肺梗塞的诊断与鉴别再研究

目的　提高肺梗塞的诊断与鉴别能力。方法　 2 0例临床症状及病变过程证实为肺梗塞的患者 ,其主要症状有突发胸闷、气短、呼吸困难 ,剧烈胸痛 ,咳血 ,低热等。患者均拍 1次以上正侧位胸片 ,14例行胸部CT扫描。 4例行SPECT检查 ,9例做心脏超声心动图。结果　发生于上叶的梗塞灶 3例 ,中叶 5例 ,下叶 12例 ,其中 6例为多叶分布。肺门截断征 2例 ,肺段肺叶锥形实变 13例 ,斑片状阴影 7例 ,胸水 15例 ,局限性胸膜肥厚 14例 ,急性肺源性心脏病 2例 ,膈肌升高 15例 ,盘状肺不张 5例。结论　影像学表现密切结合临床 ,肺梗塞多能及时做出诊断。

A Further Study of Diagnosis and Differential Diagnosis of Pulmonary Infarction

Objective To improve the ability in the diagnosis and differential diagnosis of pulmonary infarction.Methods 20 cases of pulmonary infarction,proved by clinical course and symptoms(such as:acute onset of chest distress,shortness of breath and dyspnea,drastic chest pain,hemoptysis and low fever,etc),all had frontal and lateral X-ray films taken more than once;among them 14 cases had chest CT scans;4 cases had SPECT studies,and 9 cases had echocardiograms.Results 3 cases had pulmonary infarction in the upper lobe;5 cases in the middle lobe;and 12 cases in the lower lobe.Among them,6 cases were of multi-lobar distribution.2 cases had radiological signs of hilar amputation;13 cases showed conicalshaped consolidation of lung segments or lobes;7 cases had mottling shadows;15 cases had pleural effusion;14 cases had localized pleural thickening;2 cases were with cor pulmonale of acute onset;elevation of hemidiaphram was shown in 15 cases,and disciform atelectasis was seen in 5.Conclusion Diagnosis of pulmonary infarction can be made in time and accurately,provided radiological signs are to be dealt with in the light of clinical features.