胸部创伤的X线—CT诊断

探讨闭合性及开放性胸部创伤的ＣＴ表现及诊断价值，笔者对６９全胸部创伤者进行临床，Ｘ线平片，ＣＴ扫描诊断，对Ｘ线平片与ＣＴ片进行了对比分析。结果 ＣＴ表现为肺挫伤５１例，肺撕裂伤１２例，Ｘ线平片分别漏，误诊２１例和７例。结论ＣＴ能明确创伤病变的部位，性质，程度，敏感性和特异性高，为临床诊断及处理提供较单纯Ｘ线平片更多的信息及可靠的依据，为胸部创伤最重要的检查方法之一。     

胸膜间皮瘤影像学诊断的优选

目的：评价各种影像检查在胸膜间皮瘤诊断中的作用。材料与方法：回顾性分析４７例经临床、手术及病理证实的胸膜间皮瘤的影像学资料，所有病人均经胸部Ｘ线平片检查；２７例经超声检查，其中１１例在超声引导下进行了经皮胸膜活；１０例经ＣＴ检查；１７例经ＭＲＩ检查。结果：胸部Ｘ线平片表现为单发肺野内肿块４例，波浪状胸膜增厚、多发性胸膜结节或肿块３３例，纵隔影增宽３例，心包积液样改变３例，仅表现为胸腔积液４例。超声     

脊柱转移瘤的CT诊断：附41例分析

笔者报告４１例脊柱转移瘤的ＣＴ表现。原发灶以肺癌、乳腺癌和肝癌较多见。ＣＴ表现主要呈溶骨性（６８．３％），亦可呈成骨性（１４．６％）或混合性（１７．１％）。本组４１例中２０例作平片Ｘ线检查。ＣＴ扫描在发现和估价病变方面较平片Ｘ线检查为敏感，如ｘ线平片发现骨破坏仅为５５％，ＣＴ扫描为１００％；Ｘ线平片显示椎管受累为１４％，ＣＴ扫描为６５％。对脊柱转移瘤的ＣＴ表现、ＣＴ诊断和鉴别诊断价值等进行了讨论。     

胸外伤X线平片和CT检查的评价

Ｘ线检查是发现胸部创伤最好的手段［１４］。ＣＴ的广泛应用，使更多的外伤病人特别是多发伤病人得以早期诊治。笔者从１９９３年起研究胸外伤病人的Ｘ线检查应用，根据外伤患者就诊的特点使之得以及时、合理、准确的检查。资料与方法本组１２４例除进行常规Ｘ线平片检查外，还接受了ＣＴ检查。由于胸部创伤病人多为急诊，大部分病例在Ｘ线平片检查时仅采用了仰卧前后位；少部分病人在摄取直立后前位胸部平片外，根据病情的允许和需要加摄特殊体位。ＣＴ扫描采用日本岛津４８００－ＴＦＣＴ机，以１０ｍｍ层厚进行胸部检查，部分病人增加…     

胸部疾病CT诊断的评价

本文通过２６１例Ｘ线与ＣＴ诊断比较，评价胸部ＣＴ在胸部疾病诊断中的价值。结果是（１）弥漫病变ＣＴ诊断正确率为８７．５％，Ｘ线为５８．９％；（２）纵隔肿块ＣＴ诊断正确率为６０．１％，Ｘ线为４８．０％；（３）胸膜肿块ＣＴ诊断正确率为７５．０％，Ｘ线为６６．６％；（４）肺段肺叶阴影ＣＴ诊断正确率为７１．０％，Ｘ线为６８．４％；（５）球块阴影ＣＴ诊断正确率为７３．０％，Ｘ线为７１．０％；（６）斑片阴影ＣＴ诊断正确率为６６．０％，Ｘ线为７２．０％。分析材料表明在Ｘ线检查基础上根据胸部疾病基本影像，在普遍胸部ＣＴ检查上附加高分辨、薄层及增强扫描可提高一些ＣＴ征象发现率，同时可以使胸部疾病ＣＴ诊断水平超过本文报道的水平。     

腕关节外伤X线平片,CT及三维CT对比研究

对１６例腕关节外伤患者的Ｘ线平片，ＣＴ及三维ＣＴ３种检查进行对比研究，评估在临床诊断中的价值。材料与方法１６例中，男８例，女８例，平均年龄４１岁。全部病例均经Ｘ线平片，常规ＣＴ和三维ＣＴ成像，Ｘ线平片包括常规位置和特殊位置。ＣＴ机为ＳｏｍａｔｏｍＣＲＦ。     

