肺源性纵隔气肿的CT表现及解剖学基础(附38例病例)

目的：通过对肺源性纵隔气肿的CT扫描作回顾性分析,探讨轴向肺间质与纵隔的解剖学关系。方法：搜集病例38例。26例先行胸部常规X线检查,后行CT扫描;12例直接进行胸部CT扫描。摄取胸部正侧位片均采用GE公司DR技术,胸部CT扫描采用GE公司16层螺旋CT。结果：38例病例中18例CT片示肺间质气肿与同侧肺门及纵隔相延续,16例CT片仅示纵隔及两肺中外带肺间质气肿,同侧肺门间质气肿未能显示,4例示纵隔气肿及肺门间质气肿。而肺门以外的轴向肺间质未见气肿征象。结论：肺部轴向肺间质与纵隔存在着潜在间隙。     

CT findings and temporal course of persistent pulmonary interstitial emphysema in neonates: a multiinstitutional study

OBJECTIVE: The purpose of this study was to evaluate the CT appearance, management, and temporal course of persistent pulmonary interstitial emphysema in neonates. MATERIALS AND METHODS: Criteria for inclusion in the study group included neonates with a history of prematurity who required ventilation for lung disease, development of hyperexpanded radiolucent lung lesions after typical radiographic findings of pulmonary interstitial emphysema, and CT documentation of lung abnormalities. Radiographs and CT scans were reviewed for the anatomic distribution, appearance, and presence of classic lines or dots within a radiolucent mass. We compared the management (surgical vs nonsurgical) and the temporal course in nonsurgical cases for patients in the United States and patients outside the United States. RESULTS: From seven institutions, we identified 17 patients who had persistent pulmonary interstitial emphysema with CT documentation. On CT, all lesions consisted of hyperexpanded cystic radiolucencies. Distribution was single-lobe in nine patients (left upper lobe, n = 5; left lower lobe, n = 3; right middle lobe, n = 1), multilobar in eight patients, and bilateral in six patients. Fourteen patients (82%) showed the characteristic line-and-dot pattern. All patients were initially treated conservatively; nine eventually underwent surgical resection with confirmation at pathology. Of 10 patients who underwent nonsurgical treatment for at least 1 year, lesions resolved in four patients, decreased in size in three asymptomatic patients, and enlarged in three patients, with eventual resection in two. Surgical resection was performed in 89% (8/9) of patients treated in the United States and in 13% (1/8) of patients treated outside the United States. CONCLUSION: Our study found that 82% of patients with persistent pulmonary interstitial emphysema had characteristic CT findings (central lines and dots surrounded by radiolucency). Although most patients in this series eventually underwent surgical resection, initial treatment can be conservative. The decision to perform surgery may have reflected the local medical culture.     

Pulmonary fibrosis and emphysema: Is the emphysema type associated with the pattern of fibrosis?

AIM: To investigate whether the predominant emphysema type is associated with the high resolution computed tomography (HRCT) pattern of fibrosis in combined pulmonary fibrosis and emphysema (CPFE). METHODS: Fifty-three smokers with upper lobe emphysema and lower lobe pulmonary fibrosis on - HRCT - were retrospectively evaluated. Patients were stratified into 3 groups according to the predominant type of emphysema: Centrilobular (CLE), paraseptal (PSE), CLE = PSE. Patients were also stratified into 3 other groups according to the predominant type of fibrosis on HRCT: Typical usual interstitial pneumonia (UIP), probable UIP and nonspecific interstitial pneumonia (NSIP). HRCTs were scored at 5 predetermined levels for the coarseness of fibrosis (Coarseness), extent of emphysema (emphysema), extent of interstitial lung disease (TotExtILD), extent of reticular pattern not otherwise specified (RetNOS), extent of ground glass opacity with traction bronchiectasis (extGGOBx), extent of pure ground glass opacity and extent of honeycombing. HRCT mean scores, pulmonary function tests, diffusion capacity (DLCO) and systolic pulmonary arterial pressure were compared among the groups. RESULTS: The predominant type of emphysema was strongly correlated with the predominant type of fibrosis. The centrilobular emphysema group exhibited a significantly higher extent of emphysema (P < 0.001) and a lower extent of interstitial lung disease (P < 0.002), reticular pattern not otherwise specified (P < 0.023), extent of ground glass opacity with traction bronchiectasis (P < 0.002), extent of honeycombing (P < 0.001) and coarseness of fibrosis (P < 0.001) than the paraseptal group. The NSIP group exhibited a significantly higher extent of emphysema (P < 0.05), total lung capacity (P < 0.01) and diffusion capacity (DLCO) (P < 0.05) than the typical UIP group. The typical UIP group exhibited a significantly higher extent of interstitial lung disease, extent of reticular pattern not otherwise specified, extent of ground glass opacity with traction bronchiectasis, extent of honeycombing and coarseness of fibrosis (0.039 > P > 0.000). Although the pulmonary arterial pressure was higher in typical UIP group relative to the NSIP group, the difference was not statistically significant. CONCLUSION: In CPFE patients, paraseptal emphysema is associated more with UIP-HRCT pattern and higher extent of fibrosis than centrilobular emphysema.     

