粒性肺结核时应对进行胸部CT检查。在肺外结核病方面，包括结核性脑膜炎、淋巴结结核、支气管结核、结核性浆膜炎、骨关节结核等也有重要的辅助诊断价值。 CT can determine pulmonary lesions that cannot be shown by plain films, detect hidden voids, especially voids hidden in pleural effusion, detect bronchial stenosis and bronchial obstruction and polypoid bronchial tuberculosis causing atelectasis in the bronchus. CT plays an important role in the diagnosis of primary tuberculosis, and it is also easy to detect the enlargement of hilar and mediastinal lymph nodes. CT is superior to plain film in showing early miliary shadow, so chest CT examination should be carried out when suspected miliary tuberculosis. In the aspect of extrapulmonary tuberculosis, including tuberculous meningitis, lymph node tuberculosis, bronchial tuberculosis, tuberculous serositis, osteoarthrosis tuberculosis also have important auxiliary diagnostic value. （8）：气道壁增厚与扩张 ↑ 气道壁增厚伴扩张：CT示右上叶后段肺结核病灶伴支气管壁增厚及管腔扩张。 气管壁增厚在HRCT上表现为气道壁的厚度值大于同级正常气道，气道壁的增厚有时伴有扩张，典型者可呈‘双轨征’表现。 In HRCT, the thickening of the airway wall shows that the thickness value of the airway wall is greater than that of the normal airway at the same level. The thickening of the airway wall is sometimes accompanied by expansion, and the typical one can present the 'dual-track sign'. ↑ 支气管壁增厚：CT扫描可见左肺上叶主支气管结核，导致管壁增厚、管腔不规则狭窄，远端支气管阻塞伴左上叶肺不张。 ↑ 支气管腔狭窄与闭塞：CT示左肺下叶背段结核病灶，可见支气管渐进性狭窄与闭塞伴肺实变。 （9）：间质性病变 ↑ 肺结核病灶伴间质性改变：CT示双上肺结核病灶可见线样与网织状阴影，伴弥漫分布的小结节影，右上肺可见薄壁空洞阴影。 部分肺结核患者CT表现以间质性病变为主，甚至活动性肺结核也是如此。主要包括小叶间隔增厚和小叶内间质异常，前者多发生于气道播散区，可能余小叶中心结节的增大与融合累计肺小叶结构有关。经过治疗后可大部分吸收。而肺结核小叶间质异常可能具有一定的特征性，主要出现于粟粒性肺结核和少数继发性肺结核病灶中。 CT findings of some tuberculosis patients are mainly interstitial lesions, even active tuberculosis. Mainly including interlobular septal thickening and interlobular mesenchymal abnormality, the former mostly occurs in the airway spreading area, and the enlargement of central nodules of the residual lobule may be related to the fusion accumulation of lung lobules. Most of it can be absorbed after treatment. The lobular interstitial abnormality of pulmonary tuberculosis may be characteristic, mainly occurring in miliary pulmonary tuberculosis and a few secondary pulmonary tuberculosis. （10）：淋巴结肿大 ↑ 纵隔淋巴结肿大：中纵隔内可见多发淋巴结肿大，呈薄壁环形强化，中央坏死无强化，为淋巴结结核。 胸内淋巴结肿大也是肺结核常见的征象之一，主要包括肺门和纵隔淋巴结肿大，通常以淋巴结短径大于1.0cm为增大的标准。肿大的淋巴结在CT上的表现为淋巴结均质肿大，中心液性低密度，中心脂肪密度和淋巴结钙化等，后三者多提示为良性结核病病变。病理上肿大的淋巴结外围部分为肉芽组织的纤维环，中心部分为融合性干酪样坏死灶。活动性淋巴结结核CT增强后多表现为周边环形强化或花边状融合病灶，中央坏死无强化。 Intrathoracic lymph node enlargement is also one of the common signs of tuberculosis, mainly including pulmonary hilum and mediastinal lymph node enlargement, usually with lymph node short diameter greater than 1.0cm as the standard for enlargement. On CT, the enlarged lymph nodes showed homogeneous enlargement of lymph nodes, low central fluid density, central fat density and lymph node calcification, and the latter three were mostly benign tuberculosis lesions. The peripheral part of the pathological enlarged lymph node is the fibrous ring of granulation tissue, and the central part is the fused caseous necrosis. The enhanced CT scan of the active lymph node usually shows peripheral ring enhancement or lacy fusion, but no enhancement in central necrosis. （11）：胸腔积液 ↑ 左侧大量胸腔积液：CT示左侧结核性胸膜炎伴大量胸腔积液，左肺明显压缩不张，纵隔向右侧移位。 ↑ 右侧叶间胸膜包裹性积液：CT示右侧结核性胸膜炎，胸腔积液伴叶间胸膜包裹性积液，呈椭圆形密度影。 结核性胸膜炎时可以出现胸腔积液，有时可有肺结核同时发生，胸腔积液在CT上表现为胸腔后部沿胸廓内缘走行的星月形液性密度影，有学者将液性低密度区占据胸腔前后径的后1/3视为少量积液，中1/3为中量，前1/3为大量积液。当积液进入叶间裂并发胸膜粘连时，可出现梭形或球形阴影，易与肺内病变混淆，病程较长的结核性胸膜炎易发生胸膜粘连、增厚及包裹性积液，当合并气胸和支气管胸膜瘘时，胸腔内可见液气平面。 Pleural effusion can occur during tuberculous pleurisy, and sometimes pulmonary tuberculosis can occur simultaneously. Pleural effusion on CT shows a stare-shaped liquid-liquid density shadow along the inner edge of the thoracic cavity at the back of the chest. Some scholars regard the latter 1/3 of the pleural diameter occupied by the low-density liquid area as a small amount of pleural effusion. When the effusion enters the interlobular fissure complicated by pleural adhesion, spindle shape or spherical shadow can appear, which is easily confused with pulmonary lesions. The tuberculous pleurisy with a long course of disease is prone to pleural adhesion, thickening and enveloping effusion. When combined with pneumothorax and bronchial pleural fistula, liquid-gas plane can be seen in the thoracic cavity. |
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