肺隔离症临床 影像 病理特征43例分析

目的探讨肺隔离症患者的临床特点、影像、病理特征及治疗,减少误诊。方法回顾性分析2008年2月至2014年6月浙江大学医学院附属第一医院诊断明确的43例肺隔离症患者的临床影像及病理资料。结果 43例患者中男27例,女16例。平均年龄(38±14)岁。主要临床表现为反复咳嗽、咳痰、发热、咯血或痰血。CT表现为实性肿块影21例,囊性病灶13例,囊实性病灶7例,肺不张2例。26例经影像学检查诊断。手术治疗40例,其中37例行胸腔镜肺叶切除术。手术证实叶内型36例,叶外型4例。组织病理学检查提示肺发育不良及慢性炎症改变。保守治疗3例。结论肺隔离症以肺组织发育不良及异常动脉供血为特征,临床症状缺乏特异性,影像表现具有多样性,以实性肿块影最多见,囊性病灶次之。确诊肺隔离症可以首选增强CT结合血管成像三维重建。治疗推荐尽早手术,胸腔镜微创手术证实是安全可行的治疗模式。     

成人肺隔离症16例临床病理特点及误诊分析

目的 总结成人肺隔离症的临床、病理特点.方法 收集并分析四川大学华西医院经手术病理活检证实的16例18岁以上成人肺隔离症患者的临床及病理资料.结果 16例肺隔离症患者中女性12例,男性4例,中位年龄38.5岁;咳嗽(9例)是最常见的症状.CT显示病灶位于左肺下叶9例,8例表现为肺囊肿样改变和(或)多发囊状支气管扩张,其次为肺内及其他组织器官软组织密度肿块影(7例);1例肺部增强CT显示异常的体循环供血动脉.初诊时仅2例诊断为肺隔离症,余误诊为肺囊肿样改变伴支气管扩张6例,肿瘤6例.16例患者均行外科手术治疗,手术证实13例为叶内型肺隔离症,3例为叶外型肺隔离症,组织病理学检查显示肺组织发育不良及慢性炎症性改变.结论 肺隔离症以异常动脉供血和肺组织发育不良为特征,临床症状无特异性,初诊误诊率较高,增强CT可作为成人疑似病例(尤其是左肺下叶出现囊状或肿块状病灶的中青年患者)的首选检查方法.     

多层螺旋CT对肺隔离症的诊断价值

目的探讨多层螺旋CT血管成像对肺隔离症的诊断价值。方法在13例经病理证实肺隔离症患者中,经多层螺旋CT平扫与增强扫描,并结合最大强度投影（MIP）及容积再现（VR）技术,显示异常血管与病灶的关系。结果13例肺隔离症患者中,9例病灶位于左下叶,4例病灶位于右下叶,11例为叶内型,2例为叶外型,异常供血全部来自胸主动脉。CT平扫表现为肿块形8例,不规则形5例。血管成像重组技术中13例均清晰显示异常体动脉供血。结论多层螺旋CT血管成像并结合重组技术能提高诊断肺隔离症的准确性,具有重要的诊断价值。     

肺隔离症的诊断和治疗

目的对肺隔离症的病因、分类、发病率，诊断及治疗加以探讨。方法回顾分析４２例肺隔离症的临床资料及文献复习。结果自１９６４～１９９７年间通过手术切除并经病理证实的４２例肺隔离症。发病率占同期手术的０３２％，其中叶内型３７例（８８％），叶外型５例（１２％）。叶内型２２例合并感染症状，９例合并咯血症状。叶外型１例合并感染症状，１例合并咯血症状，该病例隔离肺与食管相通。术前确诊或拟诊２９例（６９％）。结论肺隔离症诊断方法主要为Ｘ线检查，支气管碘油造影，选择性动脉造影及ＣＴ检查。术中应避免损伤隔离肺的营养血管，对叶外型肺隔离症应注意其它脏器的畸形。     

多层螺旋CT检查诊断肺隔离症8例分析

肺隔离症是一种先天性发育异常。其主要特点是病变肺组织有异常体动脉供血,但无呼吸功能。诊断本病的依据是检出供血体动脉。传统的血管造影检查,虽可发现异常供血体动脉,但为有创性检查。近来,我院采用多层螺旋CT（MSCT）检查确诊肺隔离症8例,并经手术及病理证实。现分析如下。     

