关键词: 结核, 肺/诊断, 放射摄影术, 胸部, 早期诊断

Abstract: ObjectiveTo understand further hematogenous pulmonary tuberculosis with analysis on its clinical characteristics. MethodsWe analyzed retrospectively the clinical data,image characters,misdiagnosis and therapeutic response among 202 adult cases with hemotogenous pulmonary tuberculosis hospitalized from 1998 to 2008.Results（1）The young and the middle aged patients accounted for 80.2%, but the elderly patients have increased recently.（2） The rate of sputum smear positive was only 20.7%. However,the rate of AFB positive was 35.5% by fiberoptic bronchoscopy in 31 patients with sputum smear negative. （3）Patients with ground-glass opacity in chest X-rays accounted for 12.9% at the earlier stage. 51.5% cases manifested uniform miliary nodules in size, density and distribution in the chest X-rays. （4）Chest HRCT showed that 55.0% patients with acute hematogenous pulmonary tuberculosis had miliary nodules in the lungs and 45% patients with subactue and chronic hematogenous pulmonary tuberculosis had inconsistent nodules which distributed in the upper and middle zones. 46.8% patients with hematogenous pulmonary tuberculosis had patchy, nodular and fibrotic shadow, and 43.1% had hilar and mediastinal lymph node enlargement.（5）12 of 20 cases receiving biopsy had pathological positive result.（6）44.6% patients were complicated with extra-pulmonary tuberculosis such as meningitis,oromeningitis,tuberculous lymphadenitis,brain tuberculoma tuberculosis of liver, tuberculosis of spleen, bone tuberculosis and so on.（7）42.1% cases were misdiagnosed before hospitalization. （8）The temperature of all patients except 8 returned to normal from 3 days to 12 weeks after given anti-tuberculosis chemotherapy. （9）The lesions of 79.7% cases had various degree absorption in chest X-rays after 2 months therapy. ConclusionSputum smear, chest HRCT，fiberoptic bronchoscopy and biopsy are the key Methods for early diagnosis.

Key words: Tuberculosis,pulmonary/diagnosis, Radiography,thoracic, Early diagnosis