甲型H1N1流感并发急性呼吸窘迫综合征的影像学表现分析

目的 探讨重症甲型H1N1流感并发急性呼吸窘迫综合征(ARDS)的影像学表现.方法 回顾分析12例重症甲型H1N1流感患者并发急性呼吸窘迫综合征(ARDS)的X线和CT表现.X线检查包括普通胸部DR摄片和床边DR摄片,CT检查包括常规螺旋CT扫描和高分辨率CT(HRCT)扫描.结果 (1)X线表现分为初期、进展期、恢复期3期.初期:X线检查发现单发斑片状或云雾状密度影3例.双侧多发病灶9例,其中两下肺多发片状模糊影5例,两上、中、下肺中外带多发节段性片状模糊影2例,右下肺大片实变影,同时左肺出现散在斑片状模糊影1例,两肺门影增浓、模糊,肺门周围分布点片状模糊影1例.进展期:所有病例病灶迅速扩大,表现为多肺段或多肺叶浸润,两肺均受累及,病灶多变,呈现出游走性浸润.恢复期:病灶逐渐吸收,残留有纤维条索影7例,网格状肺纹理2例,栗粒结节影2例,两下肺小片状均匀密度影1例.(2)CT表现:实变影,表现为两肺单发或多发的斑片状或大片状模糊影12例, 支气管充气像8例.磨玻璃样密度影6例.肺间质性改变包括肺纹理呈网格状5例,胸膜下弧线影3例,胸膜下斑片状磨玻璃影5例,小叶间隙增厚4例,这些征象可同时存在.(3)合并症:气胸4例,纵隔皮下气肿4例,腹膜后积气1例,真菌性空洞3例,蜂窝肺1例.结论 重症甲型H1N1流感并发ARDS影像学表现复杂、多变,并发症多,影像学检查能及时准确地显示甲型H1N1流感并发ARDS各阶段的病变过程,有利于指导和评估临床治疗效果.     

肾移植后巨细胞病毒肺炎的影像学诊断

目的 探讨肾移植术后巨细胞病毒（CMV）肺炎的影像学诊断。资料与方法 搜集13例肾移植术后CMV肺炎患者的临床、实验室以及胸片和CT检查资料，对其胸片和CT表现进行回顾性分析。结果 X线胸片早期表现基本正常或仅表现两肺纹理增多模糊，其中4例在3-7d内复查胸片，病灶发展迅速，可见磨玻璃影和大片状实变影，弥漫分布于两肺野内；CT主要影像学表现有两肺弥漫分布的磨玻璃影13例，小结节影9例，斑片状实变影8例及小叶间隔增厚7例等，其中以磨玻璃影最为常见，并通常与其他影像学表现混合存在。结论 X线胸片是肾移植术后CMV肺炎最基本的检查方法。CMV肺炎的影像学表现，尤其CT表现具有一定特点，结合临床可提示诊断。     

闭塞性细支气管炎伴机化性肺炎的高分辨CT表现

目的探讨闭塞性细支气管炎伴机化性肺炎的高分辨CT表现,并与慢性嗜酸性肺炎和寻常型间质性肺炎进行鉴别。方法结合相关文献回顾性分析12例闭塞性细支气管炎伴机化性肺炎高分辨CT表现。结果12例闭塞性细支气管炎伴机化性肺炎的高分辨CT表现如下:(1)肺内多发斑片状肺实变影和磨玻璃影(n=8),其中肺实变影中见支气管充气征(n=5)。(2)肺内多发小结节影和不规则线状影(n=7)。(3)肺内多发斑片状肺实变影和磨玻璃影伴小结节影和不规则线状影(n=3)。(4)细支气管扩张、壁增厚伴周围肺实变影(n=6)。(5)肺内肺实变影和磨玻璃影呈游走性(n=3)。结论高分辨CT可以更好地显示闭塞性细支气管炎伴机化性肺炎的病理改变,并使其能与慢性嗜酸性肺炎和寻常型间质性肺炎在影像上进行鉴别,也为纤维支气管镜下肺活检提供准确的定位。     

重症及危重症甲型H1N1流感肺炎的影像表现

目的 探讨重症及危重症甲型H1N1流感病毒肺部感染的胸部影像表现.方法 回顾性分析18例甲型H1N1流感并发肺炎患者的临床及影像资料,将其分为重症组(11例)及危重症组(7例),所有患者均经胸部X线检查,其中2例行CT检查.结果 重症组11例,8例X线表现为双侧肺野中内带分布的、边缘模糊的小斑片和结节状阴影,3例X线表现为局灶性边缘模糊的片状阴影,其中1例胸部CT表现为右下肺大片实变影.危重症组7例,4例X线表现为双肺弥漫分布的磨玻璃密度阴影伴部分实变,其中1例出现胸颈部皮下气肿,1例胸部CT表现为双肺广泛分布的、沿支气管走行的斑片状磨玻璃密度影,双下肺结节状实变病灶和胸腔积液;其他3例表现为双侧肺野内大范围实变影.结论 甲型H1N1流感肺炎的影像表现包括重症患者肺内的结节样和斑片状阴影,危重患者肺内弥漫的支气管周围分布的磨玻璃密度灶和多灶性实变.     

