胸部结节病的影像诊断

目的探讨胸部结节病的影像诊断特异性与诊断价值。方法回顾性分析经临床和病理证实15例结节病的临床、CT和MRI扫描资料。结果 15例患者中0期0例、Ⅰ期4例、Ⅱ期8例、Ⅲ期3例。本组纵隔淋巴结增大主要位于4R区,其次为11、5、7、2R区。肺内病变本组15例中12例表现为散在不规则小结节状影及支气管血管束增粗、模糊,3例可见融合而成的大块致密影呈"假肿瘤"征象。结论胸部结节病具有相对特征性表现,为临床及时正确治疗提供可靠依据。     

系统性硬化症肺部高分辨率CT影像学表现分析

目的探讨系统性硬化症(SSc)肺部高分辨率CT(HRCT)影像学特征。方法回顾性分析2013-02~2017-04该院临床确诊15例SSc肺部HRCT影像学表现。结果 15例SSc患者肺部正常4例,表现以两肺外围分布为主的间质性纤维化11例。HRCT主要表现支气管血管束扭曲变形、小叶间隔增厚,可见条索状影、胸膜下线及弧形线9例,呈网格状改变7例。沿支气管血管束及小叶间隔分布小结节状影,胸膜下见小结节影10例。单纯以磨玻璃样改变5例,轻度胸膜增厚或少量胸腔积液9例。小片状实变影及蜂窝肺4例。结论 HRCT显示SSc的间质性细微病变,在SSc的诊断和随访治疗中具有重要价值。     

新型冠状病毒肺炎肺部磨玻璃影鉴别诊断的研究

目的:在新型冠状病毒肺炎(COVID-19)流行期间,正确认读胸部CT的磨玻璃影,以早期做出鉴别诊断。方法:回顾性分析我科2020年1月至2月,收治的影像学不除外COVID-19,新型冠状病毒核酸检测为阴性的8例患者,收集其临床资料(年龄、性别、临床病史、流行病学病史、实验室检查结果)及胸部CT的影像学资料。结果:8例患者中男性4例,女性4例,年龄17~73岁。8例患者均有咳嗽及呼吸困难症状,其中7例有发热。8例患者淋巴细胞绝对值、比例均明显降低,C反应蛋白均增高。胸部CT表现为磨玻璃密度病灶(8/8)、支气管血管束增粗(6/8)、小叶间隔增厚(5/8)、实变影(4/8)、空气支气管征(4/8)、铺路石征(3/8)、树芽征(1/8)、气体陷闭(1/8)表现。结论:对于流行病史不明确,胸部CT以磨玻璃样病变为著的病例,正确认识影像鉴别的关键点,利于早期明确诊断。     

淹溺后双肺变化的斑片磨玻璃影

老年男性患者, 因淹溺伴意识丧失入院, 影像学主要表现为双肺多发的斑片磨玻璃影, 最初沿重力分布, 短期内演变为沿支气管血管束分布, 支气管肺泡灌洗液呈先浅后深的血性液体, 诊断考虑淹溺后的吸入性肺炎, 继发肺水肿伴肺泡出血。经验性抗感染治疗、有创机械通气、糖皮质激素抗炎后患者病情好转, 顺利出院, 复查胸部CT可见双肺斑片及磨玻璃影大部吸收。     

老年人退行性肺纤维化的DR、CT影像分析

目的分析研究老年人退行性肺纤维化的DR、CT影像的应用价值。方法选取2010年1月至2015年12月期间在我院接收的患有退行性肺纤维化的老年患者一共有136例,对136例患者采取DR、CT以及胸部X线进行检查,对其检查结果给予分析研究。结果胸片DR表现包括有毛磨玻璃样阴影、粟粒样阴影、结节样阴影、粗网织状阴影以及蜂窝肺等;CT表现包括有双肺弥漫分布的斑片状、蜂窝状以及索条状,58例在磨玻璃影当中能够看见小结节影,48例在两肺可以看见粗大的纤维索条影,36例病人可以看见两肺广泛分布的粗网织结节影;肺部X先表现包括有118例病人为两肺弥漫性阴影。结论对老年退行性肺纤维化患者采取DR以及CT影像检查,可以取得显著的效果,使临床确诊率明显提高,为制定临床治疗方案和预后提供重要依据,具有临床推广价值。     