增强CT扫描及后处理技术对肺隔离症的诊断价值

目的探讨增强CT扫描及其后处理技术在肺隔离症中的诊断价值。方法回顾分析18例经手术和病理证实的肺隔离症患者胸部增强CT及后处理图像。结果其中叶内型16例(89%),叶外型2例(11%);14例位于左下肺(78%),4例位于右肺(22%);实性肿块3例,囊实性肿块11例,囊性病灶1例,血管增粗及条索影3例;供血动脉2例来自腹主动脉上段,另外16例来自胸主动脉下段,其中多支供血动脉3例,单支供血动脉15例,16例引流至同侧肺静脉,1例引流至半奇静脉,1例为双重静脉引流(肺静脉、奇静脉);18例均能完整地显示异常供血动脉及引流静脉的全貌。结论增强CT扫描及其后处理技术能清晰显示病灶内异常供血动脉及引流静脉,对肺隔离症的诊断具有重要的临床应用价值,可以取代血管造影作为诊断该病的最佳检查方法。     

多层螺旋CT容积再现对肺隔离症的应用价值

目的研究多层螺旋CT容积对肺隔离症的应用价值。方法对经外科手术及病理证实的11例肺隔离症患者多层螺旋CT血管造影,利用容积再现(VR)技术,分析异常血管与病灶的关系。结果 11例患者中,7例病灶位于左下叶,4例病灶位于右下叶,异常供血全部来自胸主动脉。MSCT平扫表现为囊实性肿块6例,其他不规则形5例。VR重组技术中11例能明确显示异常体动脉供血及肺内血管网。结论多层螺旋CT血管造影及结合容积再现重组技术能直观显示肺隔离症的异常体动脉供血及肺内血管网,具有重要的临床应用价值。     

肺隔离症27例临床特点分析

目的 探讨肺隔离症的临床特点,提高肺隔离症临床诊断和治疗水平.方法 回顾性分析1999年1月至2006年12月浙江大学医学院附属第一医院收治的27例经病理证实为肺隔离症患者的临床资料并复习相关文献.结果 27例中,男18例,女9例,年龄11～65岁,平均34岁.病程1个月至20年.主要症状为反复咳嗽、咳痰、低热、咯血、胸闷及胸痛.4例无任何症状.27例肺隔离症患者中叶内型22例,叶外型5例,叶内型常有咳嗽、咳痰、发热、咯血等症状,叶外型多无症状.术前确诊或拟诊20例,主要诊断手段为x线胸片、胸部CT平扫及增强扫描、CT血管造影(CTA)、核磁共振血管造影(MRA)及选择性动脉造影.本组所有病例均行手术治疗,术后恢复顺利,随访未见复发.结论 肺隔离症临床表现无特异性,选择性动脉造影对本病的确诊有决定性意义,但为有创检查.CT增强、CTA和MRA等非侵袭性血管成像技术已成为选择性动脉造影的重要补充手段,手术为最佳治疗方法,介入治疗效果有待进一步研究.     

叶内型肺隔离症诊治分析

目的总结叶内型肺隔离症的诊断及外科治疗体会,提高对肺隔离症的认识。方法对经病理证实的23例叶内型肺隔离症的临床和影像学资料进行分析。结果 23例中,病变位于左肺下叶17例,位于右肺下叶6例。患者临床症状表现为反复咳嗽、咳痰15例,反复咯血4例,反复肺部感染3例,腰痛1例。病灶呈囊性5例,实性15例,囊实性3例。23例均为叶内型。其中20例术前经影像学检查诊断,主要诊断方法为增强CT扫描及多平面重建(MPR)、最大密度投影(MIP),可清晰显示病变的强化特点,异常供血动脉及与周围结构的关系。结论叶内型肺隔离症较易误诊,CT增强扫描及MPR、MIP能清晰的显示肺隔离症的病变特征,为首选检查方法。手术切除是本病最佳治疗方法。     