Gastric emphysema in infants with hypertrophic pyloric stenosis.

Gastric emphysema in unusual in infants and children. Air in the wall of the stomach can rarely occur in children with gastric outlet obstruction due to hypertrophic pyloric stenosis. The clinical features and radiographic appearance of this association are described in three infants, and the value of the lateral radiograph is illustrated. The differential diagnostic considerations, importance of correct radiologic diagnosis and results of proper therapy are discussed.     

Emphysema progression is visually detectable in low-dose CT in continuous but not in former smokers

Objectives

To evaluate interobserver agreement and time-trend in chest CT assessment of emphysema, airways, and interstitial abnormalities in a lung cancer screening cohort.

Methods

Visual assessment of baseline and fifth-year examination of 1990 participants was performed independently by two observers. Results were standardised by means of an electronic score sheet; kappa and time-trend analyses were performed.

Results

Interobserver agreement was substantial in early emphysema diagnosis; highly significant (p?Conclusions Visual scoring of chest CT is able to characterise the presence, pattern, and progression of early emphysema. Continuous smokers progress; former smokers do not.

Key Points

? Substantial interobserver consistency in determining early-stage emphysema in low-dose CT. ? Longitudinal analyses show clear time-trends for emphysema presence and grading. ? For continuous smokers, progression of emphysema was seen in all lung zones. ? For former smokers, progression of emphysema was undetectable by visual assessment. ? Onset and progression of interstitial abnormalities are visually detectable.     

Reproducibility of scoring emphysema by HRCT

Purpose: We evaluated the reproducibility of three visual scoring methods of emphysema and compared these methods with pulmonary function tests (VC, DL_CO, FEV₁ and FEV_%) among farmer's lung patients and farmers.Material and Methods: Three radiologists examined high-resolution CT images of farmer's lung patients and their matched controls (n=70) for chronic interstitial lung diseases. Intraobserver reproducibility and interobserver variability were assessed for three methods: severity, Sanders' (extent) and Sakai. Pulmonary function tests as spirometry and diffusing capacity were measured.Results: Intraobserver κ-values for all three methods were good (0.51-0.74). Interobserver κ varied from 0.35 to 0.72. The Sanders' and the severity methods correlated strongly with pulmonary function tests, especially DL_CO and FEV₁.Conclusion: The Sanders' method proved to be reliable in evaluating emphysema, in terms of good consistency of interpretation and good correlation with pulmonary function tests.     

Ventilator-induced pulmonary pseudocysts in preterm neonates

Twenty-three pulmonary pseudocysts were identified in 20 preterm neonates undergoing mechanically assisted ventilation. Most of the pseudocysts occurred in a right parahilar location; cysts were either single (13) or multiple/multilocular (10). The pseudocysts persisted from less than 2 days to longer than 3 months (modal duration, 7 days), and they were commonly associated with generalized pulmonary interstitial emphysema (18 of 20), pneumothorax (18 of 20), bronchopulmonary dysplasia (16 of 20), and pneumomediastinum (six of 20). The reason for the predominantly right parahilar location of these pseudocysts remains uncertain. Pulmonary pseudocysts are almost always right-sided and are associated with pulmonary interstitial emphysema and pneumothoraces; complete resolution usually occurs.     

