肺不张的少见X线表现

目的　探讨少见类型肺不张的X线征象。方法　回顾性分析了 48例胸部X线误诊的少见类型肺不张 ,男 17例 ,女 3 1例。所有病例均由CT或纤维支气管镜证实。结果　 48例少见类型肺不张中 ,两肺上叶不张 16例 ,右肺中叶不张 2例 ,两肺下叶不张 3 0例。引起不张的主要原因是支气管肺癌、支气管扩张和支气管内膜结核等。结论　熟悉肺不张的各种X线征象是减少误诊的关键     

45例结核性支气管狭窄肺不张的CT征象

目的 探讨结核性支气管狭窄肺不张的CT征象,提高诊断与鉴别诊断水平.资料与方法 回顾性分析经纤维支气管镜检查和/或痰检证实的45例结核性支气管狭窄肺不张患者的CT征象.结果 45例中,左或右上叶肺不张19例;中度及重度肺不张37例;多支支气管狭窄28例;多叶肺不张5例.不张肺叶的外缘常较平直或凹入,内缘与纵隔界面清楚;肺门区无块影;不张肺叶内常出现迂曲、变形的支气管气相8例,支气管扩张14例,钙点或钙斑12例;不张肺叶的同侧和/或对侧肺野显示新旧兼存的多形性结核病灶和支气管播散病灶25例.结论 除观察不张肺叶及其内部的CT征象外,仔细观察其余肺野、支气管、肺门及纵隔情况,有助于鉴别结核性支气管狭窄肺不张与中心型肺癌引起的肺不张.     

粘连性肺不张

目的：分析粘连性肺不张的影像学表现。材料与方法：搜集胸部肿瘤放射治疗所致肺损伤后１年，２年，３年，４年，５年的４２６例粘连性肺不张胸片观察，８０例体层观察。结果：（１）肺不张不受肺叶肺段的解剖限制；（２）肺不张不超越照射野外；（３）肺不张区常伴有胸膜肥厚；（４）肺不张体层示支气管气像存在；（５）粘连性肺不张为不可逆性。结论：粘连性肺不张是放射性肺损伤的继续。     

外伤性左支气管断裂二例

例１，男，５岁。１９９２年１月１４日左胸被拖拉机撞伤入院。胸透示左侧气胸、左全肺不张。行闭式引流后左肺仍不张。纤支镜检查示左主支气管结构不清，右侧正常。４月２日行左主支气管成形术。术中见左肺萎陷，左主支气管断裂，间距约１ｃｍ，中间为条索状瘢痕粘连。切...     

全麻双腔支气管插管下纤维支气管镜治疗创伤性肺不张

目的探讨全麻双腔支气管插管下纤维支气管镜治疗创伤性肺不张的临床应用价值。方法对32例创伤性肺不张患者（外伤后14例,手术后18例）在全麻双腔支气管插管下,应用纤维支气管镜对不张侧肺实施吸痰、灌洗和膨肺治疗。结果治疗后全组患者呼吸困难症状消失,显效30例,有效2例,呼吸功能各项指标明显提高,未发生严重并发症。结论全麻双腔支气管插管下纤维支气管镜治疗创伤性肺不张是一种有效、安全、舒适、创伤小的方法,具有一定的临床价值。     

圆形肺不张

圆形肺不张可以误诊为由其他病变引起的圆形肺损害,尤其在中、老年病人,往往被疑诊为恶性肿瘤。作者认为依据X线诊断,可避免侵入性诊断试验或不必要的治疗(如肺切除) 文中报告1例男性,年龄自59岁至61岁。X线表现典型。有2例团块显出含气支气管像,2例团块边缘有类似楔状的限制性不张(restrictive atelectasis)影。1例退缩向肺中形成慧星征,近膈处形成向后下倾斜式圆形肺不张(?)例。除1例为两下肺发病之外都是单侧一般类型(向上倾斜式)孤立病变。续发于渗出性胸膜炎、支气管扩张症各1例。1例经5年随防无变化。     

