CT诊断艾滋病合并卡氏肺囊虫性肺炎

目的：探讨研究AIDS合并卡氏肺囊虫性肺炎特征性的CT表现。方法：选取5例经HIV检测证实的AIDS合并卡氏肺囊虫性肺炎的CT影像资料并归纳总结。结果：卡氏肺囊虫性肺炎的CT表现是多变的，初期通常表现为双侧肺门区散在小灶性毛玻璃样阴影；进一步表现为广泛网状阴影为主或毛玻璃样阴影为主，可伴有明显小叶间隔增厚；还可见位于斑片状毛玻璃阴影或实变影中的囊变阴影；各期病变常同时存在。结论：正确认识AIDS合并卡氏肺囊虫性肺炎的CT表现，可发现、提示AIDS的诊断。     

特发性非特异性间质性肺炎6例临床病理分析

目的探讨特发性非特异性间质性肺炎的临床病理学特征和鉴别诊断。方法对6例特发性非特异性间质性肺炎进行临床、影像学、组织病理学和免疫组化观察，并复习相关文献。结果高分辨CT显示双肺对称性毛玻璃样阴影。镜下肺组织呈均匀一致性病变，主要表现为间质慢性炎症和纤维化，肺泡间隔增宽。免疫组化示增生的肺泡上皮和支气管上皮CK、EMA（＋）。结论特发性非特异性间质性肺炎是一种重要的特异性间质性肺炎类型，应注意与寻常型间质性肺炎、淋巴细胞性间质性肺炎及过敏性肺炎等进行鉴别，对指导临床治疗和判断预后具有非常重要的意义。     

过敏性肺炎临床病理观察

目的探讨过敏性肺炎(HP)的临床和病理特点,提高对HP的认识和诊断水平。方法介绍2例亚急性、1例慢性HP的临床病理学改变,并进行相关文献复习。结果 HP根据临床过程分为急性、亚急性和慢性期改变,急性HP的主要病理改变是急性炎症细胞浸润和急性肺损伤;亚急性HP的主要病理特征为淋巴细胞性间质性肺炎、淋巴细胞性细支气管炎和形成不良的肉芽肿,影像学示两侧肺弥漫小叶中心性结节影;慢性HP具有部分亚急性HP改变并伴有间质纤维化,影像学显示纤维化性间质性肺炎改变。结论 HP临床和病理学改变复杂,易与其他病变混淆,需结合临床、影像学及组织学改变才能做出正确诊断。     

新型冠状病毒肺炎与间质性肺炎的鉴别诊断

2019年12月以来，我国陆续出现新型冠状病毒肺炎(coronavirus disease 2019，COVID-19)病例，主要表现为发热、干咳、呼吸困难、外周血白细胞不高、淋巴细胞降低以及肺内阴影。国家卫生健康委在短期内连续7次修订诊疗方案，足以说明该病诊疗难度之大。部分COVID-19患者影像学表现为双肺弥漫性间质改变，与临床中所见的某些间质性肺炎相似。在当前全球COVID-19疫情形势仍极为严峻的情况下，需与某些急性或急进性间质性肺炎进行鉴别诊断，既要防止漏诊，又要防止因误诊而贻误原发病的治疗。本文将COVID-19与北京协和医院历年收治的多种间质性肺炎进行比较，提出了鉴别诊断思路。     

特发性肺间质纤维化的影像分析

本文介绍我院9例特发性肺间质纤维化的一般情况和检查方法，得出了肺间质纤维化的X线和CT表现。T线表现有两肺弥漫性细网织状阴影。肺透光度降低，肺毛玻璃，蜂窝肺，肺气肿，胸膜增厚等；CT表现有胸膜下小叶间隔及小叶内间质增厚，肺毛玻璃样改变，肺蜂窝样改变，空气支气管征，胸膜增厚及壁层胸膜下毛刺。通过讨论叙述了特发性肺间质纤维化的X线和CT征象与病理的演变过程。     

急性嗜酸细胞性肺炎的DR和HRCT诊断评价

目的探讨急性嗜酸细胞性肺炎DR与HRCT诊断价值,提高对此病的认识。方法回顾8例经确诊的急性嗜酸细胞性肺炎DR与HRCT表现。结果大多数病例DR可显示两肺弥漫性网状阴影,肺泡性或混合性浸润阴影;HRCT均可见不同程度磨玻璃影和光滑的小叶间隔增厚。结论DR和HRCT可为临床诊断急性嗜酸细胞性肺炎提供较明确的信息,且能从影像上对该病的发展和转归给予直观的判断。     