心源性肺淤血肺水肿的影像特征分析

目的探讨心源性肺淤血肺水肿的影像特征,为临床诊断提供更多可靠依据。 方法以我院收治的100例心源性肺淤血肺水肿患者为研究对象,采用回顾法对相关资料展开分析,探讨其影像特征。 结果通过影像分析发现,其中心脏增大96例(96.0%)、肺血转流40例(40.0%)。肺淤血改变44例(44.0%)。间质性肺水肿53例(53.0%),包括了支气管袖口22例(22.0%)和Kelery B、A、C线31例(31.0%),表现为肺纹理和肺门血管增粗、模糊,肺部小叶间隔线、胸膜下线的出现,支气管血管束增粗增多,支气管袖口征及小叶间隔呈光滑型增厚。肺泡性水肿40例(40.0%),表现为密度逐渐增高的薄纱样、云雾状以及云白样片状渗出影,典型表现为以肺门为中心的蝶翼样片状密度增高影,其中磨玻璃影或/和气腔实变以及边缘模糊19例(19.0%),蝶翼征21例(21.0%)。出现胸腔积液75例(75.0%)。 结论心源性肺淤血和肺水肿改变在影像中早于临床,具有发展迅速和变化复杂的特点,通过对肺水肿胸部影像进行分析,能为医师的临床诊断提供更多可靠依据,有助于提升临床治疗效果。     

肺部癌性淋巴管炎HRCT影像特征分析

目的探讨肺部癌性淋巴管炎高分辨扫描的影像学特征。方法分析35例病理诊断癌性淋巴管炎患者HRCT影像学资料。结果本组病例HRCT表现:支气管血管束增粗27例,小叶间隔增厚29例,小叶核心结节15例,片状磨玻璃影12例,周围线样及索条影5例,叶间裂及胸膜结节样增厚9例。结论 HRCT对癌性淋巴管炎具有相对特征性表现,并有助于和其它弥漫性间质性肺部病变的鉴别。     

特发性肺纤维化与非特异性间质性肺炎的非创伤性鉴别诊断方程

目的 为提高临床非创伤性区分特发性肺纤维化(IPF)与非特异性间质性肺炎(NSIP)的水平,建立IPF与NSIP的非创伤性鉴别诊断方程.方法 选病理确诊的14例IPF和18例NSIP患者为研究对象,记录患者临床资料、胸部高分辨率CT评分、支气管肺泡灌洗等结果.将各个变量分别赋值,筛选,建立方程,确定临界值.结果 (1)IPF组患者比NSIP组年龄偏大,男性较多,吸烟者较多.(2)与NSIP组比,IPF组患者胸部高分辨率CT评分网格影、蜂窝影评分高,磨玻璃影评分低.(3)IPF组淋巴细胞占支气管肺泡灌洗液中细胞总数大于20%低于NSIP组.(4)建立方程:Y=0.9+0.123x1-0.045x2+0.009x3+0.033x4(x1、2、3、4分别为影像学显示蜂窝影、影像学显示磨玻璃影、年龄、影像学显示网格影),方程临界值为1.5.结论 回归方程y=0.9+0.123x1-0.045x2+0.009x3+0.033x4可协助临床医生区分IPF与NSIP.     