逆行性主动脉造影诊断儿童肺隔离症

现在已认识到肺隔离症是支气管树发育异常并带有异常营养血管,系无功能的支气管肺组织团块与正常肺组织隔离分开。肺隔离症分为两型:1)叶内型:病变区与正常肺组织共同包在脏层胸膜内,但与正常支气管不相通。2)叶外型:肺隔离症组织以其自身所包被的胸膜与周围组织分开,与正常支气管不相通。多数作者认为肺副叶不应包括在肺隔离症分类内。在此病患者生存期间如不采用心血管造影检查确诊是困难的。用一般X线检查方法,如普通X线照片、支气管造影、体层摄影只能显示该病的间接X线征     

Sequestration and microvascular congestion are associated with coma in human cerebral malaria

The pathogenesis of coma in severe Plasmodium falciparum malaria remains poorly understood. Obstruction of the brain microvasculature because of sequestration of parasitized red blood cells (pRBCs) represents one mechanism that could contribute to coma in cerebral malaria. Quantitative postmortem microscopy of brain sections from Vietnamese adults dying of malaria confirmed that sequestration in the cerebral microvasculature was significantly higher in patients with cerebral malaria (CM; n = 21) than in patients with non-CM (n = 23). Sequestration of pRBCs and CM was also significantly associated with increased microvascular congestion by infected and uninfected erythrocytes. Clinicopathological correlation showed that sequestration and congestion were significantly associated with deeper levels of premortem coma and shorter time to death. Microvascular congestion and sequestration were highly correlated as microscopic findings but were independent predictors of a clinical diagnosis of CM. Increased microvascular congestion accompanies coma in CM, associated with parasite sequestration in the cerebral microvasculature.     

A quantitative ultrastructural study of renal pathology in fatal Plasmodium falciparum malaria

OBJECTIVE: To use electron microscopy to examine the role of parasitized red blood cell (PRBC) sequestration in the pathogenesis of acute renal failure in severe falciparum malaria. METHODS: Ultrastructural pathological examination of renal tissues from Southeast Asian adults (n = 63) who died from severe falciparum malaria. Qualitative and quantitative determination of the major pathological features of disease, including PRBC and leukocyte sequestration. Clinico-pathological correlation with the pre-mortem clinical picture and peripheral parasite count. RESULTS: There was a high incidence of malaria-associated renal failure in this population (> 40%) and a correlation between this incidence, severe malarial anaemia and shock. Pathological features included PRBC sequestration in glomerular and tubulo-interstitial vessels, acute tubular damage and mild glomerular hypercellularity resulting from the accumulation of host monocytes within glomerular capillaries. No evidence for an immune complex mediated glomerulonephritis was found. There was a correlation between parasite sequestration in the kidney and pre-mortem renal failure, although overall levels of sequestration were relatively low. Levels of sequestration (Knob+ PRBC) were significantly higher in malaria-associated renal failure than in fatal cases without renal failure (P = 0.005). CONCLUSION: Malaria-associated renal failure is a common and serious complication of severe Plasmodium falciparum malaria in this population, associated with acute tubular injury rather than glomerulonephritis, and linked to localization of host monocytes in the kidney as well as sequestration of PRBCs.     

Pathology of falciparum malaria in Vietnam.

Autopsy samples from the brains of 20 patients who died of falciparum malaria were examined by light microscopy and by an immunohistologic method. Particular attention was paid to a comparison of the pathologic features of the white matter and the cortex. In the high-sequestration (greater than 50%) group (n = 8), the mean +/- SD percentage of cerebral microvessels that showed parasitized red blood cell (PRBC) sequestration was 71.2 +/- 8.1% in the cortex and 84.0 +/- 6.7% in the white matter. The difference in the PRBC sequestration rate between cortex and white matter was statistically significant (P less than 0.01). Perivascular and ring hemorrhages were seen more frequently in the white matter than in the cortex. Deposition of IgG and Plasmodium falciparum antigen in the cerebral microvessels was more highly significant in the white matter than in the cortex (P less than 0.01). Our study demonstrated that the localized concentration of PRBC sequestration in the brain correlated with the marked immunohistologic differences in the microvessels of cortex and white matter.     

