High-resolution CT findings in patients with severe acute respiratory syndrome: a pattern-based approach

OBJECTIVE: We retrospectively reviewed high-resolution CT (HRCT) examinations of the lungs performed in 27 confirmed cases of severe acute respiratory syndrome (SARS). The HRCT findings at different phases of the illness were analyzed. CONCLUSION: A defined pattern of HRCT findings is observed in different phases of SARS, which is characterized by focal ground-glass and crazy paving patterns in a scattered distribution at presentation, followed by development of interstitial thickening, consolidation, pleural reaction, and scarring. Spontaneous pneumomediastinum is a distinct complication during the course of the illness.     

Late-stage adult respiratory distress syndrome caused by severe acute respiratory syndrome: abnormal findings at thin-section CT

PURPOSE: To evaluate thin-section computed tomographic (CT) abnormalities in patients in the intensive care unit during the late stage of adult respiratory distress syndrome (ARDS) caused by severe acute respiratory syndrome (SARS). MATERIALS AND METHODS: Eight patients in the late stage of ARDS (ie, more than 2 weeks after onset) were imaged with thin-section CT. Images were evaluated for ground-glass opacification, consolidation, interstitial thickening, evidence of fibrosis, and any other abnormalities. Patient records were reviewed, and relevant respiratory and ventilatory parameters, total steroid dose, and outcome were recorded. RESULTS: All patients received high-dose pulse methylprednisolone (minimum, 2.5 g total), and all patients who received ventilation received low-pressure, low-volume ventilation. Five patients received prolonged mechanical ventilation (for more than 14 days), one received ventilation for 72 hours, and two patients did not receive ventilation. Three patients died, four were discharged from the hospital, and one continued to require ventilation. Ground-glass opacification and interstitial thickening were present at CT in all eight patients. Consolidation was present in six patients. Three patients had evidence of fibrosis. Patients who received long-term ventilation, those who received short-term ventilation, and those who did not receive ventilation had similar pulmonary changes at CT. Pulmonary cysts, most of which were small (<1 cm), were present in five patients. Cysts were present in one patient who received only short-term low-pressure and low-volume ventilation and in one patient who received no mechanical ventilation. CONCLUSION: The CT features of late-stage ARDS caused by SARS are similar to those seen in late-stage ARDS of other causes, with no apparent differences between patients who do and patients who do not receive prolonged mechanical ventilation. The presence of cysts in one patient who received short-term and one patient who received no mechanical ventilation suggests that severe SARS-induced ARDS may independently result in cyst formation.     

严重急性呼吸综合征患者的胸部X线分析

目的：分析严重急性呼吸综合征(SARS）患的胸部X线表现及其与临床经过的关系。方法：分析了2003年4月17日至2003年5月20日经临床确诊的74例SARS患的胸部X线表现并与其临床经过进行了对照一大部分病例是CR系列胸片资料结果SARS患的肺部影像表现有索条斑片影、磨玻璃样影、片状影、团块影及弥漫混合影，SARS患肺部病变的分布以两肺中、下部为主(81％)。肺部病变的转归有4种模式：a)在发现病灶后3d～7d内基本吸收占39％；b)病变进展扩大占28％；c)2周以内在吸收过程中有复发占22％；以及d)持续进展在2周以上占11％。结论：SARS患肺部病变的发展有其自身的规律性，病变首次出现时间与病程密切相关，胸部X线表现是其诊断的重要依据。     

Severe acute respiratory syndrome: radiographic and CT findings

OBJECTIVE: We review the radiographic and CT findings in the lungs of 12 patients with severe acute respiratory syndrome (SARS) in an effort to describe the most common radiologic findings for this disease. CONCLUSION: The most common radiographic findings of SARS patients at presentation are unilateral or bilateral ground-glass opacities or focal unilateral or bilateral areas of consolidation. In hospitalized SARS patients, the abnormalities tend to progress to bilateral air-space consolidation. CT may reveal parenchymal disease in patients whose radiographs show normal results.     

