The HRCT Manifestations And Pathological Basis Of Interstitial Disorders In The Active Pulmonary Tuberculosis

Objective: To discuss HRCT characteristics,pathological basis and therapeutic prognosis of interstitial abnormalities in active pulmonary tuber- culosis.Methods: HRCT characteristics of 45 patients with active pulmonary tuberculosis which predominantly involved interstitial tissues(39males and 6 females,aged from 24 to 55 years,mean age, 34 years)were observed dynamically before, during and after regular anti-tuberculosis treatment.All cases were clinically diagnosed for active pulmonary tuberculosis 35 cases based on detection of acid-fast bacilli in sputum . 27 were identifled by means of smear, 8 by culture2 cases among them have confirmed by pathology through percutaneous lung puncture or bronchoscopic biopsy, others were clinical diagnosed excluding other reasons. All of the cases were observed in the regular anti-tuberculosis treatment. Chemotherapy schedule is 2HREZ/4HR.We use SPSS 11.5 statistics software package to do matched-pairs interclass chi square test respectively between the end of intensification therapy and before treatment,the end of six months treatment and before treatment.Results: Interstitial abnormalities in active pulmonary tuberculosis were mainly seen in ephebe,mostly in upper field,such as apicoposterior segment of superior lobe and superior segment of lower lobe. They have the tendency of segmental distribution along the bronchial branch or involve the extent of pulmonary lobule. HRCT appearances of interstitial ab- normalities in this group include intralobular thin reticulation 100.0%(45 cases), thickened interlobular septum and subpleural interstitium 44.4%(20 cases),thickened peribroncho- vascular interstitium 66.7%(30 cases).The important accompany signs include tree-in-bud sign 75.6%(34 cases), micro-nodule100.0%(45 cases), lobular consolidation 66.7%(30 cases),cavity73.3 % ( 33 cases ) .There is no significantly improvement of intralobular interstitium abnormalities at the end of intensification stage (P>0.05) . Most of them could vanish gradually by the time of anti- tuberculosis treatment were completed .There were significant statistics variance between before and after anti-tuberculosis treatment(P<0.01). Patho- logical proved that there are caseous necrosis nodules and fibro- plasias in lobular interstitial.Conclusion: To compare 45 patients with active pulmonary tuber- culosis which predominantly involved interstitial tissues,partly have confirmed by pathology through percutaneous lung puncture or bronch- oscopic biopsy,we make conclusions below:1,Characteristics of interstitial abnormalities in active pulmonary is intralobular interstitial abnormalities . The HRCT findings of interstitial ab- normalities in active pulmonary tuberculosis include intralobular thin reticulation and out-side tree-in-bud sign. Most of them combine with cheesy consolidation and cavitation.2,Pathological basis are airway dissemination,caseous necrosis nodules and fibroplasias in lobular interstitial.3,Active pulmonary tuberculosis which predominantly involved interstitial tissues absorption slowly. Most of them could vanish gradually after the 6 months of anti-tuberculosis treatment. Therefore insisting on standardize treatment is necceerary.4,HRCT is the ideal method to diagnosis and evaluate the active pulmonary tuberculosis which predominantly involved interstitial tissues.