支气管结核肺不张

目的：提高对支气管结核性肺不张的影像诊断水平。材料与方法：从98例已证实的支气管结核中抽出具有肺不张的55例进行回顾性分析。结果：肺不张的患者大部分肺内均有或多或少、或新或旧的肺结核灶或支气管播散灶，不张以外的支气管也有多支受累的征象。结论：在支气管性肺不张的诊断与鉴别诊断中，除不张本身的征象外，结合临床资料，注意其余肺部、支气管、肺门与纵膈的情况甚为重要。     

肺不张的X线表现

肺不张的早期诊断十分重要,它有利于发现阻塞原因,并得以及时和妥当的处理。典型的肺不张诊断不难;但是不典型的肺不张易招致误诊。早在1945年Robbins等曾对肺不张有过许多论述。最近Proto等从肺不张的基本解剖改变全面阐述了其典型和不典型的X线表现,现结合其他有关文章综述如下: 基本解剖肺不张有肺(肺泡、血管、支气管)和肺外(叶间裂、纵隔、胸壁)的改变。Proto强调指出要熟悉正侧位胸片上肺门各解剖结构的正常关系及胸部各种器官的正常解剖投影。肺不张可有其中一些有关阴影的位置投影变化。发现这些变化常有助于发现肺不张。     

老年性肺炎的X线诊断（附160例分析）

目的 探讨X线对老年性肺炎的诊断价值。方法回顾性分析160例病人的临床资料，X线胸部正位片、部分侧位片及CT片。结果依据X线胸片，老年性肺炎的类型有：支气管肺炎型109，一侧或两肺下野实变42例；肺段或肺叶含气不良或肺不张9例，以及胸腔积液36例。结论老年性肺炎常因征象不典型、多变性、多病性，易漏诊和误诊。应重视老年性肺炎的早期诊断。     

球形肺不张的CT影像分析

【摘要】目的：分析球形肺不张的MSCT影像特点。方法：回顾性分析24例经临床诊断球形肺不张患者的MSCT薄层图像、高分辨图像、多平面重组（MPR）、容积再现（VR）后处理图像,总结球形肺不张的影像特征。通过病史调查,验证球形肺不张与石棉接触等的相关性。结果：24例患者共27个病灶。位于上叶6个（22.22%）,右中叶2个（7.41%）,下叶19个（70.37%）。27个病灶均出现“彗星尾”征、病灶同侧胸膜肥厚、病灶邻近血管弧形向病变移位（100%）,胸膜钙化和胸膜斑9例（33.33%）,7个病灶近肺门侧出现“含气支气管征”（25.92%）。8例增强扫描,病灶均有强化。PET-CT检查2例,无代谢增高。手术或穿刺活检6例,病理为胸膜增厚,肺泡萎陷和慢性炎症。动态观察见胸腔积液减少后出现结节影,约1个月后可见“彗星尾”征。有石棉接触史9例,胸腔积液8例。结论：球形肺不张的早期表现为胸腔积液相连的片状实变影,1个月后可形成典型表现。本病下叶多见,中叶和上叶也可发生。接触石棉是主要病因之一,也见于多种原因的胸腔积液。MSCT图像后处理技术有利于球形肺不张特征的显示。     

外伤性支气管断裂的诊断与治疗

目的：笔者报告８例外伤性支气管断裂患者的诊断与治疗，旨在评价外伤性支气管断裂早期诊断和手术治疗效果以及延误诊断造成的后果。方法：本组４例于伤后５小时以内，１例于伤后６天内施行支气管修复手术。结果：本组８例中５例手术后痊愈。３例延误诊断３～６月，其中１例死亡，另２例合并肺部感染和脓胸未治愈。结论：早期诊断和手术治疗可减少肺和胸腔感染的机会，及时挽救患者生命和恢复呼吸功能。     