Evaluation of diagnostic accuracy of computed tomography to assess the angioarchitecture of pulmonary sequestration

Bronchopulmonary sequestration is an unusual congenital malformation consisting of abnormal lung tissue that lacks normal communication with the tracheobronchial tree. The diagnosis of pulmonary sequestration is based on identifying this systemic arterial supply. We aimed to evaluate the sensitivity of multidetector computed tomography in demonstrating the feeding artery and draining veins. Between 2003 and 2008, 8 patients (6 males, 2 females) ranging in age from 5 to 49 years with a diagnosis of pulmonary sequestration were identified. All patients underwent evaluation with chest tomography (spiral or multi detector tomography) and digital subtraction angiography. Aberrant systemic arterial supply was demonstrated in all cases: from the descending thoracic aorta (n= 6); arcus aorta (n= 1), internal mammarial artery (n= 1), intercostal arteries (n= 2) and celiac axis (n= 1). Four patients underwent surgery which confirmed the angioarchitecture depicted on angiography. One patient underwent angiography with embolization using. Computed tomography especially multidetector computed tomography is a powerful noninvasive technique for the detection of pulmonary sequestration.     

Pulmonary resection in infants for congenital pulmonary malformation

STUDY OBJECTIVES: To review our experience with indications, timing, and results of pulmonary resection in infants. DESIGN: Retrospective cohort study. SETTING: Thoracic Surgery Department, Chest Diseases Hospital, Kuwait. Patients and intervention: Forty-seven infants with congenital lung diseases were treated with pulmonary resection from January 1993 to December 2000. RESULTS: The mean age at the time of diagnosis was 90 days (range, 7 days to 11 months). Thirty-four patients were male (72%). Congenital lobar emphysema, congenital cystic adenomatoid malformation, pulmonary sequestration, and atelectasis were seen in 26, 10, 6, and 5 patients, respectively. The indications for surgery were respiratory distress in 32 patients (68%), respiratory tract infections in 12 patients (26%), and the presence of asymptomatic chest radiographic findings in 3 patients (6%). A lobectomy was performed in 42 patients (89%), bilobectomy in 2 patients (4%), left pneumonectomy in 1 patient (2%), and excision of a mass in 2 patients with extralobar sequestration (4%). An emergency lobectomy was performed in seven patients (15%). Only one postoperative death occurred following a left pneumonectomy for extensive congenital adenomatoid malformation due to pulmonary hypertension. Four patients (9%) had postoperative complications: atelectasis (n = 2), prolonged air leak (n = 1), and pneumothorax (n = 1). Mean follow-up was 4 years (range, 1 to 5 years) for all patients. None of the patients had any physical limitations. CONCLUSION: Pulmonary resection is indicated for the majority of patients with congenital lung malformations. In case of severe respiratory distress, an emergency lobectomy can be performed safely.     

Platelet-associated immunoglobulins IgG, IgM, IgA and complement C3c in chronic idiopathic autoimmune thrombocytopenia: relation to the sequestration pattern of 111indium labelled platelets

Levels of platelet-associated immunoglobulins (PAIg) IgG, IgM, IgA and complement C3c were related to parameters of 111Indium-labelled platelet kinetics in 17 patients with chronic idiopathic autoimmune thrombocytopenia (cAITP). Elevated levels of PAIg/C3c were found in 14 patients (82%) (PAIgG n = 13, PAIgM n = 11, PAIgA n = 1, PAC3c n = 5). Only PAIgG correlated with platelet counts (RS = -0.71, p less than 0.01). Mean platelet life span (MLS) was shortened in all patients (median 12.0 h, range 0.3-45.6 h) and correlated with the platelet counts (RS = 0.49, p less than 0.05). MLS was correlated with PAIgG (RS = -0.52, p less than 0.05), but not with PAIgM, PAIgA, or PAC3c. The site of sequestration was splenic in 10 patients and splenic-hepatic in 7 patients. Although no significant correlation between either site of platelet sequestration and any of the investigated PAIg/C3c was demonstrable, platelets coated with higher PAIgG levels were more readily sequestrated in the spleen, while elevations of PAC3c were found in 4 out of 7 patients with hepatic involvement.     

