Objective To investigate CT features of chest localized Castleman's disease (LCD) and their value in diagnosis and differential diagnosis. Methods Imaging of 10 LCD patients confirmed with operation and pathology, as well as of patients with atypical masses in mediastinal and hilar area including 14 carcinoids, 21 lymph tuberculosis, 15 thymomas, 9 neurogenic tumors, 12 sarcoidosis, 15 lymphoma and 25 lymphatic metastasis from lung cancer were analyzed. CT imaging and enhancement characteristics of the lesions were observed. Results Of 10 cases of LCD, 7 lesions located in the mediastinum and 2 in the hilar area were hyaline vascular types, 1 located in the right hilar was mixed type. CT showed nodules and spherical soft tissue density, clear boundary in all patients, and the branch, strip and patchy low density in 5 patients. The branch patchy calcification was found in 1 patient. One lesion of mixed type showed moderate enhancement, the others showed significantly enhancement with fast wash-in and slow wash-out. In 9 cases with significantly enhanced lesions, larger vessels were found in 4. The maximum enhancement CT value of the hyaline vascular type LCDs were significantly higher than that of thymoma, lymph node tuberculosis, neurogenic tumors, carcinoid out of bronchial lumen of pulmonary hilar, but lower than that of intraluminal endobronchial carcinoid (all P<0. 05). Conclusion CT imaging of chest hyaline vascular type LCD have certain characteristics, while dynamic enhanced CT manifestations are significantly helpful to diagnosis and differential diagnosis of LCD.%目的 探讨胸部局限性巨大淋巴结增生症(LCD)的CT表现及其诊断、鉴别诊断.方法 收集经手术病理证实的10例纵隔及肺门淋巴结LCD患者.以临床综合诊断或病理证实的影像不典型的纵隔及肺门区的团块状病变患者为对照组,包括肺门区类癌14例、纵隔及肺门区淋巴结核21例、胸腺瘤15例、神经源性肿瘤9例、结节病12例、淋巴瘤15例及肺癌淋巴结转移25例.观察肿块影像及增强扫描强化特点.结果 10例LCD患者中,7例位于纵隔及2例位于左肺门淋巴结的病灶为透明血管型,1例位于右肺门淋巴结的病灶为混合型.CT平扫10例LCD均表现为结节及球形软组织密度影,边界清晰,5例病灶内见分支、条状及斑片状低密度影,1例可见分支、片状钙化.LCD病灶强化方式:1例右肺门混合型病灶呈中度强化,其余病灶均呈明显强化并呈快进慢出型动态强化方式.9例明显强化病灶中4例病灶可见较粗大的滋养血管.9例透明血管型LCD与纵隔及肺门区常见实性结节样病变CT值比较:LCD最大增强CT值明显高于胸腺瘤、纵隔淋巴结结核、神经源性肿瘤、肺门区支气管腔外类癌,明显低于支气管腔内类癌CT值(P均＜0.05).结论 胸部透明血管型LCD的CT影像具有一定特征,动态增强扫描对诊断及鉴别诊断具有特征性意义.
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