严重急性呼吸综合征的影像学表现

目的 :分析严重急性呼吸综合征 (SARS)的X线及CT表现。方法 :回顾性分析 110例SARS患者的影像学表现。所有病例均有较完整的胸片资料 ,其中 5例同时进行了CT检查。结果 :SARS的影像学表现形式多样 ,主要表现为肺实质渗出性病变和肺间质渗出性病变两大类型。根据病变早期表现及进展情况 ,将其分为 5型 :①单纯局限型 3 4例 ,早期为肺内单一局限病灶 ,其后病变扩大或无明显增大 ;②局限 广泛型 2 0例 ,早期为肺内单一局限病灶迅速发展为病灶广泛分布 ;③多发型 2 8例 :早期即见肺内多发片状和 /或结节状病灶 ;④间质 实质型 2 2例 :早期为肺部间质性渗出 ,其后出现肺实质渗出性病变 ;⑤单纯间质型 6例 ,主要表现为肺间质渗出性病变。结论 :X线检查是发现SARS的最基本的影像学检查方法 ,CT能更好地显示病变。在SARS的诊治过程中 ,了解该病的影像学分型和分期有助于判断病情 ,指导治疗 ,估计预后。     

High-resolution CT findings of respiratory syncytial virus pneumonia after bone marrow transplantation

OBJECTIVE: The aim of this study was to describe the high-resolution CT findings of respiratory syncytial virus pneumonia in 20 patients who had undergone allogeneic bone marrow transplantation. MATERIALS AND METHODS: The study included 20 consecutive patients who developed respiratory syncytial virus pneumonia after bone marrow transplantation and who had high-resolution CT of the chest performed within 24 hr after the onset of symptoms. The CT scans were reviewed by two chest radiologists who assessed the pattern and distribution of findings. RESULTS: Bone marrow transplantation was performed on 12 male and eight female patients ranging from 3 to 48 years old (mean age, 25 years) for treatment of various forms of leukemia (n = 12), severe aplastic anemia (n = 6), Fanconi's syndrome (n = 1), and paroxysmal nocturnal hemoglobinuria (n = 1). Sixteen patients (80%) had abnormal CT findings. The predominant patterns of abnormality on high-resolution CT scans were small centrilobular nodules (10/20, 50%), air-space consolidation (7/20, 35%), ground-glass opacities (6/20, 30%), and bronchial wall thickening (6/20, 30%). The abnormalities were distributed in the central and peripheral areas of the lungs in nine cases, only in the periphery in five cases, and only in the central regions in two cases. The abnormalities were bilateral and asymmetric in distribution in 13 patients, bilateral and symmetric in two patients, and unilateral in one patient. CONCLUSION: The most common high-resolution CT findings in patients with respiratory syncytial virus pneumonia after bone marrow transplantation consist of small centrilobular nodules and multifocal areas of consolidation and ground-glass opacities in a bilateral asymmetric distribution.     

SARS的CT表现及动态变化

目的 探讨严重急性呼吸综合征的CT表现及动态变化。方法 对60例严重急性呼吸综合征患者进行X线胸片(已有另文报道)和高分辨率CT(HRCT）的动态观察。患者在入院时及入院后连续进行CT观察检查，间隔4～6d。结果 发病初期进行影像检查者25例，CT表现为小片状影像者22例，占88.0％(22／25)；其中类圆形磨玻璃样影20例，占80．0％(20／25)。其余35例在进行影像检查时已发病3d，病变已经有所进展。3d后患者肺部均出现多发大片状影像，其中呈单一磨玻璃样影者10例，占16.7％(10／60)；磨玻璃样影合并实变影者4：5例，占75．0％(45／60)；主要呈肺实变影者5例，占8.3％(5／60)。入院10～14d内病变明显进展者50例，占83.3％(50／60)；病变范围减少者10例，占16．7％(10／60)；合并肺间质增生者4例，占6．7％。结论 HRCT可清楚反映SARS病变的密度、形态和范围，以及显示肺间质增生改变。因而，HRCT可以用于早期诊断和了解病变的动态变化。     