Clinical evaluation of life size image of Fuji computed radiography for detection of diffuse interstitial lung diseases]

To evaluate the diagnostic accuracy of Fuji Computed Radiography (FCR) in the detection of interstitial pulmonary infiltrates, FCR life-size images at a pixel size of 0.1 mm were compared with conventional radiographs taken on the same day. Seventeen radiologists assessed the radiographs and FCR images of 56 cases, including 39 cases of various interstitial lung diseases such as interstitial pneumonia, pulmonary abnormalities associated with collagen disease, sarcoidosis, multiple pulmonary metastases, diffuse panbronchiolitis and pulmonary emphysema, and 17 normal controls. All of the pulmonary abnormalities were confirmed by high resolution CT. Observer performance tests were carried out using receiver operating characteristic analysis. In 21 cases of increased pulmonary density revealed by high resolution CT, FCR was significantly superior to conventional radiographs in the detection of reticular or linear shadows. In 11 cases of subtle interstitial abnormalities, there was no difference between FCR and conventional radiographs in the detection of any pulmonary abnormality, ground-glass opacities and reticular or linear shadows. There was also no difference between the two images in the detection of diffuse nodular shadow and pulmonary emphysema. These results indicate that FCR life-size images at a pixel size of 0.1 mm are useful for the detection of diffuse interstitial lung diseases.     

Chronic cystic lung disease: diagnostic accuracy of high-resolution CT in 92 patients

OBJECTIVE: The objective of this study was to determine whether the various chronic cystic lung diseases can be differentiated on the basis of the pattern and distribution of abnormalities on high-resolution CT. MATERIALS AND METHODS: High-resolution CT scans in 92 patients with chronic cystic lung diseases (18 with pulmonary Langerhans cell histiocytosis, 18 with pulmonary lymphangioleiomyomatosis, 17 with usual interstitial pneumonia, 16 with lymphocytic interstitial pneumonia, 15 with emphysema, and eight with desquamative interstitial pneumonia or respiratory bronchiolitis interstitial lung disease) were retrospectively assessed by two independent observers without knowledge of the clinical or pathologic data. The observers recorded the abnormalities, the most likely diagnosis, and the degree of confidence in that diagnosis. RESULTS: The two observers made a correct first-choice diagnosis in 148 (80%) of 184 interpretations. The correct diagnosis was made in 100% of interpretations of usual interstitial pneumonia, 81% of desquamative interstitial pneumonia or respiratory bronchiolitis interstitial lung disease, 81% of lymphocytic interstitial pneumonia, 77% of emphysema, 72% of lymphangioleiomyomatosis, and 72% of Langerhans cell histiocytosis. The two observers made a diagnosis with a high degree of confidence in 105 (57%) of 184 interpretations. The confident diagnosis was correct in 98 (93%) of 105 interpretations. CONCLUSION: Although various chronic cystic lung diseases often have a characteristic appearance that allows their distinction on high-resolution CT, considerable overlap exists among the CT findings. Therefore, lung biopsy is often required for a definitive diagnosis.     

Respiratory distress syndrome treated with human surfactant: radiographic findings

Chest radiographs of 18 newborns treated with endotracheal instillation of human surfactant for respiratory distress syndrome (RDS) were compared with those of 18 similar but untreated infants. In the treated infants, severity of RDS significantly improved after surfactant administration. Most treated infants (16/18) exhibited a left-to-right shunt, presumably through a patent ductus arteriosus; similar findings were noted in untreated infants (17/18). Complications of respiratory assistance in the treated infants included transient pulmonary interstitial emphysema (n = 1), pneumothorax (n = 1), and mild (n = 4) to moderate (n = 2) bronchopulmonary dysplasia; the incidences of these complications did not exceed those in untreated infants. In three treated infants, a transient interstitial lung disease developed 3-4 days after surfactant administration.     

