目的 分析局灶性机化性肺炎(FOP)的临床、影像学特点及其可能的病因.方法 回顾性分析2010年8月—2016年2月北京市垂杨柳医院呼吸内科及北京大学第三医院急诊科经病理确诊为FOP 19例患者的临床及影像学资料,依据病灶是否≥3cm以及是否找到继发病因分为特发性及继发性FOP,分别分析不同大小病灶以及特发/继发性FOP的临床特点.结果 FOP临床症状缺乏特异性,<3cm与≥3cm的FOP患者相比,临床症状无明显统计学差异.外周肺野分布、多边形、与胸膜宽基底接触、密度不均、周边模糊等有利于≥3cm FOP的诊断,但<3cm FOP具有肺癌常见的边缘清晰、空泡征、毛刺征等特点,初始误诊率较高.19例FOP中,找到继发病因5例:3例考虑与感染有关;1例手术活检显示抗酸染色阳性,1例因病灶存在动态增大,手术切除见到腺癌细胞.14例特发性FOP较继发性FOP病程长,发热、咳嗽、咯痰、喘息症状较少见.结论 临床症状无助于FOP诊断;依据胸部CT,大病灶FOP具有一定特点,但<3cm FOP难以与肺癌鉴别;FOP诊断主要依赖于病理,但病理诊断FOP后注意查找继发病因,并应密切监测胸部CT变化,防止误诊或漏诊.%Objective To analyze the clinical and imaging features of focal organizing pneumonia(FOP)and its pos-sible etiology.Methods From August 2010 to February 2016,retrospective analyzed clinical and imaging data of 19 cases of FOP patients,who were with pathological diagnosis in department of respiratory medicine from Beijing Chuiyangliu Hospital and department of emergency from No.3 Hospital of Peking University, on the basis of the lesion whether more than 3cm or not,and whether any secondary etiology for idiopathic and secondary FOP, analyzed the different size of lesions and clinical features of idiopathic and secondary FOP.Results FOP lack of specific clinical symptoms,compared with <3 cm FOP and more than or equal to 3 cm lesions, there was no significant difference between them in clinical symptoms.Peripheral lung field distribution,polygon,contact with pleural broadly,uneven density,the surrounding tissue blurred border are helpful to diagnosis of more than or equal to 3cm FOP,but <3 cm FOP has a clear border,vacuole sign,spicule sign and other charac-teristics,the initial misdiagnosis rate is high.In 19 cases of FOP,secondary causes were found in 5 cases:3 cases associated with infection;1 cases of biopsy showed acid fast staining positive;1 cases due to the dynamic increase of the lesions,surgical resection of adenocarcinoma cells.Conclusion The clinical symptoms contribute less to FOP diagnosis; according to the chest CT,large lesions FOP has certain characteristics,but the <3 cm FOP and lung cancer is difficult to identify;the diag-nosis of FOP mainly depends on the pathological, but find secondary causes is important after pathological diagnosis, and should closely monitor the chest CT changes,to prevent misdiagnosis or missed diagnosis.
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