Pulmonary sequelae in convalescent patients after severe acute respiratory syndrome: evaluation with thin-section CT

PURPOSE: To prospectively evaluate lung parenchyma on paired inspiration-expiration thin-section computed tomographic (CT) scans in patients recovering from severe acute respiratory syndrome (SARS). MATERIALS AND METHODS: After the institutional review board approved the study and written consent was obtained from patients, 40 patients (25 female, 15 male; mean age, 42.8 years +/- 12.3 [standard deviation]) underwent thin-section CT at 51.8 days +/- 20.2 after onset of SARS symptoms. Twenty of the 40 patients underwent follow-up thin-section CT at 140.7 days +/- 26.7 after symptom onset. Lung findings were scored according to extent and then grouped in three categories (ground-glass opacity, interstitial opacity, and air trapping) for analysis. Mean CT scores for each finding in the various patient subgroups were compared by using the Mann-Whitney test. Clinical parameters and scores were evaluated for correlation by using Spearman rank correlation analysis. Mean scores for each finding were compared between the two serial examinations by using the Wilcoxon matched-pairs signed rank test. RESULTS: Air trapping, ground-glass opacity, and reticulation were found in 37 (92%), 36 (90%), and 28 (70%) of 40 patients, respectively, at initial thin-section CT examination and in 16 (80%), 14 (70%), and 10 (50%) of 20 patients, respectively, at follow-up examination. Scans from patients with adult respiratory distress syndrome (ARDS) had a significantly higher score for ground-glass opacity than did those from patients without ARDS (P = .009). A comparison of scores for the serial thin-section CT examinations indicated a significant reduction in the extent of ground-glass opacity (P < .001) and interstitial opacity (P < .001) but not in that of air trapping (P = .38) at follow-up examination. At initial thin-section CT, scores for ground-glass opacity, interstitial opacity, and air trapping correlated with age; those for ground-glass opacity and air trapping, with peak C-reactive protein level. At the second examination, scores for ground-glass opacity and interstitial opacity correlated with peak lactate dehydrogenase level; that for air trapping, with age and peak C-reactive protein level. CONCLUSION: Thin-section CT scores correlated with clinical and laboratory parameters in patients after SARS. Although ground-glass opacity and interstitial opacity resolve over time, air trapping persists.     

Acute respiratory distress syndrome and acute interstitial pneumonia: comparison of thin-section CT findings

PURPOSE: The purpose of this work was to compare the thin-section CT findings of acute respiratory distress syndrome (ARDS) with those of acute interstitial pneumonia (AIP). METHOD: The thin-section CT scans from 25 patients with ARDS and 25 with AIP were independently assessed by two observers without knowledge of clinical and pathologic data. The presence, extent, and distribution of various CT findings were independently analyzed. RESULTS: Honeycombing was seen more frequently in lobes of patients with AIP (26%) than in lobes with ARDS (8%) (p < 0.001). Compared with patients with ARDS, a greater number of patients with AIP had a predominantly lower lung zone distribution (p < 0.05) and a symmetric distribution (p < 0.05) of the parenchymal abnormalities. CONCLUSION: Patients with AIP have a greater prevalence of honeycombing and are more likely to have a symmetric bilateral distribution and a lower lung zone predominance than patients with ARDS. However, significant overlap exists among the CT findings.     

耳硬化症的高分辨率CT表现

目的 探讨耳硬化症的HRCT表现特征.方法 回顾性分析34例61耳临床诊断明确的耳硬化症的HRCT表现.结果 55耳HRCT表现耳囊骨密度减低区,6耳HRCT未发现异常.HRCT表现异常的55耳中,6耳仅表现为前庭窗前方耳囊低密度区,6耳表现为前庭窗前方耳囊低密度区、镫骨底板增厚及耳蜗周围低密度区,11耳表现为前庭窗前方耳囊低密度区、前庭窗后方低密度区及镫骨底板增厚,20耳表现为前庭窗前方耳囊低密度区和镫骨底板增厚,10耳表现为前庭窗前方耳囊低密度区及耳蜗周围耳囊低密度影,2耳仪表现为耳蜗周围耳囊低密度区.结论 HRCT可显示耳囊骨质及镫骨底板异常,有助于进一步证实耳硬化症诊断.     

