肺密度三维定量分析对急性肺栓塞的诊断价值

【摘要】目的:探讨肺密度三维定量分析对急性肺栓塞的诊断价值。方法:回顾性收集行CT肺动脉造影（CTPA）检查者,证实为肺栓塞者195例,非肺栓塞者177例,两位影像科医生对CTPA进行阅读,记录栓子位置以及间接征象。结果:肺栓塞患者最常见的临床症状气促、咳嗽、胸痛分别占41%、39%、34%。53%的肺栓塞患者具有明确的危险因素。共发现412个栓子,间接征象在急性肺栓塞和非肺栓塞患者中出现率具有显著性差异（P<0.05）,包括:马赛克征（20.3％ vs 0％）、磨玻璃影（23.1% vs 9.4%）、肺实变（46.7% vs 18.8%）、肺不张（17.2% vs 2.8%）、胸腔积液（34.9% vs 23.3%）、胸膜肥厚粘连（77.8% vs 25.1%）。肺密度分析发现的肺野局限性低密度区在栓塞组和非栓塞组具有差别（47.2% vs 13.9%, P<0.05）。且局限性密度减低区与栓子位置的符合率为89.2%。结论:基于肺密度三维定量分析获得的局限性肺密度改变,结合肺栓塞患者的临床信息与CTPA其他间接征象对急性非栓塞诊断具有提示作用。     

肺栓塞合并胸腔积液36例分析

目的提高对肺栓塞的认识，减少其误诊率。方法回顾性分析36例肺栓塞合并胸腔积液病例。结果94例肺栓塞中合并胸腔积液36例，占38％，其中少量积液30例，中等量积液4例，大量积液2例。双侧积液21例，右侧积液9例，左侧积液6例，心包积液4例。6例中、大量积液胸水检查，均为渗出性，其中4例为血性（2例为肺癌）。36例中D-二聚体升高35例；螺旋CT36例均有肺动脉栓塞改变，其中2例合并肺不张．4例合并心包积液。15例作肺通气灌注扫描均有阳性表现。结论肺栓塞是胸腔积液的常见病因之一，临床遇到不明原因的胸腔积液特别是血性积液，要考虑肺栓塞的可能，及时筛查D-二聚体，阳性者高度怀疑肺栓塞．再行肺通气灌注扫描、螺旋CT等检查进一步明确诊断。     

应用螺旋CT确诊肺栓塞临床体会

随着先进医疗设备的不断更新及发展,对进一步明确诊断疑难杂病,减少误诊,漏诊率起到极大作用,统计我院近2年应用64排螺旋CT诊断肺栓塞疾病24例进回顾性分析发现,临床表现多样化,CT表现多样化直接征象,可见病变部位不同程度的充盈缺损.表现为血管腕的完全性阻塞,中心行阻塞,偏心性阻塞和附壁血栓,依据肺栓塞的CT表现还可推断血栓形成的时间,间接征象可见肺动脉高压,中心动脉扩张,肺血管稀疏,外周血管纤维呈"残根征",体肺侧支循环建立.梗死灶形成,胸腔积液等.体会肺栓塞是常见病,是多样性,复杂性,对比其他检查方法,应用肺部CT肺血管造影具有无创安全,快速,敏感性高,可作为确诊肺血栓的首选检测手段.     