艾滋病合并马红球菌肺部感染影像学表现

目的探讨获得性免疫缺陷综合征(AIDS)合并马红球菌肺部感染的影像学表现.资料与方法回顾性分析6例临床确诊的 AIDS 合并马红球菌肺部感染患者的影像资料,其中5例行胸部 CT 平扫,1例加做胸部增强扫描;1例行 DR 胸部正侧位摄片.结果6例患者影像学表现呈多样性,其中2例表现为单一结节肿块影,1例为斑片渗出影,3例合并浸润实变影、斑片状模糊影.6例中出现结节及团块实变影4例,空洞2例;斑片状渗出影4例,间质样改变2例,支气管扩张3例,纵隔淋巴结肿大2例,肺门淋巴结肿大1例,胸膜腔积液3例.结论结节肿块影、浸润实变影伴空洞、斑片状模糊影是 AIDS合并马红球菌肺部感染的常见影像表现.     

肝移植术后肺部感染的CT表现

目的 提高对肝移植术后肺部感染CT表现的认识,以提高诊断准确率.方法 回顾性分析45例肝移植术后肺部感染病例的CT资料.结果 CT主要表现为实变影32例,以右下肺或双下肺分布多见;磨玻璃影22例,双肺弥漫性分布多见;结节影10例,均为多发、双肺分布,直径均＜3 cm(其中直径＜1 cm者7例),包括两肺弥漫性粟粒样结节3例;网格样影或线样影4例,分布于两肺上叶2例,广泛分布于两肺各叶2例.不同感染类型表现,细菌感染以实变影最常见,其次为磨玻璃影;真菌感染实变影、磨玻璃影、结节影均较常见.结论 CT对于肝移植术后肺部感染的诊断具有重要价值.     

肾移植后巨细胞病毒肺炎的X线和CT表现

目的: 提高X线胸片和CT诊断肾移植后巨细胞病毒(CMV)肺炎的水平.材料和方法: 回顾性分析11例肾移植后CMV患者的X线胸片和CT表现.结果: 肾移植后CMV肺炎8例X线胸片表现为磨玻璃影和实变影,3例胸片正常;CT表现为双肺弥漫性病变,磨玻璃影最为常见,并与其它影像学表现合并存在,主要与实变影和多发性小结节样影合并存在;磨玻璃影在所有患者均表现为两侧肺分布.10例患者有多发性小结节样影;8例患者有多发实变影;5例并发有少量胸腔积液和小叶间隔增厚.结论: 肾移植后CMV肺炎的CT表现有一定特点,结合临床可提示诊断.     

儿童特发性肺含铁血黄素沉着症的影像学诊断

目的:探讨儿童特发性肺含铁血黄素沉着症(IPH)的影像表现。方法:回顾性分析10例经病理证实的特发性肺含铁血黄素沉着症的X线及CT表现。结果:初诊误诊为支气管肺炎3例,肺结核1例,1例先误诊为肺炎后又误诊为肺结核,误诊率50%。X线表现双肺片絮状阴影及磨玻璃样改变3例;双肺中下肺野斑片状影,肺纹理增多模糊3例;弥漫分布粟粒状、小结节状影伴磨玻璃样改变2例;弥漫分布网织状阴影2例。伴肺门影增大模糊3例、心影增大1例等。普通CT表现为两中下肺呈片絮状、小结节状阴影1例;弥漫分布粟粒状阴影伴磨玻璃样改变者2例。2例见空气支气管征,1例见多发小气囊。HRCT表现为两肺内弥漫分布网结节影1例,表现两肺网织影及散在小斑片状阴影、小叶间隔增厚1例。结论:对本病的认识不足是误诊的主要原因,X线及CT检查是发现并提示IPH的基本检查手段,影像表现结合临床,尤其是小儿痰、胃液中发现含铁血黄素巨噬细胞是提高确诊率的关键。     

