慢性阻塞性肺疾病各中医证型的CT肺功能评估及临床肺功能检查参数分析

目的:对慢性阻塞性肺疾病(COPD)患者行CT肺功能评估,探究其与肺功能检查的相关性,并分析比较COPD各中医证型的肺功能参数与CT肺功能评估结果,为COPD中医辨证提供参考依据。方法:根据COPD中医诊断标准对其进行分型,完成肺功能、CT检查,并对CT图像进行三维重建,计算肺气肿指数(LAA%)。结果:痰浊壅肺证、痰热蕴肺证、痰瘀阻肺证、肺肾气虚证之间第1秒用力呼气容积占预计值百分比(FEV1占预计值%)及第1秒用力呼气容积占用力肺活量的百分比(FEV1/FVC%)比较差异均有统计学意义(均P<0.01),FEV1占预计值%、FEV1/FVC%由痰浊壅肺证→痰热蕴肺证→痰瘀阻肺证→肺肾气虚证逐渐变小;LAA%由痰浊壅肺证→痰热蕴肺证→痰瘀阻肺证→肺肾气虚证逐渐增大。LAA%与FEV1占预计值%呈负相关(r=-0.775,P=0.001);LAA%与FEV1/FVC%呈负相关(r=-0.458,P=0.001)。结论:CT肺功能评估与临床肺功能检查之间呈负相关,随着肺通气功能的降低,COPD患者的LAA%随之升高,说明CT评估肺功能是可行的。COPD各中医证型之间LAA%、肺功能参数存在差异,可为COPD辨证分型提供一定的参考价值。     

Hypoxemia and liver cirrhosis (hepatopulmonary syndrome) in eight patients: comparison of the central and peripheral pulmonary vasculature

PURPOSE: To evaluate the pulmonary vasculature in patients with hepatopulmonary syndrome. MATERIALS AND METHODS: Conventional computed tomographic (CT) scans in eight patients with hepatopulmonary syndrome were retrospectively evaluated to compare the diameters of the pulmonary trunk, right and left main pulmonary arteries, and peripheral pulmonary vasculature in the right posterior basal segment with those in eight healthy subjects and in four patients with normoxemic cirrhosis. With thin-section CT, the ratio of segmental arterial diameter to adjacent bronchial diameter in the right lower lobe in four patients with hepatopulmonary syndrome was compared with that in four patients with normoxemic cirrhosis. RESULTS: In patients with hepatopulmonary syndrome, the peripheral pulmonary vasculature was significantly dilated compared with that in control subjects and in patients with normoxemic cirrhosis (P = .002); however, the central pulmonary arteries were not significantly dilated (P > .05). At thin-section CT, the ratio of segmental arterial diameter to adjacent bronchial diameter was significantly greater than that in patients with normoxemic cirrhosis (P < .05). CONCLUSION: In patients with hepatopulmonary syndrome, the peripheral pulmonary vasculature is significantly dilated. Dilatation of the peripheral pulmonary vasculature may be helpful in the diagnosis of hepatopulmonary syndrome.     

Horseshoe lung: clinical, pathologic, and radiologic features and a new plain film finding

Horseshoe lung is a rare congenital malformation in which an isthmus of pulmonary parenchyma extends from the right lung base across the midline behind the pericardium and fuses with the base of the left lung. Six cases are presented and eight previously published case reports are reviewed. Eleven of these 14 cases occur in conjunction with scimitar syndrome, the complex of anomalies including hypoplasia of the right lung, anomalous right pulmonary venous return, and anomalous arterial supply to the right lung. Differentiation of scimitar syndrome from horseshoe lung can be made on the plain chest film, if, in addition to the typical radiographic findings of scimitar syndrome, there is evidence of a fine linear density in the medial aspect of the left base representing the lateral extent of the pulmonary isthmus. Recognition of horseshoe lung is important because children present in the first few years of life with significant respiratory symptoms, whereas the scimitar syndrome alone is usually discovered fortuitously after the first decade of life.     