CT肺动脉成像对不同类型急性肺栓塞患者胸部继发性改变的评估

目的研究急性肺栓塞不同类型患者的临床因素及胸部继发性改变的CT肺动脉成像特征。方法选择84例急性肺栓塞患者,其中男性46例,女性38例;年龄23～79岁,平均年龄43.25岁。按照疾病不同类型分型,观察不同类型患者的临床因素,并分析其胸部继发性改变的CT肺动脉成像特征。结果 CT肺动脉成像结果显示,周围型49例,中央型35例。两型患者体质量指数、吸烟史、临床症状、风险因素、治疗方式、临床不良事件及住院病死率比较,差异无统计学意义(P 0.05);但危险分层比较,差异有统计学意义(P 0.05)。危险分层中,周围型低危高于中央型(81.63%vs45.71%),但中危、高危明显低于中央型(16.33%vs 42.86%,2.04%vs 11.43%)(P 0.05)。治疗方式中,周围型溶栓低于中央型(0.00%vs 8.57%),差异有显著统计学意义(P 0.01);而周围型抗凝95.92%,下腔静脉滤器置入6.12%,与中央型(94.29%、11.43%)相比,差异无统计学意义(P 0.05)。两型患者右心增大、肺动脉干变粗、马赛克征、肺梗死比较,差异有统计学意义(χ2=44.746、35.432、8.785、10.876,P 0.05);但心包积液、Westermark征、胸腔积液及肺不张比较,差异无统计学意义(P 0.05)。结论不同类型的急性肺栓塞患者的危险程度具有一定差异,其中中央型危险性较高,胸部继发性改变较大,应受到临床重点关注,积极确定疾病类型可为治疗及预后提供保障。     

ADAM8、ADAM9对肺腺癌及其胸膜转移的诊断价值

目的探讨ADAM8、ADAM9在肺腺癌组织及肺腺癌胸膜转移患者胸腔积液中的表达,并对其相关性进行探索。对单独及联合检测ADAM8、ADAM9对肺腺癌胸膜转移的诊断价值进行比较。方法应用IHC法检测ADAM8、ADAM9在肺腺癌、肺结核及正常肺组织中的表达,并分别对其在各组标本中的阳性表达率进行比较。绘制散点图,分析ADAM8与ADAM9表达的相关性;应用ELISA试剂盒分别检测ADAM8、ADAM9在肺腺癌组织及结核性胸膜炎患者胸腔积液中的表达水平;应用ROC曲线评价各指标对肺腺癌胸膜转移患者的诊断效能。结果与正常对照组及肺结核组相比,ADAM8、ADAM9蛋白在肺腺癌组组织表达水平显著升高(P0.05);与肺结核组相比,ADAM8、ADAM9蛋白在肺腺癌胸膜转移患者胸腔积液的表达水平显著高升(P0.05)。散点图结果提示ADAM8、ADAM9的表达水平呈正相关,Pearson相关系数r=0.699。ROC曲线评价结果显示,系列联合检测胸腔积液中ADAM8、ADAM9,可将诊断特异度提高到95%;平行联合检测胸腔积液中ADAM8、ADAM9,可将诊断灵敏度提高到90%。结论 ADAM8、ADAM9在肺腺癌组织及肺腺癌胸膜转移胸腔积液中高表达,两指标联合检测对肺腺癌胸膜转移具有更高的临床诊断价值。     

经外周静脉置入中心静脉导管术泵钙过程中导管堵塞一例原因分析

患者男,70岁,体重45kg,因间断喘憋、咳嗽、咳痰40年,加重14d,于2010年10月7日收入院。入院后患者一般情况差,慢性病容,胸片示：肺纹理增粗,可见斑片状影,胸膜增厚,胸腔积液,右心室向右偏移。既往患者40年前出现咳嗽、咳痰、喘憋,每年发作3个月左右。明确诊断：（1）慢性阻塞性肺疾病;（2）肺结     

D-二聚体检测对急性缺血性脑卒中的临床价值

目的 探讨D-二聚体在急性缺血性脑卒中（AIS）的变化及诊断价值.方法 检测78名对照组健康人和173例AIS组患者血浆D-二聚体含量.结果 AIS组血浆D-二聚体含量明显高于对照组（P＜0.05）;与对照组相比,小面积梗死组、中等面积梗死组和大面积梗死组血浆D-二聚体含量明显升高（P＜0.05）;且D-二聚体含量与脑梗死灶面积呈正相关（r =0.926,P＜0.05）.结论 AIS患者血浆D-二聚体含量明显升高,且随梗死面积的增大呈上升趋势.血浆D-二聚体对AIS的辅助诊断具有重要意义.     