Spontaneous thoracic air-leakage syndrome in patients following allogeneic hematopoietic stem cell transplantation: causes, CT-follow up and patient outcome

OBJECTIVE: The purpose of this article is to describe and illustrate the acute and follow-up imaging features, clinical constellation and outcome of patients with thoracic air-leakage syndrome following allogeneic hematopoietic stem cell transplantation (allo-HCT). METHODS: Patients with evidence of thoracic air-leakage, i.e. spontaneous pneumomediastinum, spontaneous pneumothorax or interstitial emphysema after allo-HCT were retrospectively identified by a chart review. Acute and follow-up morphology, duration and patient outcome were analyzed on CT (HRCT or MSCT with HR-reconstructions). Correlation was made with histological results of transbronchial biopsy. RESULTS: The 6 patients included (3 male and 3 female, 14-64 years old) with thoracic air-leakage after allo-HCT all had histologically proven bronchiolitis obliterans (BO) or bronchiolitis obliterans organizing pneumonia (BOOP). Thoracic air-leakage consisted of spontaneous pneumomediastinum associated with active invasive pulmonary aspergillosis (IPA) in 4/6 and spontaneous pneumothorax or interstitial emphysema each in 1/6 patients. Duration of thoracic air-leakage was 7-135 days. Of the patients with spontaneous pneumomediastinum, 3/4 died of IPA. One patient survived until complete regression of spontaneous pneumomediastinum. One patient died 7 days after spontaneous pneumothorax and one survived developing chronic interstitial emphysema. CONCLUSION: In all cases, thoracic air-leakage was associated to BO or BOOP. In the majority of cases with additional IPA, thoracic air-leakage is more indicative for severity of pulmonary disease than a life-threatening entity itself.     

The radiologic differential diagnosis of diffuse lung diseases characterized by multiple cysts or cavities.

A variety of pulmonary diseases have diffuse cystic abnormalities within the lungs, including emphysema, cystic bronchiectasis, desquamative interstitial pneumonia, lymphocytic interstitial pneumonia, usual interstitial pneumonia, lymphangioleiomyomatosis, Langerhans histiocytosis, cystic metastasis, Wegener granulomatosis, Pneumocystis carinii pneumonia, pulmonary paragonimiasis, and septic pulmonary emboli. CT can easily detect cystic abnormalities as common features in many diseases. However, some characteristic pattern of them can facilitate specific diagnoses.     

Hyperpolarized 3He apparent diffusion coefficient MRI of the lung: reproducibility and volume dependency in healthy volunteers and patients with emphysema

PURPOSE: To measure the apparent diffusion coefficient (ADC) of hyperpolarized (HP) (3)He gas using diffusion weighted MRI in healthy volunteers and patients with emphysema and examine the reproducibility and volume dependency. MATERIALS AND METHODS: A total of eight healthy volunteers and 16 patients with emphysema were examined after inhalation of HP (3)He gas mixed with nitrogen (N(2)) during breathhold starting from functional residual capacity (FRC) in supine position. Coronal diffusion-sensitized MR images were acquired. Each subject was imaged on three separate days over a seven-day period and received two different volumes (6% and 15% of total lung capacity [TLC]) of HP (3)He each day. ADC maps and histograms were calculated. The mean and standard deviation (SD) of the ADC at different days and volumes were compared. RESULTS: The reproducibility of the mean ADC and SD over several days was good in both healthy volunteers and patients (SD range of 0.003-0.013 cm(2)/second and 0.001-0.009 cm(2)/second at 6% and 15% of TLC for healthy volunteers, and a SD range of 0.001-0.041 cm(2)/second and 0.001-0.011 cm(2)/second, respectively, for patients). A minor but significant increase in mean ADC with increased inhaled gas volume was observed in both groups. CONCLUSION: Mean ADC and SD of HP (3)He MRI is reproducible and discriminates well between healthy controls and patients with emphysema at the higher gas volume. This method is robust and may be useful to gain new insights into the pathophysiology and course of emphysema.     

抗黑色素瘤分化相关基因5抗体阳性皮肌炎的临床和胸部CT表现

目的:探讨抗黑色素瘤分化相关基因5（MDA5）抗体阳性皮肌炎患者的临床表现及胸部损害的CT表现。方法:回顾性分析2017年2月至2019年10月在河南科技大学第一附属医院确诊的15例抗MDA5抗体阳性皮肌炎患者的临床表现、实验室检查及胸部CT表现。实验室检查指标主要包括抗MDA5抗体、抗Ro-52抗体、肌酸激酶等。胸部...     

