SARS的临床与影像学分析

目的 探讨严重急性呼吸综合征(SARS)的临床表现和影像学特征及其关系。方法 回顾性分析46例符合《广东省医院收治非典型肺炎病人工作指引》诊断标准的SARS患者的临床和影像学资料。所有病例均有全胸站立后前位和侧位片；6例行胸部CT扫描。结果 97．8％(45／46)的SARS患者以发热为首发表现，其体征较轻，与影像学改变不符。X线表现：(1)病变分布：两侧肺17例(37．0％)；一侧肺29例(63．0％)，其中右肺14例(14／29)，左肺15例(15／29)。病变局限于1个肺叶者28例(60．9％)，分布于2个肺叶者9例(19．6％)，3个肺叶者4例，4个肺叶者4例，5个肺叶者1例。多肺叶分布中，局限于一侧肺者1例(1／18)，两侧肺分布者17例(17／18)。(2)病灶类型：以肺间质性改变为主，表现为密度不均的斑片状阴影，其内可见增粗和紊乱的肺纹理结构；肺纹理改变型3例(6．5％)；间质型18例(39．1％)；实质型9例(19．6％)，混合型16例(34．8％)。此外还可见肺门模糊1例，少量胸水1例，轻度胸膜反应1例。6例CT扫描，3例急性期表现为磨玻璃样高密度灶或大片状渗出和实变，3例吸收期可见条索状残留灶。结论 SARS的临床与影像学表现有一定的特征，其预后与病变的严重程度相关。

Clinical and imaging analysis of SARS

Objective To investigate the clinical and imaging characteristics of the severe acute respiratory syndrome(SARS), and to study the relationship between imaging and clinical findings. Methods Forty-six patients with SARS verified by imaging and clinical data were reviewed. X-ray examination data were available in all cases and chest CT scanning was acquired in 6 cases. The X-ray and CT findings were analyzed retrospectively. Results Fever was found in 97.8%(45/46) of the patients. The clinical symptoms were mild, but findings on X-ray film and CT were distinct. Pulmonary interstitial infiltration was demonstrated on X-ray films at the onset, and then the lesion could involve the pulmonary parenchyma. (1) Location: bilateral lung involvement was revealed in 17 cases (37.0%), and unilateral involvement in 29 (63.0%). In the unilateral lung involvement group, right lung involvement was found in 14 cases (14/29), and left in 15 (15/29). The lesion was confined within one lobe in 28 cases (60.9%), two lobes in 9 (19.6%), three lobes in 4, four lobes in 4, and five lobes in 1, respectively. In cases with multiple lobe involvement, the lesion was limited to one side of the lung in 1 case (1/18), and bilateral lung involvement in 17 (17/18). (2) Type: change of lung markings in 3 cases (6.5%), interstitial type in 18 (39.1%), consolidation type in 9 (19.6%), and mixed type in 16 (34.8%). Besides, blurred hilum in 1 case, small amount of pleural effusion in 1 case, and mild pleural reaction in 1 case was detected, respectively. CT scanning demonstrated ground-glass hyperdense lesions or large patchy exudation and consolidation at the early stage in 3 cases. The different findings on X-ray and CT were related to the different phase of the disease. After treatment, most lesions were absorbed completely, but the lesions were absorbed slowly for 3 patients with multi-lobe consolidation or/and extensive interstitial infiltration. Conclusion SARS had characteristic clinical and imaging findings. The prognosis of SARS was related to the degree of lesions on X-ray and CT film.