The radiographic spectrum of pulmonary complications in burn victims.

The spectrum of pulmonary complications in 28 of 66 burn victims is analyzed according to time of onset and resultant radiographic features. Immediately recognizable pulmonary abnormalities are usually due to chemical pulmonary edema and inhalation pneumonitis. Complications manifested 2-5 days after injury include pulmonary microembolism, adult respiratory distress syndrome, and atelectasis. Delayed complications are major pulmonary embolism, pneumonia, and adult respiratory distress syndrome. In this series, 25 patients (89%) developing pulmonary complications died. The critical role of serial chest radiographs in the evaluation and management of burn victims is emphasized.     

Scimitar syndrome: confirmation of diagnosis by a noninvasive technique (MRI)

Scimitar syndrome is a rare congenital pulmonary anomaly that is characterized by hypoplasia of the right lung and the right pulmonary artery with anomalous pulmonary venous drainage to the inferior vena cava or the right atrium. Very few reports are available that analyze the value of magnetic resonance imaging (MRI) in establishing the diagnosis. We present a case with Scimitar syndrome in which anomalous pulmonary venous return was confirmed by cine MRI.     

Pulmonary complications associated with the prune-belly syndrome.

Eight patients are presented who demonstrate many of the pulmonary complications seen in the prune-belly syndrome. The patients are divided into two major groups: Group I includes pulmonary hypoplasia; Group II includes lobar atelectasis and pneumonia. The etiology, pathogenesis, and radiographic features of these complications are discussed. Pulmonary complications become more important as renal dialysis and transplantation spare more of these patients from an early uremic death. Prompt recognition of the type and the extent of pulmonary disease in patients with the prune-belly syndrome may lead to increased survival.     

Pulmonary fat embolism: common and unusual computed tomography findings

Fat embolism syndrome (FES) is a common complication of fractures, usually of the long bones and pelvis. Common computed tomography findings of pulmonary FES include areas of consolidation, ground-glass opacities, and small nodules of various sizes, whereas filling defects in pulmonary arteries are rarely described in nonfulminant syndromes. We present an unusual case of nonfulminant pulmonary FES in which computed tomography disclosed multiple macroscopic pulmonary fat emboli associated to diffuse ground-glass attenuation in both lungs.     

Rendu-Osler-Weber syndrome presenting with pulmonary arteriovenous fistula

A pulmonary arteriovenous fistula is an abnormal connection between pulmonary arteries and veins. Patients with Rendu-Osler-Weber syndrome may present with this vascular malformation, which is a typical finding of the disease. Approximately 5-15% of Rendu-Osler-Weber syndrome patients have pulmonary arteriovenous malformations (AVM) and there is usually a family history of AVM in these patients. The malformations are usually located in the lower lobes. In this paper, I describe a 49-year-old male patient with dyspnoea, cough, haemoptysis and epistaxis. Physical examination showed nasal telangiectasias, cyanosis of the lips and nails, and a systolic bruit over the left lung. Chest X-ray revealed a 5-cm mass in the left lower lobe and after magnetic resonance examination, together with 3-D magnetic resonance angiography, it was demonstrated to be a pulmonary arteriovenous fistula. The history of a niece with a similiar history of suspected pulmonary arteriovenous fistula led me to consider the possibility of Rendu-Osler-Weber syndrome presenting with a pulmonary arteriovenous fistula.     

Pulmonary artery aneurysms and pseudoaneurysms in adults: findings at CT and radiography

OBJECTIVE: The purpose of this pictorial essay is to illustrate the radiologic manifestations of pulmonary artery aneurysms and pseudoaneurysms with emphasis on the findings on contrast-enhanced CT. CONCLUSION: Pulmonary artery aneurysms and pseudoaneurysms are uncommon. Most are caused by trauma, often iatrogenic, infection, and Beh?et's syndrome. Less common causes include pulmonary hypertension, congenital heart disease, neoplasms, and connective tissue disease. Recognition of pulmonary artery aneurysms and pseudoaneurysms is important because of the high morbidity and mortality rates of rupture.     