High-resolution CT in chronic pulmonary changes after mustard gas exposure

PURPOSE: To identify the findings of high-resolution CT (HRCT) of the lung in patients with previous sulfur mustard gas exposure, and to correlate these findings with clinical and chest X-ray (CXR) results. MATERIAL AND METHODS: 50 consecutive patients were studied prospectively. The clinical data were recorded. Standard p.a. CXR and HRCT of the lung and spirometry were performed. The findings of CXR, HRCT and clinical and spirometry results were scored between 0 and 3 according to the severity of the findings. RESULTS: HRCT abnormality was detected in all 50 patients (100%), while CXR was abnormal in 40 patients (80%). The most common HRCT findings was airway abnormalities (bronchial wall thickening in 100% of cases). Other important findings were suggestive of interstitial lung disease (ILD) (80%), bronchiectasis (26%), and emphysema (24%). A statistically significant correlation was found between the severity of clinical presentation and that of the HCTR scores in patients with bronchiectasis, bronchitis and ILD (p< 0.05), but not with severity scores of HRCT in patients with emphysema. No significant correlation was found between severity scores of CXR findings. HRCT evidence of bronchial wall thickening and with a lower frequency ILD were present despite normal CXR in 20% of the patients. CONCLUSION: The results of this study suggest that bronchial wall thickening, ILD and emphysema are common chronic pulmonary sequelae of sulfur mustard injury. HRCT of the chest should be considered as the imaging modality of choice in chemical war injury.     

Ventilation-perfusion scans in neonatal regional pulmonary emphysema complicating ventilatory assistance.

Two cases of ventilator-related neonatal lobar overexpansion with similar radiographic appearance, but probably different pathogenesis, are presented. In one infant, persistent interstitial lobar emphysema was confirmed by markedly decreased perfusion shown on scintigraphy; this information was of great value in predicting the beneficial effect of lobectomy. In the other case, ventilation and perfusion scans indicated functional value of the emphysematous lobe and correctly suggested conservative management. Radioisotope lung scans may provide valuable information regarding lung function in regional pulmonary emphysema associated with assisted ventilation in neonatal respiratory distress syndrome, and thus determine patient management.     

小儿麻疹合并间质性肺炎的影像学分析

目的探讨小儿麻疹合并间质性肺炎的影像学表现,提高和重视对这一疾病的认识。方法回顾分析60例小儿麻疹合并问质性肺炎的临床资料以及X线和CT表现。结果①X线胸片：泡性肺气肿33例,其中伴右上肺斑点状,颗粒状较高密度影6例。肺门影增大、增浓56例。两肺纹理增多、模糊51例,其中密集的肺纹理使两肺透亮度减低17例,出现空气支气管征12例。间质性肺气肿i6例。网状肺纹理32例。星芒、结节状影27例。两肺磨玻璃影ll例。伴发小叶性肺炎13例,两肺单发或多发的片状实变影5例。其他表现：心影增大9例,气胸3例,纵隔皮下气肿4例,两侧少量胸腔积液8例;②10例CT检查结果：两肺大片磨玻璃影2例,实变影伴磨玻璃影3例,两肺纹理增多、模糊8例,两下肺纹理周围斑片状渗出5例。右下肺小叶间隔增厚2例,右下肺胸膜下弧线影1例,两下肺网格状、星芒状结节影2例。结论婴幼儿麻疹合并间质性肺炎的影像学表现应引起高度重视,早期发现和积极治疗有利于提高治愈率和改善患者预后。     

High-resolution CT diagnosis of emphysema in symptomatic patients with normal chest radiographs and isolated low diffusing capacity.