HRCT诊断活动性肺结核间质改变的价值观察

目的观察高分辨率CT(HRCT)诊断活动性肺结核间质改变的价值。方法选取2016年3月2019年5月哈励逊国际和平医院收治的活动性肺结核患者120例,均接受HRCT检查,依据是否存在肺间质改变分为研究组(存在间质病变)、对照组(不存在间质病变),分析肺间质病变发生特点、分布部位与特征,观察肺间质改变者治疗前后HRCT影像特征变化及与病灶吸收的关系。结果肺结核间质病变好发于两上肺野,且病变呈双肺弥漫性分布,主要为片状蔓延或沿支气管树分布,小叶内间质异常为间质改变的主要HRCT表现,包括小叶内细网织线影、微结节、磨玻璃影、树芽征等,依据间质类型分为轴心间质异常24.69%、周围间质异常40.74%、间隔间质异常34.57%,伴发实变影、支气管播散、气道增厚伴扩张、空洞、肺大疱、气胸;经规范抗结核治疗后30.86%病灶明显吸收,稍有吸收25.93%,无明显吸收43.21%,吸收组、未吸收组治疗中与治疗前各HRCT影像比较差异无统计学意义(P0.05),而治疗结束时吸收组小叶内细网织线影、微结节、磨玻璃影、树芽征检出率明显低于治疗前及治疗中(P0.05),吸收组小叶内细网织线影、微结节检出率低于未吸收组(P0.05);相关性分析显示,活动性肺结核患者HRCT的小叶内细网织线影、微结节、磨玻璃影、树芽征与病灶吸收有明显负相关性(P0.05)。结论活动性肺结核患者HRCT有一定影像学表现,以小叶内间质异常为主,表现为小叶内细网织线影、微结节、磨玻璃影、树芽征等,其中小叶内细网织线影、微结节,吸收慢,需更长时间治疗与观察。     

能谱CT成像在心源性肺水肿中的鉴别诊断应用

【】目的：探究能谱CT成像在心源性肺水肿中的临床应用价值。方法：选取2014年4月-2015年8月我院收治的80例肺水肿患者进行研究,将所有患者按照不同检查方法分成胸部CT组(n=40)和能谱CT组(n=40),两组均进行相应CT成像定量分析。观察并比较两组患者不同CT显像,分析能谱CT在诊断肺水肿性质中发挥的作用。结果：心源性肺水肿CT表现以间质性肺水肿为主,心脏和肺门硬增大,血管束增粗、增大,肺野呈毛玻璃样改变,密度增高,纹理模糊增粗,其中又以间质性肺水肿为主,CT平扫双肺明显,并见Kerley B线,双侧胸腔少量积液,左侧较多。能谱CT诊断价值较胸部CT更大,但两组比较差异无统计学意义(P>0.05)。治疗后胸膜下线、支气管血管束增粗、纤细网纹状影、小叶间隔增厚、磨玻璃样改变等征象患者例数较治疗前显著下降(P<0.05),但肺血重分布征象比较无统计学意义(P>0.05)。结论：能谱CT在鉴别心源性肺水肿中较胸部CT更具有诊断价值,因此可以作为检查诊断心源性肺水肿的方法之一,为临床提供一种无创且实用判断肺水肿手段。     

Pulmonary involvement in mixed connective tissue disease: high-resolution CT findings in 41 patients

The objective of this study was to describe the pulmonary abnormalities on high-resolution computed tomography (CT) in patients with mixed connective tissue disease (MCTD). The study included 41 patients who met the diagnostic criteria for MCTD and showed abnormal findings on high-resolution CT. The presence, extent, and distribution of various high-resolution CT findings were evaluated. The predominant abnormalities included areas of ground-glass attenuation (n = 41), subpleural micronodules (n = 40), and nonseptal linear opacities (n = 32). Other common findings included peripheral predominance (n = 40), lower lobe predominance (n = 39), intralobular reticular opacities (n = 25), architectural distortion (n = 20), and traction bronchiectasis (n = 18). Less common findings included honeycombing, ill-defined centrilobular nodules, airspace consolidation, interlobular septal thickening, thickening of bronchovascular bundles, bronchial wall thickening, bronchiectasis, and emphysema. Pulmonary involvement of MCTD is characterized by the presence of ground-glass attenuation, nonseptal linear opacities, and peripheral and lower lobe predominance. Ill-defined centrilobular opacities were uncommonly seen.     

Pulmonary involvement in sarcoidosis: CT findings at diagnosis and their changes at follow-up in cases without corticosteroid treatment]

To review the pulmonary CT findings in sarcoidosis at diagnosis, and to analyze the change in each finding at follow-up in cases without corticosteroid treatment. The study included 21 cases of pulmonary involvement of sarcoidosis. We analyzed the presence or absence and grade of each HRCT finding: bronchial wall thickening, enlargement of vascular shadows, pleural involvement, septal thickening, small nodules, ground-glass opacities, centrilobular opacities, consolidation, nodules, and volume loss. Afterwards, we compared the initial CT with the follow-up CT, and described the change of each finding as "improved" or "not improved". Furthermore, we decided if each case as a whole was improved or not after considering all of the pulmonary CT findings. Twelve of the 21 cases were improved. Small nodules, ground-glass opacities, centrilobular opacities, and nodules had improved in more than 50% of the cases since the initial CT. However, pleural involvement (10/11) and volume loss (6/9) were not improved. Pleural involvement and volume loss correlated the radiological irreversibility (p < 0.05). Of the several pulmonary CT findings in sarcoidosis, pleural involvement and volume loss show the highest rates of irreversible pulmonary changes.     