Eisenmenger syndrome and idiopathic pulmonary arterial hypertension: do parenchymal lung changes reflect aetiology?

AIM: To document the pulmonary vascular changes on thin-section computed tomography (CT) in patients with Eisenmenger syndrome and idiopathic pulmonary arterial hypertension, and to determine whether there is any correlation with pulmonary arterial pressures or the aetiology of pulmonary hypertension. MATERIAL AND METHODS: From the National Pulmonary Hypertension Database, we identified eight patients with idiopathic pulmonary arterial hypertension and 20 patients with Eisenmenger syndrome (secondary to a ventriculoseptal defect) who had also undergone contrast-enhanced thin-section CT. CT studies were reviewed for the presence of centrilobular nodules, mosaicism, neovascularity, and bronchial artery hypertrophy. Haemodynamic data were also reviewed. RESULTS: Centrilobular nodules, mosaicism, and neovascularity were seen in both patient groups (p>0.05). A significantly higher number of enlarged bronchial arteries were seen in patients with Eisenmenger syndrome. There was no correlation with pulmonary arterial pressures. CONCLUSION: Patients with idiopathic pulmonary arterial hypertension and Eisenmenger syndrome demonstrated similar pulmonary vascular changes on CT. These changes did not predict the underlying cause of pulmonary hypertension or its severity.     

Wilson-Mikity综合征的X线及CT诊断

目的:探讨X线及CT在Wilson-Mikity综合征诊断中的应用价值。方法:回顾性分析16例临床确诊的Wilson-Mikity综合征患儿的临床及影像学资料。16例患儿在疾病的早、中、晚期均进行了胸部X线检查,7例行CT检查。结果:7例出生后1周内胸片未见异常;16例出生后2～3周内胸片显示:13例双肺弥漫性片状和索条状间质浸润,14例其间有小的囊状透亮区出现;双肺基底部多个小囊状病灶,其中5例融合扩大并扩展到上肺野以下肺野明显,肺透亮度增加。7例胸部CT表现为间质性肺炎、小囊状透亮影及小叶性肺气肿。结论:X线及CT能反映Wilson-Mikity综合征的特征性影像表现,对诊断有重要价值,在明确病灶范围及形态上,CT较X线更有优势。     

Anatomical associations and radiological characteristics of Scimitar syndrome on CT and MR

PurposeTo report the anatomical associations and radiological characteristics of Scimitar syndrome on CT and MR.Materials and methodsRetrospective review of the medical records between February 2001 and February 2016 was performed. To identify patients, radiological reports were queried for “Scimitar” or “partial anomalous pulmonary venous return.” Patients with radiological findings of Scimitar syndrome were included. Patients without cross-sectional imaging were excluded. Patients' demographics, radiologic images, and medical notes were reviewed. Two radiologists re-read the available imaging studies. Images were reviewed for Scimitar syndrome confirmation, number and location of Scimitar vein drainage, number of lobes drained by the Scimitar vein, and right pulmonary artery and lung hypoplasia. In addition, the number of pulmonary veins draining into the left atrium, left sided anomalous pulmonary veins, congenital heart disease, aortic arch anomalies, cardiac dextroposition, right ventricular enlargement, pulmonary artery enlargement, and elevated QP:QS ratios were identified. Other associated anomalies including the presence of an anomalous feeding artery and pulmonary sequestration, abnormal lobar pattern, localized bronchiectasis, horseshoe lung, accessory diaphragm, diaphragmatic hernia, vertebral anomalies, and genitourinary tract anomalies were reviewed.ResultsSixteen patients (3 males, 13 females; mean age 39.5 years, range 14 days–72 years) with confirmed Scimitar syndrome on CT and MR imaging were identified. The Scimitar vein drained to the infra-diaphragmatic inferior vena cava (IVC) in ten patients and to the supra-diaphragmatic IVC in six patients. The most common associated anomalies were right ventricle enlargement (93.3%), variant lobar pattern of the right lung (92.9%), enlarged pulmonary arteries (60%), and cardiac dextroposition (50%).ConclusionRecognizing the radiologic characteristics and anatomical associations of Scimitar syndrome is important as features of the primary condition and associated anomalies may have implications in surgical management.     

