Kerley A 線的解剖病理基礎及臨床診斷意義

Kerley A 線的解剖病理基礎及臨床診斷意義
王振光 馬大慶 關硯生 陳步東 張巖松 賀文 王新蓮
【摘要】 目的 研究Kerley A 線的解剖、病理基礎及其在彌漫性肺疾病中的鑒別診斷價值。
方法 煤工塵肺和煤塵接觸者尸解肺標本28 例, 進行冠狀面高分辨率CT( HRCT) 掃描、病理大切片
和組織學切片制作及對照分析。同期搜集經病理或臨床診斷為彌漫性肺病的患者176 例進行HRCT
檢查, 并進行分析。結果 28 例尸體肺標本的冠狀面HRCT 圖像發現有Kerley A 線17 例。在大切片
上觀察有2 種解剖基礎: ( 1) 小葉間隔線的串聯組合, 14 例; ( 2) 位于肺段和亞肺段之間不完整的纖維
分隔, 內含靜脈和淋巴管, 3 例。組織病理檢查所見: ( 1 ) 間隔線內煤塵沉積和伴程度不等的纖維化;
( 2) 間隔線內靜脈血管壁增厚伴纖維化, 擴張的靜脈和淋巴管沒有超過間隔線的輪廓; ( 3) 間隔線內
的水腫和炎性滲出。176 例彌漫性肺病中發現Kerley A 線11 例( 6. 3% ) , 其中肺水腫5 例、病毒性肺
炎2 例、癌性淋巴管炎2 例、結節病1 例、肺泡蛋白沉積癥1 例。結論 在彌漫性肺病中, Kerley A 線
的數量少, 難以識別, 鑒別診斷價值有限。
【關鍵詞】 尸體解剖; 塵肺; 肺疾病; 病理學; 體層攝影術, X 線計算機
Ana tomicopathological ba sis a nd clinical diagnost ic significa nce of Kerley′s A line WANG Zhenguang
* , MA Da-qing, GUAN Yan-sheng, CHEN Bu-dong, ZHANG Yan-song, HE Wen, WANG Xin-lia n.
Department of Radiology, Beijing Friendship Hospital Affiliate of Capita l University of Medical Sciences,
Beijing 100050, China * ( Present address: Department of Ra diology, the Affiliated Hospital of Medica l
College, Qingdao University, Qingda o 266003, China)
【Abstra ct 】 Objective To study anatomic and pathological basis of Kerley′s A line, and to evaluate
the role of Kerley′s A line in differential diagnosis of diffuse lung diseases ( DLD) . Methods HRCT scans,
gross specimen section( 50—100 μm thickness) and histologic section( 5—8 μm thickness) were performed
and analyzed comparatively on 28 dry lung specimens from the patients with coal worker′s pneumoconiosis
and occupational exposure history to coal dusts. At the same time, HRCT images of 176 patients with DLD
were retrospectively reviewed for the detection of Kerley′s A line. Result s Kerley′s A lines were seen in
17 of 28 lung specimens on coronal HRCT images. The anatomic basis of Kerley′s A line represented the
continuity of two or more thickened interlobular septa ( 14 cases ) and incomplete fibrotic septa between
segments or subsegments ( 3 cases ) . Histologically, the linear opacities represented the deposits of coal
dust, fibrosis, edema, inflammation, thickened vessel wall within interlobular septa. Kerley′s A lines were
present in 11 of 176 patients ( 6. 3% ) including interstitial pulmonary edema ( 5 cases) , viral pneumonia
( 2 cases) , lymphangitic carcinomatosis ( 2 cases ) , sarcoidosis ( 1 cases ) and pulmonary alveolar
proteinosis ( 1 cases) . Conclusion Kerley′s A line has a limited usefulness in the differential diagnosis of
DLD because it is seen infrequently and not discernable.
【Key wor ds】 Autopsy; Pneumoconiosis; Lung diseases; Pathology; Tomography, X-ray
computed

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