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SARS胸部表现和并发症的CT研究
引用本文:张雪哲,王武,卢延,黄振国,洪闻,尚燕宁,任安. SARS胸部表现和并发症的CT研究[J]. 中华放射学杂志, 2003, 37(9): 775-779
作者姓名:张雪哲  王武  卢延  黄振国  洪闻  尚燕宁  任安
作者单位:100029,北京,中日友好医院放射科
摘    要:
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。

关 键 词:并发症 SARS 胸部 CT扫描 肺部表现 胸膜 局灶性 模糊 大小 提示
修稿时间:2003-06-17

CT investigation of chest findings and complications in SARS
ZHANG Xue-zhe,WANG Wu,LU Yan,HUANG Zhen-guo,HONG Wen,SHANG Yan-ning,REN An. CT investigation of chest findings and complications in SARS[J]. Chinese Journal of Radiology, 2003, 37(9): 775-779
Authors:ZHANG Xue-zhe  WANG Wu  LU Yan  HUANG Zhen-guo  HONG Wen  SHANG Yan-ning  REN An
Affiliation:ZHANG Xue-zhe,WANG Wu,LU Yan,HUANG Zhen-guo,HONG Wen,SHANG Yan-ning,REN An Department of Radiology,China-Japan Friendship Hospital,Beijing 100029,China
Abstract:
Objective To investigate the role of CT scanning in the diagnosis of severe acute respiratory syndrome (SARS) Methods One hundred and twelve spiral CT scanning examinations were performed in 82 cases of SARS, which included 106 chest, 5 brain, and 1 abdomen CT examination CT films were acquired with standard pulmonary and mediastinal window Results Of the 82 patient, pulmonary shadows involved bilateral lung field in 66 cases (80 49%) and unilateral lung field in 16 (19 51%) The shadows involved 4 to 6 lung fields in 54 cases (66 85%) and the low lung field in 63 (76 83%) The lung CT findings included sub-pleural focal consolidation in 26 cases (31 71%), patchy clouding opacity in 53 (64 63%), large consolidation in 9 (10 98%), ground-glass blurring shadow in 31 (37 80%), small nodules opacity shadow filling in the alveolar cavities in 14 (17 07%), and interstitial changes in 16 (19 51%) There were some specific signs of SARS: (1)The lesions tended to be multiple or bilaterally distributed, and bilateral lower lung field involvement was commonly seen (2)Imaging findings in lung included sub-pleural focal consolidation shadows, patchy clouding opacity, large consolidation shadows, and ground-glass blurring shadows There was air bronchogram in the shadows (3)Opacity small nodule shadows filling in the alveolar cavities (4)Dynamic follow-up observation on the chest X-ray films and CT films could reveal the rapid progression on the size, amount, and distribution of the lesions (ie, marked dynamic changes within 24 to 48 hours) These findings may suggest the pulmonary changes induced by SARS-CoV The complications were observed in 6 cases (7 32%) including tuberculosis of the lung and brain, and pneumomediastinum in one case, secondary infection of the lung in 2 cases, pneumotho rax in 1 case, pulmonary fungus in 1 case, and empyema of pleura in 1 case Conclusion CT examination is a sensitive method for SARS CT scanning can provide more accurate assessment of the abnormal changes of the lungs and detect the complications of SARS
Keywords:Severe acute respiratory syndrome  Tomography  X-ray computed  Pneumonia  Iatrogenic disease
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