肺挫裂伤的CT诊断(附89例分析)

目的:探讨肺挫裂伤的CT诊断价值。方法:结合病理生理,分析肺挫裂伤的CT征象。结果:肺纹理有改变伴有小斑点状阴影31例(34 8% ) ;出现云雾状及磨玻璃状阴影32例(35 2 % ) ;有大片模糊的较高密度影和肺囊肿影2 6例(2 9 2 % ) ;另外还发现气胸、液(血)气胸、纵隔气肿、皮下气肿及肋骨骨折等。结论:CT检查准确率高,是目前诊断肺挫裂伤的最有效的手段。     

创伤性湿肺的X线与CT诊断

目的 探讨X线摄影、CT在创伤性湿肺诊断中的应用价值及其临床意义。方法 回顾分析21例创伤性湿肺病例的X线、CT影像资料，并加以总结。结果 创伤性湿肺主要表现为肺纹影增强、模糊，占85.71%；肺内斑片影，占71.43%；面纱征或／和毛玻璃征，占23.81%；肺血肿影，占14.29%及其他如肋骨骨折、胸腔积液、膈肌破裂等影像表现。结论 X线摄影、CT检查目前仍是诊断创伤性湿肺的主要手段。     

白血病患者骨髓移植术后肺部并发症的CT诊断

目的探讨白血病患者骨髓移植术后肺部并发症的CT诊断。方法对30例白血病患者骨髓移植术后肺部并发症的CT表现进行回顾性分析。结果巨细胞病毒性肺炎可以表现为弥漫性实变、多发结节、毛玻璃改变、多发小片状影,以弥漫性实变为最多见(37.5%,3/8);真菌性肺炎主要表现为单发球形病灶(50.0%,4/8),其中3例病灶周围可见毛玻璃密度影;细菌性肺炎主要表现为单发片状影(50%,1/2);急性呼吸窘迫综合征(ARDS)主要表现为弥漫性实变(66.7%,2/3);肺水肿主要表现为支气管血管束增粗或网格状改变(66.7%,2/3);药物毒性反应可表现为弥漫性实变(50.0%,1/2)或网格状改变(50.0%,1/2);细支气管闭塞并机化性肺炎气管炎(BOOP)表现为多发结节状改变(50.0%,1/2)或毛玻璃密度改变(50.0%,1/2)。移植后3周内发生率最高的为真菌感染,移植后3~14周发生率最高的为巨细胞病毒性肺炎,移植后14周以后病例较少,主要为BOOP。结论综合分析CT表现对血病患者骨髓移植术后肺部并发症的诊断有较高价值。     

SARS胸部表现和并发症的CT研究

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。     

严重急性呼吸综合征的X线诊断价值(附30例报告)

目的探讨X线检查对严重急性呼吸综合征的诊断价值。资料与方法对30例已确诊为严重急性呼吸综合征患者的X线影像及临床资料进行总结分析。结果胸部X线表现为：肺纹理增多18例(60％)，增粗10例(33．3％)；肺纹理增多伴网状阴影7例(23．3％)，磨玻璃状阴影3例(10％)，斑片状阴影12例(40％)，片状阴影7例(23．3％)。X线改变出现较晚、吸收慢，与肺部体征相对较轻不相符。结论严重急性呼吸综合征X线表现各异。结合流行病学史、临床表现及实验室检查可明确诊断。     

Transient subpleural curvilinear shadow caused by pulmonary congestion

We present two cases of transient subpleural curvilinear shadows (SCSs) on CT caused by pulmonary congestion. Subpleural curvilinear shadows, which are usually visible in the middle or lower dorsal lung field on CT, have been reported as the initial finding of pulmonary fibrosis. But SCS is not a specific finding since pulmonary congestion may be one cause of it.     

肺动静脉瘘

先天性肺动静脉瘘比较少见，本文８例，均经手术证实。男５例，女３例。左肺３例，右肺４例，两侧同时发病１例，８例共９个病灶。Ｘ线表现主要为分叶状，粗大索条状，病灶与肺门之间可见带状阴影相连。本文还对肺动静脉瘘的病理类型、临床症状及Ｘ线表现进行了讨论。     

溺水致肺损伤的CT表现(附10例报告)

目的探讨淹溺性肺损伤的CT表现。方法对我院于2008年至2011年收治的10例淹溺性肺损伤患者的CT资料进行回顾性分析。所有患者均在离水后1～8 h内接受了首次CT检查。结果在CT像上,4例表现为两肺野肺纹理增粗、增多,广泛分布腺泡结节影与斑片状影;6例表现为两肺野磨玻璃样影,呈对称或不对称分布的片絮状,病变多分布在肺门周围;2例伴有不同程度的肺气肿和肺段肺不张;4例伴有少量胸腔积液。结论 CT检查能清晰显示溺水后的急性肺损伤,并为临床诊治提供重要信息。     

Radiation pneumonitis resembling bronchiolitis obliterans organizing pneumonia after postoperative irradiation for lung cancer: a case report

We report a case of BOOP-type pneumonitis after postoperative irradiation for lung cancer. A 60-year-old woman with adenocarcinoma in the right lung underwent lobectomy followed by radiotherapy of 50.4 Gy. After a shadow of typical radiation pneumonitis was resolved in the irradiated site, two relapses, in which migratory infiltrative shadows appeared outside the radiation field, occurred at 6 and 12 months after the completion of radiotherapy. These shadows disappeared spontaneously at 10 and 18 months after the completion of radiotherapy. The radiological findings and clinical course suggested that BOOP-type pneumonitis was the most likely diagnosis for these lesions. This type of lung damage after radiotherapy of the thoracic region should be identified and properly treated.     

