临床误诊误治2025，Vol.38Issue(20)：7-13,7.DOI:10.3969/j.issn.1002-3429.2025.20.002
以纵隔和肺门淋巴结增大为主要表现的老年肺结节病CT影像误诊分析
Misdiagnosis analysis of CT images in elderly patients with pulmonary sarcoidosis with mediastinal and hilar lymph node enlargement as the main manifestation
宋鹏 1高莹 1刘兴美 1彭莎 1魏晓旋 1杨海庆 1耿左军 1田欣1
作者信息
- 1. 河北医科大学第二医院医学影像科,石家庄 050000
- 折叠
摘要
Abstract
Objective To explore the CT imaging features and causes of misdiagnosis in elderly patients with pulmonary sarcoidosis.Methods Fifteen elderly patients with pulmonary sarcoidosis and 19 elderly patients with hilar malignancies accompanied by mediastinal lymph node metastasis who were admitted from January 2020 to December 2024 were selected.Clinical data and CT imaging data of the patients were analyzed.Results The CT value of plain CT scan of enlarged lymph nodes in elderly patients with pulmonary sarcoidosis was higher than that in elderly patients with hilar malignancies accompanied by mediastinal lymph node metastasis,showing significant difference(P<0.05).The CT value of enlarged lymph nodes in the venous phase of elderly patients with pulmonary sarcoidosis was higher than that of elderly patients with hilar malignancies accompanied by mediastinal lymph node metastasis(P<0.05).In elderly patients with pulmonary sarcoidosis,the number of enlarged lymph nodes located in 2R area was higher than that in 2L area(80.0%>33.3%),and the number of enlarged lymph nodes in the 4R area was higher than that in the 4L area(73.3%>53.3%).Moreover,in elderly patients with hilar malignancies accompanied by mediastinal lymph node metastasis,the location of enlarged lymph nodes was related to the location of the primary tumor.In elderly patients with pulmonary sarcoidosis,tiny nodules distributed along the interstitium could be seen in the lungs,and these nodules were mostly distributed in multiple lung segments.However,in elderly patients with hilar malignancies accompanied by mediastinal lymph node metastasis,the tiny nodules distributed along the interstitium in the lungs were located around the malignant tumors.Interstitial changes occurred more frequently in elderly patients with pulmonary sarcoidosis than in those with hilar malignancies accompanied by mediastinal lymph node metastasis(P<0.05).Among elderly patients with pulmonary sarcoidosis,10 patients were misdiagnosed with pulmonary malignant tumors,and were diagnosed with pulmonary sarcoidosis via lymph node biopsy and showed improvement after subsequent glucocorticoid treatment.Conclusion There is a certain overlap in imaging manifestations between pulmonary sarcoidosis and hilar malignancies accompanied by mediasinal lymph node metastasisv in the elderly.Accurate differentiation requires the combination of multiple aspects of clinical and imaging examination information.The main cause of misdiagnosis is multiple enlarged lymph nodes in the mediastinum accompanied by pulmonary nodules,which are similar to the manifestations of malignant lung tumors.Combining the imaging features of mediastinal lymph nodes,interstitial changes in the lungs,and the distribution range of micronodules in the lungs is helpful for differentiating elderly patients and pulmonary sarcoidosis and those with hilar malignancies and mediastinal lymph node metastasis.关键词
结节病/误诊/肺门肿瘤/恶性/老年人/纵隔淋巴结转/CT检查/影像学特征Key words
sarcoidosis/misdiagnosis/hilar tumor/malignant/elderly/mediastinal lymph node metastasis/CT examination/imaging features引用本文复制引用
宋鹏,高莹,刘兴美,彭莎,魏晓旋,杨海庆,耿左军,田欣..以纵隔和肺门淋巴结增大为主要表现的老年肺结节病CT影像误诊分析[J].临床误诊误治,2025,38(20):7-13,7.