Problematic diagnosis of bronchial foreign bodies in children

Bronchial foreign bodies by children are dangerous and require immediate therapeutic measures. Findings and significance of chest film in the diagnosis of bronchial foreign bodies in 24 children were analysed. All patients were symptomatic. 18 patients had an abnormal and 6 normal auscultation finding. In three cases the physician did not suspect aspiration, and the diagnosis was delayed, which caused the death of one child. Roentgenpositive foreign bodies were found in 8 and -negative in 16 cases. Secondary changes (obstructive emphysema, atelectasis, pneumonia) were seen in 16 cases. In emergency cases the chest films were analysed by physician and later by a radiologist, who found 88% of them to be abnormal. Fluoroscopy of expiratory chest film helps to detect the unilateral emphysema more distinctly. The diagnosis must always be confirmed with bronchoscopy and extraction thereby is the adequate treatment of bronchial bodies.     

Traumatic rupture of the right hemidiaphragm: Diagnosis by chest radiography

Sixteen cases of blunt trauma resulting in surgically confirmed traumatic rupture of the right hemidiaphragm were reviewed from the Trauma Registry of Allegheny General Hospital. Only 10 of the 16 cases (63%) could be retrospectively diagnosed on chest radiographs. We found that a diagnosis of right-sided diaphragmatic rupture can be suggested when the apex of the right hemidiaphragm is shifted superomedially to a position approximately midway between the mediastinum and the right chest wall. Eight of these 10 cases with positive chest radiographic findings exhibited this superomedial shift of the diaphragmatic apex. On initial assessment, without using this sign, 5 of these 10 cases were not diagnosed. We feel that the combination of elevation of the right hemidiaphragm in association with a medial shift of the apex of that diaphragmatic dome in a patient who has suffered extensive blunt thoracoabdominal trauma is strongly suggestive of traumatic rupture of the diaphragm.     

外伤性支气管断裂早期诊断和治疗

目的 报告15例外伤性支气管断裂患者的诊断与治疗，旨在评价其早期诊断和手术治疗效果以及延误诊断造成的后果。方法 本组15例中早期行支气管修补术7例，3例于伤后2－6个月行支气管重建术。结果 本组10例手术后痊愈，另5例未行手术者3例死亡、2例合并肺部感染和脓胸失去治疗机会。结论 早期诊断和手术治疗可减少肺和胸腔感染机会，及时挽救患者生命和恢复呼吸功能。     

18例创伤性气管、支气管断裂的诊断与治疗

目的　探讨创伤性气管、支气管断裂的诊断和治疗方法 ,提高诊断率及治疗效果。方法　回顾性分析 18例创伤性气管、主支气管断裂病人的临床资料。 15例行支气管端端吻合术 ,1例行支气管修补术 ,其中 1例术后支气管狭窄而行肺叶切除术 ,1例行气管修补术 ,1例行狭窄气管切除、气管端端吻合、T形硅胶管置管术。术后行纤维支气管镜 (FB)检查。结果　术后早期吻合口水肿狭窄呈裂隙状 2例 ,1个月后复查局部通畅均为良好。结论　创伤性支气管断裂容易误诊 ,FB检查是早期诊断最重要的手段 ,后期在切除狭窄段支气管时瘢痕要切除干净     

气管支气管破裂的诊断和处理

目的 评价早、晚期气管、支气管断裂的诊断、治疗特点与动脉血气改变。方法 分析34例气管、支气管破裂的病裂,包括气管重建2例、修补2例及保守治疗3例,支气管重建19例,全肺切除6例。术前和术后2周进行动脉血气分析。结果 29例经手术治疗后痊愈,4例保守治愈,1例拒绝手术。结论 诊断依据胸部外伤史、胸部X线检查和纤维支气管镜检查,治疗采取气管、支气管重建术。重建术后出现支气管吻合口狭窄者经再次手术治疗效果仍满意。动脉血气分析显示,术后2周多数患者PaO2和SaO2可恢复到正常水平。     

Superior mediastinal widening from spine fractures mimicking aortic rupture on chest radiographs