Iliofemoral vein thrombosis and pulmonary embolism associated with a transient ischemic attack in a patient with antiphospholipid syndrome

Several clinical conditions, such as deep vein thrombosis, cerebral infarct, pulmonary infarct, skin ulcers, renal failure, and habitual abortion, are thought to be associated with the antiphospholipid syndrome. The authors describe a 32-year-old woman who had characteristics of the antiphospholipid syndrome including increased immunoglobulin G-cardiolipin antibody titers, iliofemoral vein thrombosis, pulmonary embolism, headache, visual disturbances, and habitual abortion. During hospitalization, she suddenly experienced right-sided weakness. A Tc-99m HMPAO brain scan showed the probability of a transient ischemic attack in the left frontotemporal cortex.     

The role of spiral multidetector dynamic CT in the study of Williams-Campbell syndrome

Williams-Campbell syndrome is a cystic bronchiectatic disease secondary to deficiency or defect of cartilaginous plates in the wall of the airways. In the literature, two main forms are suggested: congenital and acquired (post-infectious). The most frequent symptoms are represented by recurrent pulmonary infections from childhood. Multislice spiral dynamic CT has a major role in the study of cystic pulmonary disease and in differentiating Williams-Campbell syndrome from the other causes of cystic bronchiectasis, in which even lung function tests can give deceptive results.     

造血干细胞移植术后肺部并发症的CT表现

造血干细胞移植术后不同肺部并发症具有不同的时间分布特点。早期（术后30d内）多见感染性病变和非感染性病变,以肺水肿、弥漫性肺泡出血以及特发性肺炎综合征为主。中期（术后30~100d）感染性病变多为巨细胞病毒、侵袭性真菌感染,非感染性病变以特发性肺炎综合征、急性移植物抗宿主病、急性放射性肺炎以及肺细胞溶解性血栓为主。后期（术后100d以后）多以非感染性病变为主,慢性移植物抗宿主病最常见。综述早期、中期、晚期不同胸部并发症的CT表现。     

Scimitar syndrome: morphological diagnosis and assessment of hemodynamic significance by magnetic resonance imaging

Scimitar syndrome has a variable presentation depending on the age at which the diagnosis is made. We report a case of a young woman (age 18 years) with suspected right pulmonary hypoplasia in whom a scimitar syndrome was diagnosed. Using MRI morphological findings and hemodynamic significance of the syndrome were assessed. Left-to-right shunt was calculated from blood flow measurements performed in the ascending aorta, the main pulmonary artery, and the aberrant scimitar vein.     

Radiologic features of all-trans-retinoic acid syndrome.

OBJECTIVE: The treatment of acute promyelocytic leukemia with all-trans-retinoic acid (ATRA) sometimes results in a syndrome characterized by fever, respiratory distress, weight gain, pleural and pericardial effusion, and pulmonary infiltrates. We report the radiologic features of ATRA syndrome. MATERIALS AND METHODS: During the past 5 years, 69 patients with acute promyelocytic leukemia were treated with ATRA. Of this group, 15 patients developed ATRA syndrome. Serial chest radiographs of the 15 patients with ATRA syndrome were evaluated retrospectively for the presence of pleural effusion, pulmonary nodules, consolidation, ground-glass opacity, septal lines, increased pulmonary blood volume, peribronchial cuffing, and air bronchogram. Also, we measured the cardiothoracic ratio and the vascular pedicle width. RESULTS: Chest radiographs showed increased cardiothoracic ratio in 13 of the 15 patients, increased vascular pedicle width in 13, increased pulmonary blood volume in 13, septal lines in nine, peribronchial cuffing in nine, ground-glass opacity in nine, consolidation in seven, and nodules in seven. Pleural effusion was noted in 11 of the 15 patients, and air bronchogram was noted in five of the 15 patients. Pulmonary hemorrhage developed in three patients who were being treated with ATRA; they showed bilateral, diffuse, poorly defined nodules and ground-glass opacity on radiography. CONCLUSION: Most patients with ATRA syndrome have abnormal findings on chest radiographs, and the abnormalities are similar to those of pulmonary edema.     

