摘要目的 探讨胸膜结核瘤的临床、病理和影像学特征.方法 回顾性分析上海市肺科医院2005年6月至2008年6月经病理和(或)细菌学证实的83例胸膜结核瘤患者的临床、实验室检查、病理和影像学等资料.结果 83例中男50例、女33例,年龄7～85岁,平均37.8岁.患者以咳嗽、发热和胸痛为常见症状,无症状者(25例)也不少见;部分患者有阳性体征,如叩诊浊音和呼吸音减低等.83例中合并肺结核36例,80例有明确的结核性胸膜炎病史,3例无明确病史;胸膜炎治疗不及时者45例,抗结核治疗方案不规范者42例,未应用糖皮质激素者48例;59例行CT引导下经皮穿刺活检,24例行胸腔镜手术治疗,其中经病理证实为结核性病变者62例.病理所见:肉芽肿性炎症、凝固性坏死或干酪样坏死、淋巴细胞、类上皮细胞、朗汉斯巨细胞、炎症细胞、脓细胞、组织细胞和瘢痕组织等;15例穿刺物抗酸杆菌染色阳性,21例穿刺物MTB培养阳性.X线胸片示:病变呈单发者68例,多发者15例,以右下肺居多(46例),类圆形影最常见(63例).胸部CT示:病灶密度均匀20例,不均匀40例,伴钙化9例,病灶中心密度较低6例.胸部CT强化扫描示:病灶密度均匀18例,不均匀65例,伴钙化9例,病灶中心密度较低34例,边缘强化者28例.结论 胸膜结核瘤是结核性胸膜炎发生、发展与转归的一个重要过程,掌握其临床、病理和影像学特征,对诊断和鉴别诊断具有重要的价值.

abstractsObjective To investigate the clinical,pathological and radiological characteristics of pleural tuberculoma,so as to improve the understanding of this disease.Methods We retrospectively analyzed the clinical,laboratory,pathological and radiological data of 83 cases of pleural tuberculoma diagnosed by pathology and(or)bacteriology in Shanghai Pulmonary Hospital Affiliated to Tongji University.Results In the recruited 83 cases,there were 50 males and 33 females,aged from 7 to 85 years old,with a mean age of 37.8 years.Cough,fever and chest pain were common symptoms,but no significant symptoms were seen in 25 patients(31.3%).Some patients had positive physical signs,such as dullness to percussion and low breath sound.Pulmonary tuberculosis was also present in 36 patients(43.3%)with pleural tuberculoma.A history of tuberculous pleurisy was elicited in 80 patients,among whom 45(56.3%)received delayed antituberculous treatment and 42(52.5%)received nonstandard treatment.Forty-eight cases(60.0%)did not receive corticosteroids.Fifty-nine cases underwent CT-guided percutaneous biopsy,while 24 underwent thoracoscopic surgery,and tuberculosis was pathologically confirmed in 62(74.7%).Pathological profiles included granuloma,coagulation or caseation necrosis,lymphocyte infiltration,epithelioid cells,inflammatory cells,histiocytes and scar tissue.Fifteen(18.1%)specimens from percutaneous biopsy were anti-fast smear positive,while Mycobacterium tuberculosis was obtained by culture in 21(25.3%)cases.Chest X-ray showed that solitary lesions were seen in 68 cases,multiple foci in 15.The lesions of 46 cases(55.4%)occupied the lower right lobes.Round-like shadows were the most common signs,which were present in 63 cases(75.9%).CT examination demonstrated homogeneous density in 20,heterogeneous density in 40,calcification in 9,central attenuation in 34,and peripheral intensification in 28 cases.Conclusions Pleural tuberculoma is an important sequelae of tuberculous pleurisy.Understanding its clinical,pathological and radiological characteristics is helpful for the differential diagnosis of pleural and lung diseases.