ABSTRACT
Objective:To explore the evolution of CT characteristics of the "reversed halo sign" of pulmonary tuberculosis, and to further improve the recognition of its CT signs.Methods:Clinical and CT data of 12 patients with pulmonary tuberculosis who were clinically and pathologically confirmed and accompanied with CT manifestation of "reversed halo sign" in First Affiliated Hospital of Henan University of Science and Technology from August 2013 to April 2020 were analyzed retrospectively. Pathological and imaging contrastl analysis was performed on 1 patient undergoing surgical treatment.Results:Among 12 cases with "reversed halo sign", there were 2 cases with single lesion in unilateral lung, 2 cases with multiple lesions in unilateral lung, and 8 cases with multiple lesions in bilateral lungs. Three cases showed only "reversed halo sign", 9 cases showed both halo-like sign and uniform fireworks sign. "Tree-in-bud "sign was found in all 12 patients in the outer ring of the "reversed halo sign". Eight patients received three or more CT examinations, and six of them showed reduction of density and volume of the "reversed halo sign" after standardized anti-tuberculosis treatment. Under the natural course of the disease in two cases, the overall enlargement of the lesion was observed in 1 case, and the overall density of the lesion was reduced and the outer ring wall of the "reversed halo sign" was thinned in 1 case. The pathology of one case after surgical lobectomy showed granulomatous inflammatory nodules of varying sizes containing Langerhans nodule giant cells in the lung parenchyma. The typical caseous necrotic granulomatous nodules were rare here. The "reversed halo sign" showed dense Langerhans nodules in the outer ring, sparse central areas with fibrous hyperplasia and alveolar wall thickening.Conclusions:The outer ring of "reversed halo sign" of pulmonary tuberculosis shows as "tree-in-bud" sign, and its center shows as the fine reticulation pattern. After effective anti-tuberculosis treatment, both the overall density of "reversed halo sign" and the lesion size reduced. Finally, the lesions mostly present as as fine grid shadows for a long time.
ABSTRACT
Objective To investigate precise and regulable animal model of benign bile duct strictures.Methods Mini pigs were divided into four groups as sham surgery group, conventional surgery group, small caliber group and large caliber group according to random number table, with 6 pigs in each group.For the small caliber group, outside diameter 3.0mm catheter were inserted into bile duct and partial sutured.For the large caliber group, outside diameter 6.0mm catheter were inserted into bile duct and partial sutured.Conventional surgery group were treated with 5-0 absorbable suture on distal bile duct and controlled stricture severity visually.For sham surgery group, bile duct were exposed without suture.Observe the general condition of four groups.Test liver function on 1st, 3rd, 7th, 14th, 21st and 28th day postoperative.Perform cholangiography on 30th day postoperative.All four groups were put to death to observe the histological changes of liver and bile duct.Results Liver function of sham surgery group showed no obvious change during observation.On 28th day postoperative, compared to conventional surgery group, the liver enzymes ALT, AST, γ-GT, ALP, bilirubin level of small caliber group elevated(P<0.05)and the liver enzymes ALT, AST, γ-GT, bilirubin level of large caliber group elevated(P<0.05),while ALP level lowered(P<0.05).Cholangiography showed bile duct stenosis of different degree on 6 pigs of small caliber group with average diameter 2.7mm (from 2mm to 4mm).As for large caliber group, 5 pigs showed stenosis with average diameter 5.5mm (from 5mm to 7mm).3 pigs of conventional surgery group showed no obvious bile duct stenosis.The 6 pigs of sham surgery group showed no bile duct stenosis.According to designed stenosis standard, the success rate of small caliber group and large caliber group are both higher than conventional surgery group.(P<0.05).30 days after surgery, all 6 pigs of small caliber group had postoperative intraperitoneal adhesion, hepatomegaly, obvious expansion of intrahepatic bile duct and gallbladder expanded by 4~5 times.5 pigs of large caliber group had hepatomegaly, slight dilation of intrahepatic bile duct, obvious expansion of gallbladder, clear choledochal edema, sutured tissue thickening and visible bile duct stenosis.HE staining with the small caliber group showed hepatocyte spotty degenerative necrosis, expanded cholestatic intrahepatic small bile duct, swelling hepatocyte and fibrous septa.HE staining with the large caliber group showed intrahepatic small bile duct slightly expanded and hepatocyte arranged basically normal.VG staining with the small caliber group showed excessive accumulaton of collagen fibers outside bile duct mucous cells, randomly and densely arranged and irregularly shaped.VG staining with the large caliber group showed increased collagen fibers in bile duct submucosa, densely and banded arranged.Conclusion This animal model of mini pig is an relatively ideal large animal model of biliary stricture with high surgical success rate and few postoperative complications.