Kerley A 线的解剖病理基础及临床诊断意义

Kerley A 线的解剖病理基础及临床诊断意义
王振光 马大庆 关砚生 陈步东 张岩松 贺文 王新莲
【摘要】 目的 研究Kerley A 线的解剖、病理基础及其在弥漫性肺疾病中的鉴别诊断价值。
方法 煤工尘肺和煤尘接触者尸解肺标本28 例, 进行冠状面高分辨率CT( HRCT) 扫描、病理大切片
和组织学切片制作及对照分析。同期搜集经病理或临床诊断为弥漫性肺病的患者176 例进行HRCT
检查, 并进行分析。结果 28 例尸体肺标本的冠状面HRCT 图像发现有Kerley A 线17 例。在大切片
上观察有2 种解剖基础: ( 1) 小叶间隔线的串联组合, 14 例; ( 2) 位于肺段和亚肺段之间不完整的纤维
分隔, 内含静脉和淋巴管, 3 例。组织病理检查所见: ( 1 ) 间隔线内煤尘沉积和伴程度不等的纤维化;
( 2) 间隔线内静脉血管壁增厚伴纤维化, 扩张的静脉和淋巴管没有超过间隔线的轮廓; ( 3) 间隔线内
的水肿和炎性渗出。176 例弥漫性肺病中发现Kerley A 线11 例( 6. 3% ) , 其中肺水肿5 例、病毒性肺
炎2 例、癌性淋巴管炎2 例、结节病1 例、肺泡蛋白沉积症1 例。结论 在弥漫性肺病中, Kerley A 线
的数量少, 难以识别, 鉴别诊断价值有限。
【关键词】 尸体解剖; 尘肺; 肺疾病; 病理学; 体层摄影术, X 线计算机
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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