艾滋病卡氏肺孢子虫肺炎患者的临床影像学分析

目的：总结艾滋病肺孢子菌肺炎（PCP）的影像学特征,以提高该病影像学诊断水平。方法：回顾性分析3例艾滋病PCP确诊患者的胸部影像学资料及特点。结果：例1首次胸片及CT检查示双肺随机分布的多发斑片状、大片状渗出性高密度影,伴磨玻璃密度渗出影;抗渗出治疗1周复查,病变进展至双肺弥漫渗出伴实变。例2初次CT检查示双肺弥漫分布的磨玻璃渗出及部分实变影,伴间质渗出改变;抗感染抗病毒治疗5 d复查CT,双肺渗出无明显吸收,肺实变显著进展,范围扩大,大量纵隔气肿。例3双肺弥漫性多发片状磨玻璃影及实变影,以肺门为中心向心性实变、背侧实变,左侧少量胸腔积液。结论：艾滋病PCP影像学表现具有特征性,结合症状、体征及实验室检查,对临床诊断有较好地提示。     

活动性肺结核肺间质病变的HRCT研究

目的 探讨活动性肺结核肺间质改变的HRCT表现.资料与方法 搜集肺部CT扫描以间质改变为主的活动性肺结核29例,分别在治疗前、治疗中和疗程结束时行HRCT检查,分析间质改变的影像特点及变化.结果 肺结核间质病变好发于两上肺野,主要表现为片状蔓延和沿支气管树分布两种形式.小叶内间质异常是肺结核间质改变的主要HRCT表现,包括小叶内细网织线影、微结节、磨玻璃影、树芽征等,其发生率分别为100%(29例)、100%(29例)、82.8%(24例)、69%(20例).此外可合并气道壁增厚、融合性实变、空洞、结节等征象.经抗结核治疗后间质病变吸收较缓慢,但在疗程结束时均大部分吸收.结论 小叶内细网织线影、微结节、磨玻璃影、树芽征为活动性肺结核间质的主要HRCT表现.     

成人麻疹病毒肺炎的影像表现

目的 探讨成人麻疹肺炎的胸部影像表现.方法 对163例成人麻疹患者行胸部X线平片检查,其中3例行MSCT扫描,共确诊10例成人麻疹肺炎患者.结果 10例肺炎患者中8例X线胸片异常,特征性表现为磨玻璃密度影(6例)和支气管增粗(2例);2例X线胸片正常者行MSCT检查.MSCT表现为双肺磨玻璃密度灶1例,右上叶呈肺小叶分布的磨玻璃密度灶2例.结论 了解麻疹肺炎的X线胸片和MSCT表现可以缩小鉴别诊断范围,首次X线胸片正常患者不能除外肺部受累.

Abstract：

Objective To illustrate the chest radiography and MSCT findings of measles pneumonia in adults. Methods One hundred and sixty three measles patients underwent chest radiography, MSCT was performed in 3 of them. Measles pneumonia was confirmed in 10 patients (6.13%). Results Eight of 10 patients had abnormal appearances in initial chest radiography. The characteristic chest radiographic findings were ground-glass opacities (n=6) and bronchial wall thickening (n=2). MSCT showed bilateral multiple ground-glass opacities in 1 patient,unilateral patchy ground-glass opacities with lobular distribution in the right upper lung in 2 patients. Conclusions Familiarizing with radiographic and MSCT appearances of measles pneumonia in adults is very important for the differential diagnosis and appropriate management of measles pneumonia. Normal initial chest radiography cannot exclude the involvement of the lungs.     

Reversed halo sign on thin-section CT in a patient with non-specific interstitial pneumonia

We present a case of non-specific interstitial pneumonia (NSIP) with reversed halo sign on thin-section CT. A 52-year-old female presented with a cough and New York Heart Association (NYHA) class 2 dyspnoea of 4 months duration. A chest radiograph showed poorly defined, patchy ground-glass opacities in both lungs. Thin-section CT demonstrated the reversed halo sign, which is a central ground-glass opacity surrounded by crescent or ring-shaped areas of consolidation in multifocal areas. Multifocal patchy ground-glass opacity and consolidation and enlarged paratracheal, hilar and subcarinal lymph nodes were also shown. Video-assisted thoracic surgical (VATS) lung biopsy was performed, and histopathology revealed cellular NSIP.     