Thoracic manifestation of Churg-Strauss syndrome: radiologic and clinical findings

STUDY OBJECTIVES: To describe the radiologic and clinical findings of Churg-Strauss syndrome (CSS) and its thoracic manifestations. DESIGN: We used retrospective analysis to review and characterize the radiographic, thin-section CT, and clinical findings of CSS. PATIENTS: The study involved nine patients with CSS. The patients included four men and five women, whose ages ranged from 18 to 60 years (median, 35 years). Thin-section CT scans and chest radiographs were retrospectively analyzed by three radiologists in consensus. Clinical data were obtained by chart review. Histologic samples were available in eight patients. RESULTS: All patients had a history of asthma averaging 28 months (range, 4 to 72 months) prior to the initial symptom of vasculitis and marked peripheral blood eosinophilia (mean peak count, 8,726/microL; range, 3,000 to 32,000/microL; mean differential count, 41%; range, 19 to 67%). All patients had systemic vasculitis involving the lung and two to four extrapulmonary organs, most commonly the nervous system (n = 8) and skin (n = 7). Chest radiographs showed bilateral nonsegmental consolidation (n = 5), reticulonodular opacities (n = 3), bronchial wall thickening (n = 3), and multiple nodules (n = 1). The most common thin-section CT findings included bilateral ground-glass opacity (n = 9); airspace consolidation (n = 5), predominantly subpleural and surrounded by the ground-glass opacity; centrilobular nodules mostly within the ground-glass opacity (n = 8); bronchial wall thickening (n = 7); and increased vessel caliber (n = 5). Other findings were hyperinflation (n = 4), larger nodules (n = 4), interlobular septal thickening (n = 2), hilar or mediastinal lymph node enlargement (n = 4), pleural effusion (n = 2), and pericardial effusion (n = 2). CONCLUSIONS: In CSS, thoracic organs are invariably involved with additional diverse manifestations. The possibility of CSS should be raised in patients with a history of asthma and hypereosinophilia who present with thin-section CT findings of bilateral subpleural consolidation with lobular distribution, centrilobular nodules (especially within the ground-glass opacity) or multiple nodules, especially in association with bronchial wall thickening.     

Lymphocytic interstitial pneumonia: follow-up CT findings in 14 patients

The aim of the present study was to assess the evolution of various computed tomographic (CT) findings of lymphocytic interstitial pneumonia (LIP) with determination of potentially reversible or irreversible features. The study included 14 patients with biopsy-proved LIP who had serial thin-section CT examination 4 to 82 months (median 13 months) apart. Initial and follow-up CT scans were evaluated independently and then directly compared with each other by two observers. The main parenchymal abnormalities on the initial CT scan consisted of ground-glass attenuation (n = 14), thickening of interlobular septa (n = 13), centrilobular nodules (n = 12), cystic airspaces (n = 10), and airspace consolidation (n = 4). On follow-up CT, nine patients improved, one showed no change, and four showed increased extent of disease. With the exception of cysts, the parenchymal opacities were reversible. On follow-up CT, new cysts were seen in three patients; these developed mainly in areas with centrilobular nodules on initial CT. Honeycombing was seen on follow-up CT in four patients; in three patients it developed in areas of airspace consolidation and in one patient it developed in an area with ground-glass attenuation on initial CT. The majority of patients with LIP improved on follow-up. However, airspace consolidation may progress to honeycombing and centrilobular nodules may precede cystic formation.     