艾滋病合并肺部真菌感染的CT表现

目的:探讨艾滋病合并肺部真菌感染的CT表现特点。方法:回顾性分析14例艾滋病合并真菌感染患者的胸部CT扫描资料。结果:病变主要位于肺外周、胸膜下或沿支气管分布,双肺散在或弥漫分布6例,局限性病灶8例,其中病灶位于肺下叶和/或中叶(舌叶)7例,右上叶4例,左上叶(除舌叶)1例。病灶呈大小不等结节影6例,单发类圆形肿块影2例,以空洞为主的病灶4例,小片状或大片状融合实变影5例,网结状影2例;纵隔及肺门淋巴结肿大3例,少量胸腔积液1例,高分辨力CT扫描显示树芽征3例。结论:艾滋病合并肺部真菌感染CT表现各异,主要表现为肺叶外周单发或散在分布大小不等结节伴或不伴空洞影、小片状或大片状实变影、网结状影及"树芽征",艾滋病患者CT扫描一旦出现此类征象,应高度警惕伴有真菌感染的可能。     

A computer system for image feature analysis of chest radiographs in CT-documented interstitial lung diseases]

This paper reports the clinical significance of a computer-analyzing system to detect and characterize interstitial lung diseases in chest radiographs. One hundred and sixty-four ROIs were selected in the right lungs of 41 patients with normal and those of 41 with diffuse interstitial involvement proved by X-ray CT. Selected ROIs were processed by 4-directional Laplacian-Gaussian filtering, binarization, and determination of linear shadows. For quantitative analysis of interstitial shadows, radiographic index, normalized percent-area of shadows in a ROI, was determined and evaluated in the images. Then, the radiographic indices were compared with CT-documented characteristics of interstitial lung shadows. The results were as follows: 1) Abnormal and normal lungs were well differentiated each other by all kinds of the radiographic indices obtained from the images filtered by 4-directional Laplacian-Gaussian filters and from those processed by determination of linear shadows. 2) ROIs with honeycombing shadows and with other interstitial shadows (interstitial changes other than honeycombing and nodulation) shown in CT were differentiated each other by the radiographic indices obtained from the summation image and the vertical directional image processed by determination of linear shadows (p less than .01). However, ROIs with multiple nodular shadows and with other interstitial shadows were not classified by these radiographic indices. These results indicate that this system may be useful for detection and characterization of interstitial diseases in chest radiographs.     

Thin-walled ring shadows in early pulmonary sarcoidosis

The appearance of ring shadows on the chest radiograph of patients with sarcoidosis is usually associated with generalised, irreversible pulmonary fibrosis. We report three patients in whom thin-walled ring shadows appeared early in the disease. These ring shadows occurred in areas of pre-existing lung shadowing and in two patients they disappeared with corticosteroid therapy over a period of 1-2 years. We postulate that these early sarcoid ring shadows may be caused by a combination of central necrosis of areas of coalescent granulomas and a check-valve mechanism beyond partial obstruction of airways by endobronchial sarcoidosis.     

严重急性呼吸综合征的胸部X线表现

目的探讨严重急性呼吸综合征的胸部X线表现。资料与方法对经确诊的53例严重急性呼吸综合征的X线表现进行回顾性分析。结果严重急性呼吸综合征的胸部X线表现为两肺大片状或小片状密度增高阴影(27例)；磨玻璃样影(22例)；1侧肺叶或肺段的小片状或斑片状影(19例)；表现肺段内结节影(3例)以及两肺间质改变，肺纹理增粗，呈网格状及不规则线状影(4例)。结论严重急性呼吸综合征的胸部X线表现多种多样。如两肺片状影，磨玻璃状影，呈游走性，以及肺纹理增粗、增多，呈网状改变。结合临床表现发热、咳嗽、白细胞降低或正常等，应考虑严重急性呼吸综合征的可能。     

早产婴肺的X线诊断

目的：研究早产婴肺的X线表现,提高其诊断及鉴别诊断能力。材料和方法：回顾性分析10例临床证实的早产婴肺的X线表现。结果：早产婴肺10例中,早产婴肺并发吸入性肺炎1例和早产婴肺并发肺透明膜病2例。早产婴肺的X线表现为：肺野透光度减低、肺野内弥漫性颗粒状影和下肺野淡片状影伴肺门区索条状影,但无支气管充气征。结论：X线平片结合临床可诊断早产婴肺。     

