急性氯气中毒患者胸部X线和CT表现分析

目的 探讨急性氯气中毒患者胸部X线和CT表现及诊断价值.方法 对南京军区南京总医院28例氯气中毒患者发病后一系列胸部X线和CT表现进行回顾性比较分析.结果 X线表现:9例胸片正常;2例首诊胸片正常,1～2 d后见异常.17例首诊X线表现异常:急性气管-支气管周围炎3例,急性化学性支气管肺炎6例,弥漫性间质性肺水肿和中央性肺水肿为8例.CT表现:发病1～3 d,轻者两肺散在斑点状致密影;中重度者为多发斑片状或弥漫性渗出,部分融合实变,见空气支气管征及胸腔积液.发病4～10 d,轻者基本吸收,中重度者斑片状渗出影吸收变淡,两肺实变面积缩小.发病10 d后,4例完全恢复正常,6例30～40 d时表现为肺内少许纤维条索影,1例42 d时表现为两肺内细小点状模糊影,呈较淡毛玻璃样改变.结论 急性氯气中毒因病变程度不同可表现为急性支气管-肺炎和急性肺水肿的影像改变,一系列胸部X线检查有助于掌握病情的动态变化,CT检查能较准确地评价肺部病变.

Radiographic and computed tomographic manifestations of chest in patients with acute chlorine gas poisoning

Objective To investigate the radiographic and computerized tomographic features of chest in patients with acute chlorine poisoning and its diagnostic value.Methods Twenty-eight cases of chlorine poisoning were reviewed.And their radiographic and computerized tomographic features were compared and analyzed.Results Radiographic findings: Among 28 patients, 9 cases were normal and 2 cases had no abnormalities on the first chest X-ray and became abnormal one or two days later.And there were abnormal findings in first chest X-ray in 17 patients: acute tracheal inflammation of peribronchitis (n = 3), acute chemical bronchopneumonia(n = 6)and diffuse interstitial and central pulmonary edema (n = 8).CT manifestations: At Days 1-3, the patients of mild poisoning had scattered patchy dense shadow;those of moderate to severe poisoning showed multiple patchy or diffuse infiltration(ground-glass opacity).And partial consolidation, air bronchogram and pleural effusion could be observed.At Days 4-10, the manifestations of mild poisoning were largely absorbed;those of moderate to severe poisoning manifested the absorption of diffuse or multiple patchy effusion and a fading of shadow.And the size of lung consolidation became smaller than before.At Day 10 after onset, 4 patients completely recovered.At Days 30-40, 6 cases showed traces of fibrous shadow and one case showed small punctiform opacities in both lungs.And at Day 42, there was slight ground-glass change.Conclusion Acute chlorine gas poisoning in varying degrees may manifest acute bronchial pneumonia and acute pulmonary edema.During treatment, a series of chest X-ray examinations will help to follow the changes of disease.And CT examination can offer a more accurate evaluation of lung lesions.