CT影像征象对非小细胞肺癌胸膜浸润的影响分析

目的:基于CT影像征象探究非小细胞肺癌胸膜浸润的影响因素.方法:回顾性分析 2021 年1 月至 2023 年5 月于我院就诊的 78 例非小细胞肺癌患者临床资料,其中发生脏层胸膜浸润者(n=40)为浸润组,未发生脏层胸膜浸润者(n=38)为无浸润组.采用多因素Logistic回归分析非小细胞肺癌胸膜浸润的影响因素.结果:两组患者的肿瘤部位、病理类型、分化程度情况均无明显差异(P＞0.05),肿瘤直径、N分期、M分期差异具有统计学意义(P＜0.05).两组患者CT影像空泡/空洞征、支气管充气征、分叶征、毛刺征、血管集束征、及胸腔积液等征象均无明显差异(P＞0.05),胸膜凹陷征、病灶紧贴胸壁情况差异具有统计学意义(P＜0.05).回归分析显示,肿瘤直径、N分期、M分期、胸膜凹陷征及病灶紧贴胸壁是NSCLC胸膜浸润的特征指标(P＜0.05).结论:部分CT征象与NSCLC胸膜转移具有相关性,肿瘤直径、N分期、M分期、胸膜凹陷征、病灶紧贴胸壁均为NSCLC患者胸膜浸润的特征指标.     

肺栓塞肺动脉能谱CT胸部扫描影像学特征及其诊断价值

目的：探讨肺栓塞（PE）肺动脉能谱CT胸部扫描影像学特征及其诊断价值。方法：回顾性分析53例高度疑似PE患者,获取单能量能谱CT肺动脉造影（CTPA）图像和碘基肺灌注图,记录CTPA图像和碘基肺灌注图检出的肺动脉栓子数目及其分布、分型情况;分析肺动脉能谱CT胸部扫描影像学特征;比较不同栓塞程度及类型能谱CT扫描碘基值;比较栓塞区与对照区能谱CT扫描碘基值、水基值和CT值等能谱CT扫描参数。结果：以CTPA为金标准,53例高度疑似PE的患者中确诊32例。能谱CTPA检出162个栓子,完全型栓子37个,非完全型栓子125个;碘基肺灌注图检出171个栓子,完全型栓子49个,非完全型栓子122个。中心型、偏心型和完全型栓子栓塞区能谱CT扫描碘基值均明显低于对照区（P<0.05）;附壁型栓子栓塞区能谱CT扫描碘基值与对照组无显著差异（P>0.05）;完全型栓塞区碘基值显著低于中心型、偏心型和附壁型等非完全型栓塞区（P<0.05）。结论：PE肺动脉能谱CT胸部扫描影像学特征主要表现为肺动脉内充盈缺损、肺动脉扩张、肺动脉高压、马赛克征、轨道征等征象,肺动脉能谱CT胸部扫描碘基肺灌注...     

早期周围型肺癌CT征象及追踪观察

目的 分析周围型肺癌不同时期的CT征象.方法 搜集有CT随访资料的早期周围型肺癌16例,总结其早期征象.结果 其早期征象以肺内孤立结节状病灶为主,平均直径1.5cm,CT值20～30Hu,进展期以圆或椭圆形肿块为主,平均直径4.2cm,CT值为30～45Hu,瘤体内部结构;空泡征多见于早期,空洞征进展期出现率高,瘤体边缘征象;毛刺、分叶及胸膜凹陷征象,进展期亦比早期多见.结论 肺内孤立结节,直径≤1.5cm,周边有毛刺、分叶及胸膜凹陷征,灶内有空泡征,应提示早期肺癌,且以腺癌可能性大.     