严重急性呼吸综合征患者肺内残留病变CT表现的随访观察

目的 探讨严重急件呼吸综合征（SARS）患者临床治疗后，CT复查肺内残留病变的动态变化情况。方法 对124例治疗后的SARS患者进行CT复查随访，失访13例，资料完整111例，对平均病程第3、6、12及18个月行螺旋CT检杏的结果进行对比分析，总结其影像动态变化的特征。结果 病程18个月内，相继有70例（占63．1％）患者肺内CT表现恢复止常。6、12、18个月时CT主要征象：（1）磨玻璃样病变残留率分别为33．3％（37／111）、24．3％（27／111）、20．7％（23／111）。（2）小叶间隔或小叶内间质增厚残留率分别为37．8％（42／111）、28．8％（32／111）、25．2％（28／111）。以上2种主要病变在随访期内的总体变化经对比分析X^2检验，差异有统计学意义（P〈0．01）。（3）胸膜下弧线影15例，随访期内病变有不同程度的吸收，但无一例病变消失。（4）不规则纤维条索影18个月时残留率17．1％（19／111）。少见征象：（1）实变病灶1例，病程第12个月完全吸收。（2）空洞病灶2例，1例于病程第12个月基本吸收，1例随访期内末完全吸收。（3）牵拉性支气管扩张1例，随访期内无明显变化。（4）小结节灶3例，1例病程第12个月基本吸收，2例无明显变化。结论 病程第18个月SARS患者肺内磨玻璃样病变残留率为20．7％。17．1％的患者残留局限性肺间质纤维化改变。对肺内残留磨玻璃样病变的患者继续定期随访间隔6～12个月为宜，其他患者可以延长随访间隔时间至12个月以上。     

耳硬化症的高分辨率CT表现

目的 探讨耳硬化症的HRCT表现特征.方法 回顾性分析34例61耳临床诊断明确的耳硬化症的HRCT表现.结果 55耳HRCT表现耳囊骨密度减低区,6耳HRCT未发现异常.HRCT表现异常的55耳中,6耳仅表现为前庭窗前方耳囊低密度区,6耳表现为前庭窗前方耳囊低密度区、镫骨底板增厚及耳蜗周围低密度区,11耳表现为前庭窗前方耳囊低密度区、前庭窗后方低密度区及镫骨底板增厚,20耳表现为前庭窗前方耳囊低密度区和镫骨底板增厚,10耳表现为前庭窗前方耳囊低密度区及耳蜗周围耳囊低密度影,2耳仪表现为耳蜗周围耳囊低密度区.结论 HRCT可显示耳囊骨质及镫骨底板异常,有助于进一步证实耳硬化症诊断.     

耳硬化症的高分辨率CT表现

目的 探讨耳硬化症的HRCT表现特征.方法 回顾性分析34例61耳临床诊断明确的耳硬化症的HRCT表现.结果 55耳HRCT表现耳囊骨密度减低区,6耳HRCT未发现异常.HRCT表现异常的55耳中,6耳仅表现为前庭窗前方耳囊低密度区,6耳表现为前庭窗前方耳囊低密度区、镫骨底板增厚及耳蜗周围低密度区,11耳表现为前庭窗前方耳囊低密度区、前庭窗后方低密度区及镫骨底板增厚,20耳表现为前庭窗前方耳囊低密度区和镫骨底板增厚,10耳表现为前庭窗前方耳囊低密度区及耳蜗周围耳囊低密度影,2耳仪表现为耳蜗周围耳囊低密度区.结论 HRCT可显示耳囊骨质及镫骨底板异常,有助于进一步证实耳硬化症诊断.     