粟粒性肺结核的影像学诊断

目的：分析粟粒性肺结核的影像表现．提高肺内弥漫性结节性病变的诊断水平。方法；回顾分析经病理或临床证实的80例粟粒性肺结核患者的X线及CT片，与7例肺转移瘤和3例尘肺的影像表现进行比较。结果：粟粒性肺结核的影像学表现为两肺弥漫分布的粟粒样大小结节阴影．急性者结节的大小、分布及密度均匀，结节大小平均为2．8mm；亚急性及慢性者则大小、分布及密度都不均匀，结节平均5．7mm．伴钙化结节32例，肺纤维化11例，局限性肺气肿12例；肺转移瘤结节平均5．2mm；尘肺结节平均6．2mm，均有钙化、肺纤维化和局限性肺气肿。结论：高分辩率CT对肺内弥漫性结节性病变有重要的诊断价值。     

HRCT对肺间质性病变的诊断价值

目的研究肺间质病变的高分辨CT（HRCT）表现及鉴别诊断。方法采用HRCT法对88例临床病理证实的肺间质病变作影像分析。结果HRCT可清晰显示所有病例的肺间质病变征象，常表现为支气管血管束周围间质增厚（27例）；肺小叶改变，其中包括小叶内间质异常（35例）、小叶间隔增厚（36例）；毛玻璃影（38例）；蜂窝征（41例）；胸膜下间质改变（33例）：出现界面影、胸膜下线、网织样变；受牵支气管扩大（28例）。结论HRCT对判断肺间质病变有影像诊断价值。     

肺部弥漫性病变中肺癌和肺结核的CT影像鉴别

目的通过采用高分辨率CT(HRCT)对肺部进行扫描,探讨肺小叶结构异常征象在表现为肺部弥漫性病变中的肺结核和肺癌诊断和鉴别中的价值。方法选取2013年6月~2014年6月于我院进行治疗的98例肺部弥漫性病变患者对其进行HRCT检查,然后图像用高分辨重建。结果肺淋巴道转移癌、肺血行转移癌、弥漫结节型细支气管肺泡癌、急性血行播散性肺结核及亚慢性血行播散性肺结核大部分均出现小叶间隔异常。而支气管播散结核并没有出现小叶间隔异常现象,表明没有出现小叶间隔异常可以作为诊断支气管播散结核的重要依据;急性血行播散性肺结核和肺血行转移癌小叶间隔异常主要表现为呈结节状和串珠状改变;肺淋巴道转移癌中最容易出现小叶内细线、网状影,为58.3%(7/12);支气管播散性肺结核在小叶核心异常表现上较具有特征性,主要表现为小叶核心结节和分支状影(即树芽征),占到90.0%(9/10)。结论 HRCT影像鉴别在显示肺小叶结构异常时具有明确的特征性表现,对肺小叶结构异常特点采用HRCT影像分析可以提高肺部弥漫性病变中肺癌和肺结核诊断和鉴别水平。     

29例肺弥漫性病变的临床诊断和鉴别诊断

目的：探讨肺弥漫性病变的临床诊断、鉴别诊断及对预后判断的意义．方法：对29例以弥漫性肺间质性病变为主要表现患者的临床症状、体征、x线胸片和高分辨率CT表现及其他辅助检查等结果进行回顾性分析。结果：29例中，男女比例为1：1．9．分别确诊为特发性肺间质纤维化9例(31％)，特发性非特异性间质性肺炎9例(31％)及特发性脱屑性间质性肺炎1例；结缔组织病肺部表现4例(14％)；过敏性肺泡炎2例(7％)；细支气管肺泡癌、转移性肺腺癌、嗜酸性粒细胞浸润性肺炎、非霍奇金淋巴瘤肺间质病变各1例(共占14％)，特发性肺间质纤维化组的病程长于特发性非特异性间质性肺炎组[3～25(中位数14)个月比1～5(中位数2)个月，P=0．036]，前者更易出现呼吸困难、紫绀、杵状指；X线及高分辨率CT检查特发性肺间质纤维化主要为网格状和蜂窝状表现，特发性非特异性间质性肺炎则以片状磨砂玻璃样影为主；特发性肺间质纤维化组ESR明显增快，且有明显肺通气和弥散功能障碍。结论：弥漫性肺疾病的诊断是一综合过程，除了与结缔组织疾病及肿瘤鉴别外，区分特发性肺间质纤维化与特发性间质肺炎，对指导治疗和判断预后具有重要意义。     

Acute exacerbation of subclinical pulmonary fibrosis after red blood cell transfusion: a case report

