关键词: 结核, 肺, 肺栓塞, 体层摄影术, X线计算机, 对比研究

Abstract:

Objective: To analyze the chest CT imaging manifestations of patients with pulmonary tuberculosis complicated with pulmonary embolism, and to improve clinicians’ understanding of the imaging of this disease. Methods: A total of 101 patients diagnosed with pulmonary tuberculosis combined with pulmonary embolism in the Kunming Third People’s Hospital from January 2017 to December 2022 were retrospectively selected as the observation group (all patients admitted during this period), and 101 patients diagnosed with simple pulmonary tuberculosis were selected as the control group from 39495 patients by random numbers generated by Excel. The general data and chest CT imaging data were collected, and the distribution, morphology, lesion type and location were summarized and analyzed. Results: The median age of the observation group (65.00 (51.00, 71.50) years) was higher than that of the control group (39.00 (27.00, 55.00) years) (Z=―7.562, P<0.001). Proportion of retreatment patients (57.4%, 58/101) in the observation group was statistically higher than that (32.7%, 33/101) in the control group (χ²=12.499, P<0.001). In the observation group, 43 cases (42.6%, 43/101) had emboli located in the lower right lung lobe. The distribution of lesions in the observation group were 53 cases (52.5%, 53/101) in the right upper lobe, 26 cases (25.7%, 26/101) in the right middle lobe, 49 cases (48.5%, 49/101) in the right lower lobe, 50 cases (49.5%, 50/101) in the left upper lobe, 43 cases (42.6%, 43/101) in the left lower lobe, while for the control group were 50 cases (49.5%, 50/101), 19 cases (18.8%, 19/101), 39 cases (38.6%, 39/101), 43 cases (42.6%, 43/101), 37 cases (36.6%, 37/101), the differences were not statistically significant (χ²=0.339, P=0.560; χ²=1.616, P=0.204; χ²=2.702, P=0.100; χ²=1.410, P=0.235; χ²=1.020, P=0.312); In the observation group, 70 cases (69.3%, 70/101) had lesions accumulated in three or more than three lobes, 56 cases (55.4%, 56/101) showed patchy shadow, 12 cases (11.9%, 12/101) showed consolidation shadow, 37 cases (36.6%, 37/101) showed destroyed lungs, they were all higher than that in the control group (36 cases (35.6%, 36/101), 39 cases (38.6%, 39/101), 2 cases (2.0%, 2/101) and 4 cases (4.0%, 4/101)), and the differences were all statistically significant (χ²=31.439, P<0.001; χ²=6.012, P=0.014; χ²=8.176, P=0.004; χ²=33.325, P<0.001); In the observation group, there were 29 cases (28.7%, 29/101) complicated with emphysema, 30 cases (29.7%, 30/101) with pericardial effusion, 43 cases (42.6%, 43/101) with bilateral pleural effusion, 37 cases (36.6%, 37/101) with right heart enlargement, 17 cases (16.8%, 17/101) with atelectasis, and 33 cases (32.7%, 33/101) with pulmonary artery thickness, which were all statistically higher than that of the control group (5 cases (5.0%, 5/101), 4 cases (4.0%, 4/101), 8 cases (7.9%, 8/101), 4 cases (4.0%, 4/101), 6 cases (5.9%, 6/101), 3 cases (3.0%, 3/101); χ²=20.688, P<0.001; χ²=24.243, P<0.001; χ²=33.635, P<0.001; χ²=49.155, P<0.001; χ²=6.488, P=0.011; χ²=33.223, P<0.001). The working characteristic curves showed that when D-dimer >1.290 μg/ml, pulmonary tuberculosis patients were more likely to develop pulmonary embolism. Conclusion: In older patients with retreated pulmonary tuberculosis whose CT show patchy shadow, consolidation shadow or damaged lungs, accompanied by emphysema, pericardial effusion, bilateral pleural effusion, right heart enlargement, atelectasis, pulmonary artery thickening and D-dimer >1.290 μg/ml, it is necessary to be alert to the occurrence of pulmonary embolism. Doctors should consider clinical symptoms and other laboratory examinations of patients to make early diagnosis and treatment.

Key words: Tuberculosis, pulmonary, Pulmonary embolism, Tomography, X-ray computed, Comparative study