Does the site of platelet sequestration predict the response to splenectomy in adult patients with immune thrombocytopenic purpura?

Splenectomy is the only potentially curative treatment for chronic immune thrombocytopenic purpura (ITP) in adults. However, one-third of the patients relapse without predictive factors identified. We evaluate the predictive value of the site of platelet sequestration on the response to splenectomy in patients with ITP. Eighty-two consecutive patients with ITP treated by splenectomy between 1992 and 2013 were retrospectively reviewed. Platelet sequestration site was studied by ¹¹¹Indium-oxinate-labeled platelets in 93% of patients. Response to splenectomy was defined at last follow-up as: complete response (CR) for platelet count (PC) ≥100?×?10⁹/L, response (R) for PC≥30?×?10⁹/L and <100?×?10⁹/L with absence of bleeding, no response (NR) for PC<30?×?10³/L or significant bleeding. Laparoscopic splenectomy was performed in 81 patients (conversion rate of 16%), and open approach in one patient. Median follow-up was 57 months (range, 1–235). Platelet sequestration study was performed in 93% of patients: 50 patients (61%) exhibited splenic sequestration, 9 (11%) hepatic sequestration and 14 patients (17%) mixed sequestration. CR was obtained in 72% of patients, R in 25% and NR in 4% (two with splenic sequestration, one with hepatic sequestration). Preoperative PC, age at diagnosis, hepatic sequestration and male gender were significant for predicting CR in univariate analysis, but only age (HR?=?1.025 by one-year increase, 95% CI [1.004–1.047], p?=?0.020) and pre-operative PC (HR?=?0.112 for?>?100 versus <=100, 95% CI [0.025–0.493], p?=?0.004) were significant predictors of recurrence-free survival in multivariate analysis. Response to splenectomy was independent of the site of platelet sequestration in patients with ITP. Pre-operative platelet sequestration study in these patients cannot be recommended.     

Platelet associated IgG, platelet survival, and platelet sequestration in thrombocytopenic states

S ummary . Platelet-associated IgG (PAIgG), platelet mean life span (MLS), and platelet sequestration sites were studied in 69 patients with immune (ITP) and presumed nonimmune thrombocytopenias (NTP). A shortened MLS was associated with elevated PAIgG (N=46), and with normal PAIgG (N=15), Four patients had a normal MLS, but elevated PAIgG, four patients were normal for both parameters. The highest PAIgG values occurred in ITP patients with a very short MLS. Nine NTP patients had also elevated PAIgG, but a normal or slightly shortened MLS. There was a significant double log correlation between PAIgG and MLS for ITP, but not for NTP patients. Judged from the coefficient of determination, only 10% of PAIgG were directly related to a shortened MLS.
70% of patients (N= 63) had exclusively splenic and 30% hepatosplenic sequestration. PAIgG was elevated in 29/44 patients with splenic (66%) and in 16/19 patients with hepatosplenic sequestration (84%). In ITP, PAIgG-positive cases were observed in 69% of splenic v 82% of hepatosplenic sequestration, while in NTP the corresponding figures were 6/11 and 2/2. No significant correlation between PAIgG and either sequestration type was demonstrable.
We conclude that in immunologically mediated thrombocytopenia only a small portion of PAIgG accounts for a decreased MLS, and that the concentration of PAIgG per se does not determine the platelet sequestration type.     

血小板活化因子拮抗剂对猪急性重症胰腺炎后肺和气？…

目的 探讨血小板活化因子（ＰＡＦ）在猪急性重症胰腺炎（ＡＳＰ）性肺和气管粘膜损伤中的作用机制,观察一种新型ＰＡＦ受体拮抗剂（ＢＮ５０７３９）对ＡＳＰ后肺和气管粘膜中嗜中性粒细胞（ＰＭＮ）弹性蛋白酶（ＮＥ）和磷麦Ａ２（ＰＬＡ２）活性的影响。方法 选健康长白种猪２８只,体重１６￣２２ｋｇ,雌雄不限,随机分为５组：Ⅰ组（假手术对照组,５只）;Ⅱ组（ＡＳＰ对照组（６只）;Ⅲ组「二甲亚砚（ＤＭＳＯ）对照组,