BACKGROUND: Red blood cell (RBC) transfusion is associated with lung injury in susceptible hosts, although many cases do not meet criteria for transfusion‐related acute lung injury. Patients with underlying pulmonary fibrosis can exhibit precipitous deteriorations in respiratory status of unknown etiology defined as acute exacerbations due to superimposed lung injury syndrome. It is unclear whether RBC transfusion is associated with acute exacerbation of underlying pulmonary fibrosis. CASE REPORT: We describe a patient who underwent an uneventful elective left total hip replacement but developed anemia postoperatively. Twenty‐four hours after transfusion of her fifth nonleukoreduced AS‐5 RBC unit, she developed new bilateral airspace infiltrates associated with progressive hypoxemia. These RBC units were 35 to 38 days old. Despite supportive care and diuresis, the patient remained profoundly hypoxemic with infiltrates that progressed to fibrosis. RESULTS: The patient had mild subclinical lower‐lobe predominant interstitial pulmonary fibrosis but developed diffuse bilateral ground glass opacities with areas of consolidation 24 hours after receiving her last RBC unit. Transbronchial biopsy of the right lower lobe showed active organizing pneumonia and underlying interstitial fibrosis, supporting the clinical diagnosis of acute exacerbation of pulmonary fibrosis. The bronchoalveolar lavage showed progressive bloody effluent, consistent with diffuse alveolar hemorrhage, a marker of lung injury. There was no evidence of viral inclusions, fungal elements, pneumocystis, or bacterial organisms. CONCLUSION: Transfusion of multiple units of aged RBCs was temporally associated with an acute exacerbation and rapid progression of underlying subclinical pulmonary fibrosis.     

肺功能成像在新型冠状病毒肺炎急性及康复期病变的研究进展

截至2022年11月4日，新型冠状病毒肺炎（coronavirus disease 2019, COVID-19）确诊病例超过6.28亿，死亡人数超过657万。肺是COVID-19最常累及的器官，主要表现为COVID-19肺炎、肺血栓栓塞等急性病变及康复期COVID-19相关小气道病变、肺间质纤维化。肺功能成像使用影像学成像技术对肺功能进行区域性可视化量化评估，并额外提供常规肺功能检查未涉及的区域分布及定位信息。为全面了解肺功能成像技术在COVID-19患者中的应用价值，本文归纳总结CT、MRI及核医学成像技术在COVID-19急性及康复期病变早期识别、诊断及随访中的初步应用，并展望各种成像模态及相关技术在未来更广泛的应用。     

Idiopathic Pulmonary Fibrosis: Evolving Concepts

Idiopathic pulmonary fibrosis (IPF) occurs predominantly in middle-aged and older adults and accounts for 20% to 30% of interstitial lung diseases. It is usually progressive, resulting in respiratory failure and death. Diagnostic criteria for IPF have evolved over the years, and IPF is currently defined as a disease characterized by the histopathologic pattern of usual interstitial pneumonia occurring in the absence of an identifiable cause of lung injury. Understanding of the pathogenesis of IPF has shifted away from chronic inflammation and toward dysregulated fibroproliferative repair in response to alveolar epithelial injury. Idiopathic pulmonary fibrosis is likely a heterogeneous disorder caused by various interactions between genetic components and environmental exposures. High-resolution computed tomography can be diagnostic in the presence of typical findings such as bilateral reticular opacities associated with traction bronchiectasis/bronchiolectasis in a predominantly basal and subpleural distribution, along with subpleural honeycombing. In other circumstances, a surgical lung biopsy may be needed. The clinical course of IPF can be unpredictable and may be punctuated by acute deteriorations (acute exacerbation). Although progress continues in unraveling the mechanisms of IPF, effective therapy has remained elusive. Thus, clinicians and patients need to reach informed decisions regarding management options including lung transplant. The findings in this review were based on a literature search of PubMed using the search terms idiopathic pulmonary fibrosis and usual interstitial pneumonia, limited to human studies in the English language published from January 1, 2000, through December 31, 2013, and supplemented by key references published before the year 2000.     

Disorganizing-fibrosing processes in alveolar walls of interstitial pneumonia, "alveolopneumonitis": a morphopathological study

Disorganizing-fibrosing processes of alveolar walls in 13 autopsied (including 4 previously biopsied) and 3 biopsied cases of acute and chronic interstitial pneumonia were presented. The processes of alveolar walls were characterized initially by histolysis of the alveolar walls and transformation of the tissue into mesh or reticular structure caused by proliferation of fixed cells probably of endothelial cell origin, subsequently by formation of basement membrane-like structures along the proliferated cells, and ultimately by either fibrosis of the entire thickness of the disorganized tissue or axial fibrosis with accumulation of proliferated cells towards axis and peripheral recanalization. These processes tended to occur in the subpleural regions and extend thereafter to the deeper portions of lungs. In some cases recurrent alveolitis which occurred on the basis of axial fibrosis as aforementioned was noted. Problems concerning genesis and nature of these processes were discussed, and a new nomenclature "alveolopneumonitis" was proposed instead of interstitial pneumonia.     