支原体肺炎临床X线分析

目的 分析支原体肺炎的临床与X线表现，以便提高对本病的诊断与治疗水平。方法 对100例临床上诊断的支原体肺炎之X线表现进行了回顾性分析。结果 在X线胸片上支原体肺炎为各种各样的表现且缺乏特征性。常见的表现有如下3种类型：a)肺泡实质浸润型，病变常局限于1个或2个肺段，表现为云絮状或片状阴影，肺纹理增重，沿增重的肺纹理出现不规则的点片状阴影；b)肺间质浸润型，病变区肺纹理增重，伴有网状阴影；c)合并胸膜炎。通常，肺部X线表现较重而临床表现较轻可看作是本病的一个特点。结论 支原体肺炎的X线表现没有特征性，与细菌性肺炎不易区分。临床上、血清冷凝集试验阳性，血清特异性IgM抗体反应阳性，以及大环内酯类抗生素如红霉素治疗具有显著疗效有助于本病的确诊。     

肺错构瘤的CT表现及其与其他疾病的鉴别

目的分析肺错构瘤的MSCT表现及其与其他疾病的鉴别。方法对26例行MSCT检查并经手术和病理证实的肺错构瘤进行回顾性分析。结果本组26例均为单发肺错构瘤,其中22例为周围型,位于右肺12例,位于左肺10例;4例为腔内型,其中,1例位于气管中段腔内,1例位于左主支气管内,2例位于左肺下叶支气管内。病灶呈圆形或椭圆形,边缘锐利,9例显示有浅分叶,但均无毛刺。本组22例周围型错构瘤中,3例病灶内含有脂肪密度影;9例病灶内含有钙化影,其中3例为典型的爆米花样钙化;10例病灶呈均匀软组织密度影。4例腔内型错构瘤中,3例病灶内含有脂肪成分,1例含有钙化影。本病主要需于肺炎性假瘤、小叶癌、结核瘤相鉴别。结论肺错构瘤的MSCT表现有一定特征,病灶边缘清楚,内含有脂肪和钙化有助于正确诊断。     

相邻两年内尘肺病X线胸片对比分析

本文对接尘二年以上的３４９名工人，相邻两年内的两次Ｘ线胸片６９８张，进行了对比分析，两次Ｘ线表现比较肺纹理增多好转２３５人，占６７．３％；肺内网状阴影好转２４８人，占７１．１％；类圆形小阴影好转１５３人，占４３．８％；不规则形小阴影好转５３人，占１５．８％。作者认为Ｘ线胸片的改变可能是由于肺部感染所致。     

肾移植术后肺巨细胞病毒感染的影像学表现

目的:探讨肾移植术后肺巨细胞病毒感染的CT特点。方法:回顾性分析24例经临床及实验室检查证实的巨细胞病毒感染(CMV)的CT特征。结果:本组24例巨细胞病毒感染患者中有2例CT表现未见明显异常,其余22例均有毛玻璃样阴影改变,其中呈两肺多发、散在分布7例,呈两肺弥漫性分布15例。仅表现为毛玻璃影者4例,伴有小叶间隔增厚10例,伴有实变影者7例,伴有多发小结节影者8例,伴有少量胸腔积液者4例。结论:肾移植术后肺巨细胞病毒感染最常见CT表现为双肺弥漫性分布的毛玻璃样阴影,且常伴有小叶间隔增厚、小结节影、实变影等表现。     

前庭导水管扩大畸形的CT诊断

目的评价横轴位高分辨率CT扫描对前庭导水管扩大畸形的诊断价值。方法分析16例前庭导水管畸形横轴位耳部扫描的高分辨率CT图像并与50例正常人进行对比分析。结果正常人前庭导水管表现为岩骨后缘小而浅的模糊骨切迹或者与后半规管平行的略低小细管状影。前庭导水管扩大大多表现为岩骨后缘深大三角形骨缺损影,少数为深长裂隙影,岩骨后缘骨缺损影边缘均清晰锐利,其内侧缘绝大部分与总脚或前庭直接相通,前庭导水管中段最大前后径大于1.5mm。结论CT轴位扫描对前庭导水管扩大畸形的诊断有重要价值。     

Cystic fibrosis: scoring system with thin-section CT

The progression of lung disease in patients with cystic fibrosis (CF) was evaluated with chest radiography. The severity and extent of the various radiographic changes were scored with the Chrispin or the Birmingham method, which involves the use of imprecise and subjective terms, such as line shadows, large pulmonary shadows, and nodular cystic lesions. Although computed tomography (CT) has been shown to be helpful in the evaluation of lung disease in CF, no scoring system or other objective criteria have been developed for the evaluation of the wide range of pulmonary changes in these patients. A CT scoring system was devised that incorporates all of the changes seen in the lungs of patients with CF. Such a scoring system may facilitate objective evaluation of existing and newly developed therapeutic regimens and may be a valuable tool in the preoperative evaluation of patients being considered for lobectomy or bullectomy and in the selection of patients for lung transplantation.