Pulmonary abnormalities in ankylosing spondylitis: inspiratory and expiratory high-resolution CT findings in 17 patients

OBJECTIVE: The purpose of this study was to evaluate pulmonary manifestations of ankylosing spondylitis on inspiratory and expiratory high resolution CT. MATERIAL AND METHODS: The study included 17 patients ranging from 40 to 62 years in age. Fifteen patients were male, and 8 were smokers. All patients underwent chest radiography and high-resolution CT. High-resolution CT was obtained using 1 or 2 mm collimation scans at 10-mm intervals at the end of maximal inspiration and at 3 cm intervals at the end of maximal expiration. RESULTS: Pulmonary abnormalities were evident on chest radiography in 2 patients and on CT in 15 patients. The abnormalities on CT included evidence of airway disease in 14 (82%), interstitial abnormalities in 11 (65%), and emphysema in 6 (35%) patients. Airway abnormalities included bronchial wall thickening in 7 (41%), mosaic perfusion in 3 (18%), centrilobular nodules in 3, bronchiolectasis in 2, and air trapping on expiratory CT in 7 (41%) patients. Interstitial abnormalities included parenchymal bands in 7 (41%), intralobular linear opacities (n = 2), and 1 patient each with irregular thickening of interlobular septa, subpleural lines, and honeycombing. CONCLUSION: The majority of patients with ankylosing spondylitis have airway and interstitial abnormalities evident on high-resolution CT. These abnormalities are usually mild and therefore seldom evident on the chest radiograph.     

Comparison of pulmonary abnormalities on high-resolution computed tomography in patients with early versus longstanding rheumatoid arthritis

OBJECTIVE: To identify the predominant radiological abnormalities in the lungs of patients with early rheumatoid arthritis (RA) and in those with longstanding RA. METHODS: We performed high-resolution computed tomography (HRCT) on a total of 126 patients with early RA (n = 65) and longstanding RA (n = 61). The most likely diagnosis for each case was made on the basis of the predominant HRCT findings and their extent in the lungs. Pulmonary function tests were done for RA patients with parenchymal abnormalities. RESULTS: The most frequent finding was bronchial dilatation (41.3%), followed by ground-glass attenuation (27.0%), parenchymal micronodules (15.1%), subpleural micronodules (15.1%), reticulation (11.9%), bronchial wall thickening (11.9%), nodules (10.3%), honeycombing (8.7%), and airspace consolidation (4%). Parenchymal micronodules and bronchial wall thickening, indicative of small airway diseases, were more prominent in the patients with longstanding RA. There were no significant differences in the frequency of interstitial abnormalities such as ground-glass attenuation, reticulation, honeycombing, or consolidation between the 2 groups. We identified 10 patients with bronchiolitis pattern, 11 with nonspecific interstitial pneumonia (NSIP) pattern, 2 with usual interstitial pneumonia (UIP) pattern, and 2 with organizing pneumonia (OP) pattern. Mean values of FEV1/FVC ratio and FEV25-75 were lower in the patients with the bronchiolitis pattern, and DLCO was decreased in the patients with the NSIP or UIP pattern. CONCLUSION: Interstitial abnormalities were frequently observed even in patients with early RA, although most of them had no respiratory symptoms. Bronchiolar abnormalities were associated with the duration of RA.     

Pulmonary involvements of sarcoidosis

We reported about intrathoracic changes and prognosis of 686 patients with sarcoidosis diagnosed in our hospital between 1963 and 1988. We evaluated CT findings in 135 patients with sarcoidosis and found pulmonary involvements in 81. We analyzed CT findings according to the classification by Tuengerthal which classified radiographic findings combining ILO classification of pneumoconiosis and characteristic findings of bronchovascular sheath with sarcoidosis. The CT findings were as follows: small opacities (44 out of 81 cases, 54.3%), large opacities (37 cases, 46.7%). Additional findings were as follows: peribronchial marking (42 cases, 51.9%), contraction (17 cases, 21.0%), pleural involvement (9 cases, 11.1%), bulla (5 cases, 6.2%). The characteristic CT findings of serious sarcoidosis were extasis of bronchus, thickening of the bronchial wall, unclearness of vascular shadow, atelectasis and thickening of pleura. Concerning the prognosis of pulmonary involvement, according to age, patients younger than 30 years old at initial diagnosis were better than those of 30 years and over in terms of disappearance of pulmonary involvements. According to stage, patients of stage I and stage II were better than those of stage III. Among the patients we were able to observe chest X-ray findings during five years according to the character of shadow, ill-defined shadow of small opacities and rounded shadows of large opacities had a higher disappearance rate of pulmonary involvements than irregular shadows of large opacities, atelectasis and contraction.     