Mediastinal widening on chest radiographs associated with lower cervical and upper thoracic spine fractures can mimic the radiographic findings of aortic rupture. Frontal chest radiographs from 54 patients with traumatic fractures of at least one vertebral body from C6 to T8 were examined for signs suggestive of aortic rupture. These signs included (1) mediastinal width equal to or greater than 8 cm; (2) presence of a left apical cap; (3) a right paratracheal stripe of 5 mm or more; and (4) deviation of the nasogastric tube, when present, to the right of the T4 spinous process. Thirty-seven patients (69%) had radiographic signs suggestive of aortic rupture on the initial anteroposterior chest film. The single patient in this group who actually had an aortic rupture died in the emergency department shortly after admission. The spine fracture could be identified on the initial chest radiograph in 19 (51%) of the 37 patients. These results show that a widened mediastinum on chest radiographs after trauma is not a specific finding of aortic rupture. In these cases, the upper thoracic spine should be examined closely on the initial frontal chest radiograph for evidence of fracture. If a fracture of the upper thoracic spine is identified, an aortic rupture is unlikely in the absence of clinical signs and symptoms supporting this diagnosis.     

Sudden death due to rupture of major aortopulmonary collateral arteries in a patient with tetralogy of Fallot and pulmonary atresia

We report a case of fatal mediastinal hemorrhage in a 20-year-old man caused by rupture of the major aortopulmonary collateral arteries (MAPCAs). The patient had an unoperated tetralogy of Fallot with pulmonary atresia. Plain chest radiograph and computed tomography showed a large hematoma in the upper mediastinum. Previous cardiac angiography, performed 6 years previously, demonstrated markedly tortuous vascular structures arising from the inferior aspect of the aortic arch. In this case, the mediastinal hemorrhage was thought to be due to rupture of the MAPCAs. If a patient presents with sudden cardiac arrest and mediastinal dilatation, and unoperated congenital heart disease is suggested by a plain chest film, the radiologist should consider the possibility, although rare, of mediastinal hemorrhage resulting from rupture of the MAPCAs.     

An unusual case of bronchial rupture—pneumomediastinum appearing 7 days after blunt chest trauma

We present a case of bronchial disruption after blunt chest trauma, which is unusual because the pneumomediastinum on the chest radiograph was detected 7 days after the injury. The first day imaging methods of the thorax showed only the fractures of the first and third left rib without any complications. A computed tomography (CT) scan was done following control chest radiograph and it revealed a rupture of the left main bronchus with pleural effusion, subcutaneous emphysema and pneumomediastinum. This case shows that a finding of pneumomediastinum after blunt chest trauma should always merit further investigation of its cause, even in cases of postponed detection of pneumomediastinum and regardless of the absence of other indicators of tracheobronchial disruption. Although fiber-optic tracheobronchoscopy is considered a diagnostic golden standard, in this case, diagnosis was clearly confirmed by spiral CT scan, due to thin slices and continuous data acquisition.     

Value of plain chest film in predicting traumatic aortic rupture

Plain chest film performed after blunt chest trauma showed blurring of the left pulmonary hilum in 53% of cases of traumatic aortic rupture (Group A, n = 15), and in no cases with negative aortography (Group B, n = 10). This sign can be explained by diffusion of mediastinal hemorrhage through the peri-bronchovascular connective tissue; the close relationship between aortic isthmus, the side of most frequent rupture, and the left pulmonary hilum is the anatomical basis for this asymmetrical finding. Review of all radiological alterations of the plain chest film shows a statistically significant difference between groups A and B only for mediastinal widening and aortic knob alterations (p less than 0.05). A combination of some findings due to aortic injury (mediastinal widening, aortic knob alterations, shift of trachea and left main bronchus, left apical cap, left hilar blurring, obscuring of descending aorta) was typical of aortic rupture when four or more signs were found (33%); these findings were absent only in patients with negative aortogram (8%). In the remaining cases (60%), the plain chest film showed two or three of these signs in both groups, making it impossible to differentiate between patients with and without aortic injury.