SARS的胸部X线与CT诊断

目的 评价X线平片和CT检查在严重急性呼吸综合征(SARS)的诊断价值。方法 回顾性分析29例临床诊断SARS的患者，对发病后的一系列胸片和CT影像进行分析。结果 X线表现：发热后1周内胸片显示单侧或双侧肺局灶性斑片状模糊影，然后迅速扩大到其他肺野，部分呈片团状弥漫分布，部分融合呈大片状，中心密度高，周边密度低，可见支气管气像。按病变高峰期侵犯肺的范围将病变分为轻、中、重度，轻度5例，中度10例，重度14例。CT表现：发病1～10d有4例CT扫描显示两肺多发斑片状实变影，边缘模糊，部分融合成大片状，可见支气管气像。发病10～30d有9例进行CT检查，表现为两肺大部或弥漫磨玻璃样改变，肺间质增厚，呈粗大网状，夹杂斑块状肺实变影，胸膜下区可见小叶过度充气征象；发病30d后，有19例进行检查，2例CT表现正常，17例主要表现为两肺局灶或广泛性不同程度的肺间质增厚影像。结论 SARS同时存在急性肺炎和急性间质性肺炎的影像改变，在治疗过程中，一系列胸片检查有助于掌握病情的变化，CT检查能较准确地评价肺部病变。     

Idiopathic interstitial pneumonias: CT features

Idiopathic interstitial pneumonias comprise usual interstitial pneumonia (UIP), nonspecific interstitial pneumonia (NSIP), desquamative interstitial pneumonia (DIP), respiratory bronchiolitis-associated interstitial lung disease (RB-ILD), cryptogenic organizing pneumonia (COP), acute interstitial pneumonia (AIP), and lymphoid interstitial pneumonia (LIP). Each of these entities has a typical imaging and histologic pattern, although in practice the imaging patterns may be variable. Each entity may be idiopathic or may be secondary to a recognizable cause such as collagen vascular disease or inhalational exposure. The diagnosis of idiopathic interstitial pneumonia is made by means of correlation of clinical, imaging, and pathologic features. The characteristic computed tomographic (CT) features of UIP are predominantly basal and peripheral reticular pattern with honeycombing and traction bronchiectasis. NSIP is characterized by predominantly basal ground-glass opacity and/or reticular pattern, often with traction bronchiectasis. DIP and RB-ILD are smoking-related lung diseases characterized by ground-glass opacity and centrilobular nodules. COP is characterized by patchy peripheral or peribronchovascular consolidation. AIP manifests as diffuse lung consolidation and ground-glass opacity. LIP is associated with a CT pattern of ground-glass opacity sometimes associated with perivascular cysts.     

Shark liver oil-induced lipoid pneumonia in pigs: correlation of thin-section CT and histopathologic findings.

PURPOSE: To evaluate sequential changes in thin-section computed tomographic (CT) findings after inducement of lipoid pneumonia and provide the histopathologic bases of these findings. MATERIALS AND METHODS: Shark liver oil was administered to 12 sites in seven pigs. Thin-section CT scans were obtained within 1 hour and at 1 week, 2 weeks, 4 weeks, 8 weeks, 12 weeks, and 16 weeks after oil administration. Scans were assessed for opacity, distribution, location at the lobular level, extent, and volume of the lesions. The CT number in consolidation areas also was measured. Findings at CT were correlated with those in the histopathologic specimens. RESULTS: Diffuse ground-glass opacity was noted on all immediately obtained scans. The opacity of the lesions was highest at 1 week; then it decreased gradually to an area of ground-glass opacity. The extent and volume of the lesions decreased at follow-up CT. Histopathologically, the lesions showed a lobular distribution sharply demarcated from the normal lungs. The lobules of decreased volume showed residual thickening of the alveolar walls with bronchiolectasis and mild collagen deposition of the interlobular septa. Pathologic examination of the low-attenuating consolidation area at CT revealed evidence of partial aeration. CONCLUSION: Thin-section CT findings of lipoid pneumonia include ground-glass opacity and airspace consolidation, followed by complete or incomplete resolution with volume loss and septal thickening. Low-attenuating consolidation at CT does not always indicate the presence of fat.     