Intrathoracic Involvements of Immunoglobulin G4-Related Sclerosing Disease

To investigate clinical and radiological features of IgG4-related disease (IgG4-RD) patients with intrathoracic involvement.A prospective cohort study was performed and IgG4-RD patients were enrolled from January 2011 to March 2015 in Peking Union Medical College Hospital, in which the clinical and radiological characteristics of IgG4-RD patients with intrathoracic involvement were summarized.Out of total 248 cases with IgG4-RD, 87 cases had intrathoracic lesions, including 58 male cases and 29 female cases, with average age of 54.19 ± 13.80 years. Hilar and mediastinal lymphadenopathy were the most common manifestations of IgG4-related intrathoracic disease, accounting for 52.9% (46/87). Other imaging findings of pulmonary disease included: solid nodular (25.3%), round-shaped ground-glass opacities (9.2%), alveolar-interstitial type (20.7%), bronchovascular type (23.0%), pleural effusion (4.6%), and pleural nodules or thickening (16.1%). Only 27 patients presented with respiratory symptoms, including cough, breathless, chest pain, and asthma. Compared with patients without intrathoracic disease, IgG4-related intrathoracic disease had higher IgG4 and C-reactive protein level, and higher incidence of allergy, fever, and multi-organ involvement. Most of lung interstitial disease, mediastinal mass, and bronchial thickening were sensitive to corticosteroid and immunosuppressant therapy, while 36.3% (8/22) of solitary nodular lesions were unresponsive to treatment. Eight patients were on no treatment, with 5 cases remained stable, 2 patients improved spontaneously, and 1 patient was lost follow-up.Intrathoracic lesions are not rare in patients with IgG4-RD, involving bronchial thickening, nodules, ground glass opacity, pleural thickening/effusion, lymphadenopathy, etc. Efficacy of corticosteroid and immunosuppressant therapy were noted in most of patients with lung interstitial disease, mediastinal mass, and bronchial thickening.     

Churg-Strauss syndrome: high resolution CT and pathologic findings

OBJECTIVES: The purpose of this study was to evaluate high-resolution CT findings in 7 patients with Churg-Strauss syndrome and to compare the CT with the histopathologic findings. MATERIALS AND METHODS: High-resolution CT scans of 7 asthmatic patients (4 women, 3 men, age range, 34-62 years, mean 49 years) with Churg-Strauss syndrome were reviewed by 2 observers. Histologic specimens of lung obtained at surgical (n = 3) or transbronchial (n = 3) biopsy or autopsy (n = 1) were reviewed by an expert lung pathologist. The diagnosis of Churg-Strauss was based on clinical, laboratory, and histologic findings. RESULTS: Parenchymal and airway abnormalities included ground-glass opacities (n = 5), areas of air-space consolidation (n = 4), centrilobular nodules (n = 5), nodules 1-3 cm in diameter (n = 3), interlobular septal thickening (n = 4), bronchial wall thickening (n = 4), and areas of atelectasis (n = 1). Surgical biopsy (n = 3) and autopsy (n = 1) specimens demonstrated airspace disease in 3 patients, interlobular septal thickening in 3 patients, and airway abnormalities in 2 patients. Histologically, the airspace disease included eosinophilic pneumonia (n = 2) and small foci of organizing pneumonia (n = 1). The septal thickening was due to edema combined with numerous (n = 2) or few (n = 1) eosinophils. The airway abnormalities (n = 2) included muscle hypertrophy and large airway wall necrosis (n = 1) and eosinophilic infiltration of the airway walls (n = 1). Transbronchial biopsy (n = 3) demonstrated increased eosinophils. CONCLUSION: The main high-resolution CT findings of Churg-Strauss syndrome consist of airspace consolidation or ground-glass opacities, septal lines, and bronchial wall thickening. These reflect the presence of eosinophilic infiltration of the airspaces, interstitium, and airways, and interstitial edema.