The Clinical Analysis Of 138 Cases Of Pulmonary Tuberculosis With Solitary Pulmonary Nodule Or Mass As The First Imaging Performance

Objective To investigate the clinical features of pulmonary tuberculosis with solitary pulmonary nodule or mass as the first imaging performance.Methods The clinical data of 138 Patients with solitary pulmonary nodule or mass as the first imaging performance who were diagnosed as pulmonary tuberculosis from September 2012 to March 2017 in the First Affiliated Hospital of Soochow University were retrospectively analyzed.Results The male to female ratio was 93:45(2:1).The average age was(51±14)years old(ranged from 25 to 80).The incidence was higher among subgroup of 45-54 years old(25.4%).There were 112(81.2%)solitary nodules and 26(18.8%)isolated masses.100 patients(72.5%)were asymptomatic and the lesions were found by accident on routine check-up.38(27.5%)patients had symptoms,which included cough,expectoration,chest or back pain,hemoptysis or blood-streaked phlegm.117(84.8%)patients did not have underlying disease;21 patients(15.2%)had underlying diseases such as type 2 diabetes and malignant tumors.The lesions of 104 patients(75.4%)were located in the apicoposterior segment of upper lobe and the dorsal segment of lower lobe.Imaging characteristics of 138 patients included:uneven density(76.8%),atypical pleural indentation(31.9%),long burr sign(31.2%),pleural adhesion(26.1%),cavity(24.6%),uniform density(23.2%),calcification(21.7%),shallow lobulated sign(21.7%),typical pleural indentation(20.3%),deep lobulated sign(12.3%),short burr sign(10.1%),smooth edges(9.4%).68(49.3%)patients underwent CT-enhanced scan with no enhancement(63.2%),uneven enhancement(35.3%),and uniform enhancement(1.5%).All patients were diagnosed after operation via pathological findings.The preoperative diagnosis included lung cancer(n=127,92.0%),idflammatory pseudotumor(n=6,4.4%),aspergilloma(n=3,2.2%),and hamartoma(n=2,1.4%).41 patients were lost to follow-up,97 patients were followed up for 19-73 months.58 patients underwent standardized anti-tuberculosis treatment for 6 months or more;39 patients didn't accept further treatment(n=26)or acccept anti-tuberculosis treatment less than 6 months(n=13)due to poor compliance.None of the 97 patients was found to have relapse.Conclusions In this study,pulmonary tuberculosis with solitary pulmonary nodule or mass as first imaging performance occurs mainly in men,and the most common age subgroup is 45-54 years old.Clinically,patients are usually asymptomatic without underlying diseases.The lesions occure more often in apicoposterior segment of upper lobe and dorsal segment of lower lobe.Pulmonary tuberculosis should be considered firstly if the lesions have features of calcification,cavities,smooth edges,no lobulation or shallow lobulated sign,no burrs or long burrs,pleural adhesions or atypical pleural depression and no enhancement or uneven enhancement.Standardized anti-tuberculosis treatment should be given after surgery.