To determine the prevalence of "nonobstructive" (impairment of gas transfer) emphysema in a select population of smokers with dyspnea, a retrospective study of patients with emphysema evident at high-resolution computed tomography (HRCT) was undertaken. Four hundred seventy HRCT studies were reviewed. In 47 cases, centrilobular emphysema was the dominant or sole parenchymal abnormality. Concomitant chest radiographs were available in 41 of these cases; 16 of the 41 lacked radiographic findings of emphysema. Among these 16 patients, pulmonary function testing revealed 10 to have normal flow rates (ratio of forced expiratory volume in 1 second to forced vital capacity and forced expiratory volume in 1 second greater than 80% predicted) and impaired gas transfer (single-breath carbon monoxide diffusing capacity [DLCOSB] less than 80% predicted). With the exclusion of one patient with congestive heart failure from the group of 10, the severity of emphysema at HRCT correlated inversely with DLCOSB (r = -.643). These results indicate that HRCT allows detection of emphysema in symptomatic patients when chest radiographs and pulmonary function tests are nondiagnostic.     

Role of emphysema in the etiology of functional impairment in patients with severe chronic obstructive pulmonary disease. Study with high resolution computerized tomography]

PURPOSE: To investigate whether high-resolution CT (HRCT) can detect the subjects with massive emphysematous destruction in a group of patients with severe chronic obstructive pulmonary disease (COPD) and therefore be of help in selecting the candidates to surgical lung volume reduction. MATERIAL AND METHODS: We examined 40 former smokers with severe COPD (FEV1, < or = 40% of the predicted value, with no major improvement after inhalation of bronchodilators). Clinico-functional assessment included: a flow/volume loop (mean FEV1 = 28.6% of predicted), arterial blood gas analysis at rest breathing room air (mean values: PaO2 = 65.2 mmHg, PaCO2 = 47.4 mmHg), hematocrit value (mean: 45.2%) and the body mass index (mean value: 23.8). The patients were divided into two groups, namely bronchitic (21) and dyspneic (19) subjects, according to onset symptoms. All the patients underwent HRCT with evaluation of emphysema presence, type, site and extent: centrilobular emphysema was seen in 11 cases, panlobular emphysema in 3 and mixed emphysema in 26 cases; the site was superior in 75%, inferior in 7.5% and diffuse in 17.5% of cases; the mean visual score was 40.8%. The presence, type, site and severity of airways disease were also studied, as well as the pathologic dilatation of the pulmonary artery. The patients were divided into three groups (mild, moderate, severe) according to emphysema extent and they were considered to have bronchial disease in the presence of at least 2 of the 6 signs of bronchial involvement. RESULTS: The emphysema extent score was significantly correlated with the hematocrit value and Tiffeneau index (p < .2) in all the 40 patients. The severity of bronchial obstruction was the same in bronchitic and dyspneic patients. The subjects with chronic bronchitis had milder emphysema (mean extent 35% versus 47% in the dyspneic subjects) and a higher frequency of bronchial involvement. A decrease in FEV1 was significantly correlated with emphysema extent (p < .1) in dyspneic, but not in bronchitic, patients. Moreover, the former had better arterial blood gas and lower hematocrit values. CONCLUSIONS: HRCT is a useful tool in diagnosing the presence of emphysema in vivo and in assessing its extent in COPD patients because it permits to divide the patients into two groups which roughly correspond to the clinical patterns of types A (dyspneic) and B (bronchitic). Severe emphysema patients are the best candidates to surgical lung volume reduction. Airways involvement might play a major role in causing bronchial obstruction in the subjects with mild emphysema. In our series HRCT did assess the severity of emphysema in COPD subjects, but our lung function screening failed to predict emphysema extent.     

Pulmonary pseudocysts in newborn infants with respiratory distress syndrome.

Twelve neonates who developed intrathoracic cystlike structures ("pseudocysts") are described. All infants had clinical and radiographic respiratory distress syndrome and all were treated with assisted ventilation. Pulmonary interstitial emphysema preceded the development of the pseudocysts in all cases. The pseudocysts appeared between 0 and 6 days of life (average, 2.4 days), and radiographically documented disappearance occurred in 10 patients at 3--18 days old (average, 7.0 days). Two patients had persisting pseudocysts at 8 and 25 days of age, and no subsequent radiographs. In no case did these structures persist symptomatically or require surgical intervention such as has been described with patients in other series. In two cases, abrupt disappearance of the pseudocysts was accompanied by increased extraalveolar gas in other locations. Eight patients developed radiographic bronchopulmonary dysplasia, which was severe in two of the cases.