Pulmonary vascular disease

This review article discusses three topics related to pulmonary vascular disease: 1) pulmonary vascular changes associated with portal hypertension, 2) ANCA-associated pulmonary vasculitis, and 3) Takayasu's arteritis. Hepatopulmonary syndrome and pulmonary hypertension have recently been reported as pulmonary vascular changes accompanied with portal hypertension. Endogenous vasoactive agents that reach the pulmonary circulation through porto-systemic shunt vessels are thought to contribute to these vascular changes. In ANCA-associated vasculitis, hemorrhage, interstitial pneumonitis, and nodular lesions are common manifestations in the lung. In Takayasu's arteritis, CT occasionally demonstrates mosaic attenuation owing to pulmonary arteritis and peripheral reticulolinear changes probably due to thromboembolism.     

一氧化氮治疗急性呼吸窘迫综合征的临床进展

急性肺损伤(ALI)/急性呼吸窘迫综合征(ARDS)是在严重感染、休克、创伤及烧伤等非心源性疾病过程中,肺毛细血管内皮细胞和肺泡上皮细胞损伤造成弥散性肺间质及肺泡水肿,导致的急性低氧性呼吸功能不全或衰竭.目前对于ARDS的治疗手段众多,其中之一的选择性肺血管扩张剂一氧化氮(NO)于20世纪后期开始进入临床治疗领域.NO...     

Hermansky-Pudlak syndrome: radiography and CT of the chest compared with pulmonary function tests and genetic studies

OBJECTIVE: The objective of our study was to describe the chest radiographic and high-resolution CT findings in patients with Hermansky-Pudlak syndrome and to correlate the radiologic findings with age, causative gene, and pulmonary function. SUBJECTS AND METHODS: Sixty-seven patients with Hermansky-Pudlak syndrome underwent high-resolution CT of the chest. A scoring system based on the extent of pulmonary involvement and specific high-resolution CT findings was used, and the findings were compared with patient age and the results of pulmonary function and genetic studies. Fifty-eight (87%) of the 67 patients also underwent chest radiography. These radiographs were compared with the high-resolution CT scans. RESULTS: High-resolution CT was more sensitive than chest radiography in evaluating the extent of pulmonary disease in patients with Hermansky-Pudlak syndrome. All patients with mild findings on high-resolution CT scans had normal findings on chest radiographs. Common chest radiographic findings included reticulonodular interstitial pattern, perihilar fibrosis, and pleural thickening. High-resolution CT showed septal thickening, ground-glass opacities, and peribronchovascular thickening. For patients with Hermansky-Pudlak syndrome who were 30 years old or younger, high-resolution CT findings were usually minimal. Among patients who were older than 30 years, the 34 patients with HPS1 mutations had a score of 1.38+/-0.18 (mean+/-standard error of the mean) on high-resolution CT. This score is significantly greater than the score for the 11 patients without HPS1 mutations (0.36 +/- 0.15) (p < 0.001). The score based on high-resolution CT findings inversely correlated with percentage of forced vital capacity and was useful in defining the progression of interstitial disease. CONCLUSION: High-resolution CT provides a good radiologic monitor of disease status and progression in patients with Hermansky-Pudlak syndrome and correlates well with patient age, extent of pulmonary dysfunction, and genetic findings.