以“支气管树爬行征”为主要影像特征的肺结核1例并文献复习

doi:10.3969/j.issn.1004-583X.2025.08.009

摘要/Abstract

摘要：

目的探讨以“支气管树爬行征”为主要影像特征的肺结核的影像特点及临床诊断价值。方法选取西充县人民医院呼吸科患者1例,回顾性分析其临床资料和影像学特点。结果患者为55岁男性,罹患2型糖尿病,主因检查发现肺部结节10个月就诊,在8个月内肺部病灶由左上肺尖后段结节起始,逐步形成沿支气管血管束向肺门延伸的“支气管树爬行征”,病理组织活检提示肉芽肿性炎伴坏死,经TB-DNA检测确诊为继发性肺结核。结论 “支气管树爬行征”可作为肺结核,特别是继发性肺结核的影像学提示征象,对提高早期诊断准确性具有一定价值。

关键词: 结核, 肺, 支气管树爬行征, 影像学, 肉芽肿

Abstract:

Objective To explore the imaging characteristics and clinical diagnostic value of pulmonary tuberculosis with the “crawling sign” as the main radiological feature. Methods Clinical and imaging data of a patient treated in the Respiratory Department of Xichong County People's Hospital were retrospectively analyzed. Results A 55-year-old man with type 2 diabetes mellitus presented with a pulmonary nodule found on routine examination 10 months earlier. During an 8-month follow-up, chest CT showed disease progression from a solitary nodule in the apicoposterior segment of the left upper lobe to a tubular lesion extending along the bronchovascular bundles toward the hilum, which was known as the crawling sign. Pathologic biopsy revealed granulomatous inflammation with necrosis. Tuberculosis (TB)-DNA testing confirmed a diagnosis of secondary pulmonary tuberculosis. Conclusion The crawling sign may serve as a suggestive imaging feature of pulmonary tuberculosis, particularly secondary pulmonary tuberculosis. It helps improve the accuracy of early diagnosis.

Key words: tuberculosis, pulmonary, crawling sign, imaging, granuloma

中图分类号:

R521

李果, 郭三君. 以“支气管树爬行征”为主要影像特征的肺结核1例并文献复习[J]. 临床荟萃, 2025, 40(8): 721-725.

Li Guo, Guo Sanjun. Pulmonary tuberculosis with the “crawling sign” as the main imaging feature:A case report and literature review[J]. Clinical Focus, 2025, 40(8): 721-725.

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链接本文: https://www.lchc.cn/CN/10.3969/j.issn.1004-583X.2025.08.009

https://www.lchc.cn/CN/Y2025/V40/I8/721

图/表 5

图1 2022年11月10日胸部CT 左肺上叶尖后段实性结节,约16 mm×9 mm,形态欠规则,其内可见低密度影,周围可见磨玻璃影及小结节;纵隔窗示结节外侧可见点状钙化;冠状位重建图像示结节呈管状形态,内侧有一支气管与其相连

Fig. 1 Chest CT on November 10, 2022 revealed an irregular solid nodule (16 mm×9 mm) in the apical-posterior segment of the left upper lobe, containing a low-density area, surrounded by ground-glass opacity and small satellite nodules. The mediastinal window showed punctate calcification at the nodule's periphery. Coronal reconstruction demonstrated a tubular morphology with a connected bronchus

图2 2022年12月8日胸部CT 左肺上叶尖后段结节较前稍缩小,周围磨玻璃影及小结节有所吸收

Fig. 2 Chest CT on December 8, 2022 showed a slight reduction in nodule size and partial resolutions of surrounding ground-glass opacity and satellite nodules

图3 2023年7月5日胸部CT 左肺上叶尖后段见一管状稍高密度影,约40 mm×16 mm×14 mm,CT值约20 HU,其内可见气泡影,邻近胸膜增厚、粘连;非同日胸部增强CT提示病灶呈轻中度不均匀强化

Fig. 3 Chest CT on July 5, 2023 displayed a tubular hyperdense shadow (40 mm×16 mm×14 mm, CT value: 20 HU) with internal air bubbles and adjacent pleural thickening/adhesion. Contrast-enhanced CT revealed a mild-to-moderate heterogeneous enhancement

图4 横轴位及冠状位多平面薄层CT组合图像 “支气管树爬行征”,即位于肺外周的病灶、外侧部分体积大于内侧部分且有沿着支气管血管束向肺门“爬行”生长的趋势

Fig. 4 Multiplanar thin-slice CT (axial and coronal) demonstrated the crawling sign: a peripherally located lesion with larger outer volume, extending along the bronchovascular bundle toward the hilum

图5 肺穿刺活检病理多个大小不等肉芽肿形成,伴凝固性坏死以及淋巴细胞和浆细胞浸润(HE×100, ×200, ×400)

Fig. 5 Lung biopsy pathology showed granulomas of varying sizes with coagulation necrosis, lymphocytes, and plasma cell infiltration (H&E×100, ×200, ×400)

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