重型颅脑损伤合并急性呼吸窘迫综合征的相关因素

本文选择重型颅脑损伤合并ARDS患者 36例 ,比较分析格拉斯哥昏迷评分 (GCS)、生理指标及治疗情况与ARDS的关系。结果显示 ,持续高颅压 (ICH)、继发性的高血压和医源性因素与ARDS有密切关系     

Musculoskeletal complications of severe acute respiratory syndrome

The severe acute respiratory syndrome (SARS) was a highly infectious pneumonia that emerged in southern China early in 2003. A large number of SARS patients experienced large joint arthralgia, although this was, for the most part, not associated with any abnormality on magnetic resonance imaging. The main musculoskeletal complications of SARS were osteonecrosis and reduced bone mass, and these arose not from the disease per se but as a sequel to treatment of SARS with high-dose steroids. SARS patients were almost universally steroid naive with no other known predisposition to osteonecrosis. Prevalence of osteonecrosis in SARS patients treated with steroids ranged from 5% to 58%. Osteonecrosis most commonly affected the proximal femur and femoral condyles and was most strongly related to cumulative steroid dose and duration of steroid therapy. Osteonecrosis risk was <1% in patients receiving <3 g and 13% in patients receiving >3 g cumulative prednisolone-equivalent dose. Most osteonecrotic lesions tended to improve with a reduction in lesion volume over a follow-up period of 5 years. The relative reduction in osteonecrotic lesion volume was greatest for smaller lesions.     

Clinical implications of CT findings in mesenteric venous thrombosis at admission

Purpose

The main aim of this study was to evaluate the association of computed tomography (CT) findings at admission and bowel resection rate in patients with mesenteric venous thrombosis (MVT). It was hypothesized that abnormal intestinal findings on CT were associated with a higher bowel resection rate.

Methods

Retrospective study of MVT patients treated between 2004 and 2017. CT images at admission and at follow-up were scrutinized according to a predefined protocol. Successful recanalization was defined as partial or complete recanalization of the portomesenteric venous thrombosis at the latest CT follow-up (n =?70).

Results

We studied 102 patients (median age 58 years, 61 men). Lifelong anticoagulation was initiated in 64 patients, and bowel resection rate was 17%. No referral letter indicated suspicion of MVT, whereas three indicated suspected intestinal ischemia. Previous venous thromboembolism was associated with increased bowel resection rate (p?=?0.049). No patient with acute pancreatitis (n?=?17) underwent bowel resection (p?=?0.068). The presence of mesenteric oedema (p?=?0.014), small bowel wall oedema (p?<?0.001), small bowel dilatation (p?=?0.005), and ascites (p?=?0.021) were associated with increased bowel resection rate. Small bowel wall oedema remained as an independent risk factor associated with bowel resection (OR 15.8 [95% CI 3.2–77.2]). Successful thrombus recanalization was achieved in 66% of patients.

Conclusion

The presence of abnormal intestinal findings secondary to MVT confers an excess risk of need of bowel resection due to infarction. Responsible physicians should therefore scrutinize the CT images at diagnosis together with the radiologist to better tailor clinical surveillance.

     

SARS的临床X线分析

目的 探讨严重急性呼吸综合征(severe acute respiratory syndrome，SARS)的X线特征。方法 对29例已确诊为SARS患者的临床资料和X线表现进行总结分析。结果 本地区有SARS爆发流行。本组病例均以发热为首发症状。15例(51．7％)病人有咳嗽，多为干咳。10例(34．5％)患者入院前使用抗生素治疗无明显效果。血白细胞计数正常18例(62．1％)、降低11例(37．9％)；血小板计数轻度降低7例(24，1％)；肝功能异常16例(55．2％)，主要表现为血清酶学的改变。肺部体征轻微，与X线胸部阴影显著的表现不相符。其胸部X线表现为：肺纹理增多伴网状阴影7例(24，1％)，磨玻璃状阴影3例(10．4％)，斑片状阴影12例(41．4％)，片状阴影7例(24．1％)。X线改变出现晚、吸收慢。结论 SARS患者的X线表现各异。结合流行病学史、临床表现、实验室检查和影像学检查可明确诊断。