CT检查在尿毒症肺炎诊治中的临床价值

目的评估CT检查对尿毒症肺炎患者临床诊断指导、疗效评估的价值。方法回顾2011年2月-2013年1月64例尿毒症肺炎患者入院和治疗后临床表现、病程转归,对比分析CT影像改变和临床疗效关系。结果64例尿毒症肺炎患者胸部CT表现：出现肺淤血27例,肺间质水肿5l例,肺泡渗出水肿8例,肺间质纤维化15例,各个病程阶段有不同的影像表现;CT检查清楚显示浆膜腔积液和心脏形态改变;临床血液透析、对症治疗后复查CT所见：27例肺淤血、51例肺间质水肿及42例胸腔积液治疗前后对比CT影像改变差异有统计学意义（P〈0．001）;8例肺泡水肿治疗前后肺部影像表现有差异（P〈0．05）;15例肺间质纤维化患者治疗前后肺部CT影像无变化,14例患者伴有心包积液,经过治疗仍有6例积液未吸收,两者差异无统计学意义（P〉0．05）。结论尿毒症肺炎的诊断主要依靠影像诊断,CT的影像表现可对尿毒症肺炎提供临床分期,对治疗方法的选择和疗效评估起重要作用。     

甲型H1N1流感肺炎影像学表现

目的 总结甲型H1N1流感肺炎影像学表现,提高对本病的认识。方法 回顾性分析17例确诊甲型H1N1流感肺炎患者胸部X线片及64层螺旋CT检查系列影像学资料。结果 17例甲型H1N1流感肺炎患者均有1次以上胸部计算机X线摄影术(CR)检查,其中8例接受CT检查。17例胸部X线及CT表现均以斑片或大片实变影合并磨玻璃密度影为主要表现。病变累及单侧肺野者4例,占23.53%;双侧肺野均受累者13例,占76.47%;随访病例均有不同程度的纤维化改变。结论 甲型H1N1流感肺炎X线及CT表现具有一定特征性。肺部病变以多叶段分布渗出性改变为其共有表现,病程后期两肺以纤维化表现为主。     

军团菌肺炎的影像学表现及其诊断价值

目的探讨军团菌性肺炎的影像学表现及其影像诊断价值,提高对本病的认识。方法回顾分析经临床综合诊断35例军团菌性肺炎的临床及系列影像资料,并总结其影像学特征。结果军团菌性肺炎的主要影像学表现为:多形态病变31例;多叶多段病变25例;胸腔积液10例;肺脓肿6例;临床症状与影像学表现不一致21例;影像学改变吸收缓慢(时间大于2周者)30例;伴有纤维索条、网状影或蜂窝影者28例。因此,军团菌性肺炎的征象主要以多形态病变、多叶多段病变以及多伴有纤维索条、网状影或蜂窝影等纤维化为特征;而其动态影像学主要是以影像学改变吸收缓慢和影像学改变与临床症状不一致为特征。结论军团菌性肺炎的影像学表现虽较复杂,但也有一定特征性,结合病史、体征及实验室检查可提示诊断。     

Clinical review: Idiopathic pulmonary fibrosis acute exacerbations - unravelling Ariadne's thread

Idiopathic pulmonary fibrosis (IPF) is a dreadful, chronic, and irreversibly progressive fibrosing disease leading to death in all patients affected, and IPF acute exacerbations constitute the most devastating complication during its clinical course. IPF exacerbations are subacute/acute, clinically significant deteriorations of unidentifiable cause that usually transform the slow and more or less steady disease decline to the unexpected appearance of acute lung injury/acute respiratory distress syndrome (ALI/ARDS) ending in death. The histological picture is that of diffuse alveolar damage (DAD), which is the tissue counterpart of ARDS, upon usual interstitial pneumonia, which is the tissue equivalent of IPF. ALI/ARDS and acute interstitial pneumonia share with IPF exacerbations the tissue damage pattern of DAD. 'Treatment' with high-dose corticosteroids with or without an immunosuppressant proved ineffective and represents the coup de grace for these patients. Provision of excellent supportive care and the search for and treatment of the 'underlying cause' remain the only options. IPF exacerbations require rapid decisions about when and whether to initiate mechanical support. Admission to an intensive care unit (ICU) is a particular clinical and ethical challenge because of the extremely poor outcome. Transplantation in the ICU setting often presents insurmountable difficulties.