Objective: To analyze the clinical features of 3 cases of Takayasu arteritis(TA) with pulmonary cavities on chest computed tomography(CT). Methods: The clinical data of 3 TA patients with cavities on the chest CT who were admitted into Beijing Chaoyang Hospital were retrospectively analyzed. A literature search was performed with "Takayasu arteritis" and "pulmonary" as the key words in China Knowledge Resource Intergrated Database (CNKI) and Pubmed Database for publications from Jan 1, 2000 to Dec. 31,2017. The relevant literatures were reviewed. Results: Among the 3 patients, 2 were males and 1 was female, aging 49, 28 and 28 years, respectively. They presented with cough, fever and chest pain, and chest CT showed cavities, single or multiple, either with thick or thin wall, or wedge-shaped consolidation, residual stripes after being absorbed, and one case had pulmonary biopsy results which showed hemorrhagic infarction. They were all misdiagnosed before as pneumonia, pulmonary tuberculosis, pulmonary thromboembolism. After being treated by combination therapy of glucocorticoids and immunosuppressive agents, the disease improved significantly. A total of 777 cases with TA involving pulmonary arteries were reported, from which 13 cases with involvement of pulmonary parenchyma were described. Therefore total 16 cases including the 3 cases in this article were included for analysis. Twelve cases showed patchy or wedge-shaped ground-glass opacity and consolidation, and peripheral lung stripes remained after being absorbed. Two cases showed pleural effusion, and 4 cases showed cavities, 3 cases were misdiagnosed as pulmonary tuberculosis, 7 as pulmonary infection, and 5 as pulmonary thromboembolism. Conclusions: TA with pulmonary arteries involved is susceptible to be misdiagnosed and missed, and therefore, in patients with cough, hemoptysis, chest pain and cavities in pulmonary parenchyma, TA should be suspected. Early diagnosis and appropriate treatment can lead to a better prognosis.
目的： 分析胸部CT呈空洞病变的大动脉炎的临床特点，以提高对该病的认识。 方法： 回顾性分析北京朝阳医院收治的胸部CT呈空洞病变的3例大动脉炎的临床资料。以"Takayasu动脉炎/大动脉炎"和"肺"为关键词检索中国知网数据库，以"Takayasu arteritis"和"pulmonary"为关键词检索Pubmed数据库，检索起止时间为2000年1月1日至2017年12月31日，结合文献进行分析。 结果： 3例患者分别为49、28、28岁，其中男2例，女1例，均因咳嗽、发热及胸痛就诊，胸部CT呈空洞性病变，表现为厚壁或薄壁、单发或多发的空洞或楔形实变影，在吸收后残留条索影，其中1例进行了病理学检查，结果符合出血性肺梗死表现。3例患者曾被误诊为肺炎、肺结核和肺栓塞，给予糖皮质激素联合免疫抑制剂治疗后空洞吸收、症状缓解。文献检索获得中、英文文献85篇（777例），阅读后筛选出7篇（13例）患者存在肺实质损害的描述，结合本组3例患者共16例，其中男2例，女14例，年龄18~58岁，多以发热、伴或不伴咳嗽、咯血、乏力、呼吸困难就诊。其中12例为片状或楔形磨玻璃影和实变影，吸收后残留肺外周或沿支气管血管束的索条影，2例为胸腔积液，4例出现空洞征象；16例中3例曾误诊为肺结核，7例误诊为肺部感染，5例误诊为肺栓塞。 结论： 大动脉炎累及肺动脉极易误诊和漏诊，对于表现为咳嗽、咯血、胸痛合并肺实质空洞性病变的患者，需高度警惕大动脉炎的可能性，早期筛查、确诊，控制疾病进展，改善患者预后。.
Keywords: Pulmonary arteries; Pulmonary cavities; Pulmonary parenchymal lesions; Takayasu arteritis.