螺旋CT血管造影对肺动脉栓塞的诊断价值

目的 评价螺旋CT血管造影（SCTA）对肺动脉栓塞（PE）的诊断价值。方法 对临床疑诊PE的20例患者进行螺旋CT血管造影成像（SCTA）．结果 20例患者中确诊PE7例。7例PESCTA直接征象：肺动脉主干或分支内混合性、附壁性、中心性充盈缺损。间接征象：局限性肺纹理稀疏，肺动脉高压，右心室增大，胸腔积液等。结论 螺旋CT血管造影具有准确、快速、无创性的优点，对肺动脉栓塞的诊断具有广泛应用价值。     

Pulmonary tumor embolism to alveolar septal capillaries. A prospective study of 12 cases

Pulmonary tumor embolism leading to subacute cor pulmonale has been extensively studied. However, to our knowledge, the involvement of pulmonary alveolar capillaries has not previously been studied in detail. A prospective study was conducted on 112 autopsied patients with cancer to determine the presence of microembolism in the alveolar septal capillaries. Fifteen sections of predetermined lung areas were obtained and examined. Tumor embolism to alveolar septal capillaries was detected in 12 cases (10.7%), with simultaneous involvement of other vascular territories in 11. Seven patients had dyspnea; four, right ventricular failure; four, hypertrophy of the right ventricle; and three, arterial vascular sclerosis. The present data have led us to conclude that pulmonary tumor embolism to alveolar septal capillaries occurs in association with the involvement of arterial or lymphatic vessels and should be analyzed within the context of the study of subacute cor pulmonale.     

亚段及单一段肺栓塞临床特点分析

目的 探讨亚段及单一段肺栓塞的临床特征、高危因素、治疗及预后。方法 分析我院收治的60例累及亚段及单一段肺栓塞患者的危险因素、临床表现、动脉血气分析、D-二聚体、栓塞部位,比较单一段及亚段肺栓塞的临床特征及预后。结果 60例患者中累及单一段36例,累及亚段24例。累及亚段或单一段的肺栓塞患者临床表现不典型,主要包括呼吸困难、心绞痛样胸痛、心悸、胸膜炎样胸痛、咳嗽,其中8.33%无临床症状。单一段组呼吸困难发生率为80.56%,高于亚段组的45.83%（P＜0.05）。栓塞部位累及右肺多见。60例患者中合并高血压病（48.33%）,糖尿病（18.33%）,COPD（6.67%）,脑卒中（10.00%）,肿瘤（8.33%）,心衰（11.67%）,房颤（13.33%）,高脂血症（38.33%）,冠心病（23.33%）,感染性疾病（3.33%）,手术、外伤、骨折（11.67%）,下肢静脉曲张（5.00%）,合并DVT（16.67%）。单一段组肺泡动脉氧分压差、D-二聚体阳性率均高于亚段组（P＜0.05）。结论 累及亚段或单一段的肺栓塞临床表现多样,血浆D-二聚体敏感性不高,抗凝治疗总体预后良好。     

经胸超声心动图在肺动脉栓塞诊断中的应用价值

目的:探讨经胸超声心动图(TTE)对肺动脉栓塞(PE)的诊断价值.方法:回顾性分析21例经 CT肺动脉造影检查确诊为 PE患者的经胸超声心动图表现.结果:本组21例,经胸超声心动图大致正常者6例;直接检出主肺动脉及左、右肺动脉近段血栓8例;间接征象提示右心负荷过重15例(包括8例直接检出血栓者),均有右心扩大的表现,其中右室内径(30.7±5.4)mm,右房内径(59.4±6.6)mm.彩色多普勒观察到三尖瓣返流16例,检测其返流速度估测出肺动脉收缩压增高15例,收缩压均高于40 mmHg.结论:经胸超声心动图对中央型肺栓塞具有较高的诊断价值,它可以显示血栓发生的部位.对周围型(肺段及远端分支)肺栓塞虽然不能直接做出诊断,但根据右心扩大、三尖瓣返流及肺动脉高压等间接征象,可为肺动脉栓塞的诊断提供佐证,为临床诊断提供帮助.     