重症与危重症甲型H1N1流感肺炎的影像学特点比较分析以及临床联系

目的：比较重症与危重症甲型 H1N1流感肺炎胸部CT影像表现。方法收集本院近3年来22例甲型H1N1流感肺炎患者的临床及影像资料,患者分为重症组(8例)和危重症组(14例)。回顾性分析2组之间的临床特点和实验室检查结果,以及比较胸部CT影像学特征的差别。结果危重症甲型 H1N1流感肺炎呼吸困难的表现更为明显。实验室检查结果中,重症组血中性粒细胞百分比为(63.4±18)%,危重症组为(83±9.9)%,重症组血淋巴细胞百分比为(24±13.3)%,危重症组为(11.7±7.3)%,2组间差异有统计学意义(z=-2.662,P=0.008;z=-2.246,P=0.025)。重症组中单侧多叶受累多见,7例(87.5%)胸部 CT 表现磨玻璃影;危重症组中病变多双肺受累,12例(85.7%)CT表现为磨玻璃影及实变影。危重症患者死亡率较高。结论血淋巴细胞减低,初期CT表现为双肺受累、肺内出现实变影的甲型 H1N1流感患者,易发展为危重症。     

Interstitial lung disease in association with polymyositis-dermatomyositis: long-term follow-up CT evaluation in seven patients

PURPOSE: To determine the long-term follow-up computed tomographic (CT) findings of interstitial lung disease associated with polymyositis-dermatomyositis. MATERIALS AND METHODS: CT scans in seven patients with interstitial lung disease and associated polymyositis-dermatomyositis were evaluated retrospectively. Six patients underwent sequential CT (follow-up range, 2-8 years; mean, 4.3 years). Histologic confirmation of pulmonary involvement was available in five patients. RESULTS: The predominant finding on the initial CT scans in four patients was subpleural consolidation, which corresponded to bronchiolitis obliterans organizing pneumonia with or without coexistent chronic eosinophilic pneumonia. In most cases, consolidation improved with use of corticosteroid and/or immunosuppressive therapy; in two patients, however, consolidation evolved into honeycombing. In one patient, diffuse areas of ground-glass opacity and consolidation appeared rapidly during illness; this patient died of sudden, rapid deterioration. In one patient with subpleural linear opacities, parenchymal abnormalities slowly progressed, and linear opacities had evolved into honeycombing at 8-year follow-up. In one patient with histologically proved organizing diffuse alveolar damage, bilateral patchy areas of ground-glass opacity and consolidation were seen. In one patient, subpleural bands changed to subpleural lines on sequential CT scans. CONCLUSION: CT provides an excellent demonstration of the lung changes in patients with interstitial lung disease and associated polymyositis-dermatomyositis.     

甲型H1N1流感合并肺炎的影像表现

目的 探讨甲型H1N1流感合并肺炎的影像表现.方法 分析确诊的甲型H1N1流感合并肺炎患者51例,均摄床旁X线胸片,44例同期行胸部CT检查.按肺内病变程度将所有患者分为轻度、中度、重度3型.结果 轻度患者4例,表现为肺内局限片状阴影;中度33例,肺内片状阴影超过2个肺野,其中双侧病变30例,单侧病变3例;重度14例,肺内广泛分布片状及磨玻璃密度阴影,可以合并间质改变,其中2例合并感染,成人呼吸窘迫综合征(ARDS)6例,并发皮下气肿1例.结论 甲型H1N1流感合并肺炎以片状影及磨玻璃密度阴影为主,可见间质病变,合并感染后影像表现多样,部分患者可进展为ARDS.     

SARS胸部表现和并发症的CT研究

目的 探讨CT扫描在SARS诊断中的作用。方法 82例SARS患者行螺旋CT扫描112次，其中胸部106次，头颅5次，腹部1次。采用标准肺窗、纵隔窗摄片观察。结果82例中病变位于双侧肺野66例(80．49％)，单侧16例(19．51％)。病变累及4～6个肺野的54例(65．85％)，下肺野63例(76．83％)。病变形态表现为胸膜下局灶性实变影26例(31．71％)，斑片状实变影53例(64．63％)，大片实变影9例(10．98％)，磨玻璃样模糊影31例(37．80％)，肺泡实质影14例(17．07％)，间质改变16例(19．51％)。发生并发症6例(7．32％)，其中1例同时并发肺、脑部结核及纵隔气肿；余5例分别为肺部继发感染2例，肺霉菌、气胸、脓胸各1例。根据上述所见，作者提出了SARS的相对特征性肺部表现：(1)病灶呈多发性、两侧性分布，以两下肺多见。(2)斑片状、大片实变影，胸膜下局灶性实变和磨玻璃样模糊影，伴有支气管充气征。(3)肺泡内点状高密度影。(4)胸部X线检查和CT扫描动态观察中发现病灶大小、数量及分布部位有迅速变化和进展(即在24～48h内有动态变化)。上述征象提示为SARS病毒引起的肺部表现可能。结论 CT扫描检查是一种敏感的检查方法，能较准确地评估SARS患者肺部病变的演变过程和及时发现所出现的并发症。