Echocardiographic analysis of changes in the heart in patients with systemic lupus erythematosus

Fifty-six patients, 49 females and 7 males, with the confirmed diagnosis of systemic lupus erythematosus were examined by M-mode, 2--D and Doppler echocardiography. Pericardial effusion was found in 15 patients (27%), while pericardial thickening was suspected in 6 additional patients (37.5% altogether). Two patients had the signs of a pericardial tamponade, but both of them were uraemic. Libman-Sacks endocarditis was suspected in 4 patients (7.5%) because of verrucous changes in the aortic or mitral valve and regurgitant jet. Slight to moderate left ventricular hypocontractility was present in 3 patients (5%), while 3 additional patients had borderline values of the left ventricular contractility parameters. Left ventricular hypertrophy, usually mild, was found in 21 patients (37.5%). Echocardiographic signs of pulmonary hypertension were present in 2 patients (3.6%). It has been concluded that pericardial affection is frequent during the course of systemic lupus erystematosus, while a diffuse myocardial involvement is rare, except the consequences of arterial hypertension and accelerated coronary atherosclerosis. Libman-Sacks endocarditis still represents a diagnostic problem. For a more precise definition of cardiac involvement in systemic lupus erythematosus, a comparative analysis of the disease activity and immunosuppressive therapy is needed.     

Leiomyosarcoma of pulmonary truncus

Insidious and progressive right heart failure of obscure origin warrants differential diagnosis of primary sarcoma of the pulmonary artery in patients of both sexes and 20 years of age and older. We report a case of primary leiomyosarcoma of the pulmonary truncus in a 67 years old woman. She had been well in general until when she started having fluctuating and progressive right heart failure three years ago. Clinical data included systolic murmurs in the pulmonary valve area, right ventricular hypertrophy, diminished x-ray density of the pulmonary vasculature, moderate elevation of serum LDH, alkaline phosphatase, and uric acid, and prolonged or unobtainable circulation time from the arm to lungs. The immediate cause of death was attributable to right heart failure due to pulmonary arterial stenosis caused by a locally invasive leiomyosarcoma apparently arising in the pulmonary truncus. Contributing to this right heart failure were 280 ml of serosanguinous pericardial effusion and fibrinous pericarditis. Acta pathol. jpn. 34: 863～867, 1984.     

Hemodynamically unstable pericardial effusion in the Intensive Cardiac Unit: prospective study

The authors have conducted a prospective investigation on 15 patients with hemodynamically unstable pericardial effusion (main criteria: echocardiographic signs of various degrees of right ventricular diastolic collapse and clinical instability) hospitalized in the Intensive Cardiac Unit (1.97% of all patients) for one year and have compared the results with literature data. The causes of pericardial effusion were neoplasms, infections, rupture of heart of aorta and hypothyroidism. Investigation revealed the most frequent findings: symptoms (dyspnea, retrosternal pain, loading intolerance, nonproductive cough), clinical signs (soft heart sounds, changes in pulmonal findings, fever, jugular venous distention, tachycardia, arterial hypotension and hepatomegaly), laboratory changes (elevated erythrocyte sedimentation rate, leukocytosis), ECG changes (ST-T abnormality, microvoltage, tachycardia) and chest X-rays changes (enlarged cardiac silhouette, pleural effusion). Echocardiography found an average width of pericardial effusion of 2.5 cm (+/- 1.2), frequently thickened pericardium and changes in heart motions. The most used drugs in therapy were indomethacin, antibiotics, analgesics and corticosteroids. In three patients pericardiocentesis, and in two pericardiectomy were performed. Two patients died, 13 patients were discharged from the ICU with an improved health condition. Literature data on this condition are either lacking, or differ from the above findings.