胸腔入口区肿瘤影像诊断的评价

目的：评价Ｘ线、ＣＴ及ＭＲＩ等影像检查在胸腔入口区肿瘤的诊断价值。材料与方法：回顾性分析４４例经病理证实的神经源性肿瘤、肺上沟癌、甲状腺瘤、支气管囊肿、脂肪瘤等肿瘤。所有病人均有正侧位Ｘ线平片检查；２８例行ＣＴ检查；４０例行ＭＲＩ检查。结果：４２例经Ｘ线发现肿瘤阴影。２８例行ＣＴ检查，定位正确者２７例；定性正确者２５例，定性诊断正确率为８９％。４０例ＭＲＩ定位均正确；定性正确者３６例，定性诊断正确率为９０％。结论：Ｘ线平片仍是首选方法，是发现肿瘤的重要手段。ＣＴ检查对组织成分的显示优于Ｘ线检查，显示钙化、骨质破坏、坏死及脂肪等均较满意。非侵袭性的ＭＲＩ检查对胸腔入口区肿瘤诊断准确性高，是最佳的影像学检查方法，但不应列为首选检查。ＭＲＩ显示血管及臂丛神经受侵是其特有表现，显示钙化及骨质受侵不如ＣＴ扫描。     

胸部创伤的CT影像分析(附46例报告)

目的：探讨ＣＴ对胸部创伤的诊断价值及特征。方法：对４６例胸部创伤进行回顾分析，并对常规Ｘ线表现及ＣＴ表现进行比较。结果：单纯肋骨骨折５例，骨折并发气胸１５例，纵隔积气５例，胸腔积血２５例，胸腔脏器损伤３８例，合并腹腔脏器损伤６例。结论：ＣＴ可早期发现轻度肺实质改变及细微变化。能清晰显示平片难以发现的少量胸腔积液、积气，对异位积气检出率高，对危重及复合伤病人可减少搬动，并能及时较快完成，检查有助于早期预防ＡＲＤＳ的发生     

X线平片和CT扫描对胸部创伤的诊断价值

目的：探讨X线平片和CT对胸部创伤的临床诊断价值。方法：总结分析386例严重胸部创伤患者的影像检查,以临床诊断和影像复查为金标准,对X线平片与CT对胸部创伤的诊断价值进行对比分析。结果：386例中,胸壁骨折328例,气胸82例,血胸98例,血气胸136例,肺挫伤265例,肺撕裂伤150例,肺不张75例,支气管损伤11例,胸主动脉损伤8例,纵隔血肿9例,心包心脏损伤12例,膈肌损伤17例,创伤后呼吸窘迫综合症（ARDS）52例。X线平片分别漏诊22,22,20,22,133,72,36,4,6,9,11,17,28例,CT除17例肋骨骨折外均准确诊断。结论：X线和CT联合检查能够明确胸部创伤病变的部位、性质、程度,为临床提供可靠诊断,可监测病情演变,评价治疗效果。     

46例肺栓塞的胸部螺旋CT及X线平片影像学比较

提高胸部Ｘ线平片和螺旋ＣＴ对肺栓塞诊断的认识。材料与方法,经临床确诊４６例肺栓塞的影像学表现进行回顾性分析。结果胸部Ｘ线平片中７０％病例肺血管纹理改变为肺少血“缺血区”,呈肺叶、段分布;４６％病例有肺动脉、肺门动脉增粗;３０％病例贝肺周的浸润灶、纤维索条影及太肺不张;     

Evaluation of the role of chest computed tomography in the management of trauma patients

The role of chest computed tomography (CT) in the management of trauma patients is evolving. The present study reviews the chest radiographic and chest CT findings in a group of trauma patients to determine the clinical impact of findings noted exclusively on chest CT.Fifty-five trauma patients examined with chest radiography and chest CT and whose clinical charts were available for review were retrospectively identified. There were 46 men and 9 women, with a mean age of 39 years. The presence (and size) of pneumothorax, hemothorax, pulmonary contusion, and fractures was tabulated for the chest radiographs and CT scans. The presence of mediastinal widening on chest radiographs and all mediastinal findings on CT were noted. The results of aortography, when applicable, were correlated. The clinical charts were reviewed to assess the impact of CT findings on patient management.Pneumothorax (P<0.05), hemothorax (P<0.05), pulmonary contusions, and fractures were noted more frequently on chest CT than on chest radiography. However, clinical management was affected in only three (5%) of these patients. Chest CT findings related to the mediastinum affected patient management in 13 (24%) patients. CT obviated the need for aortography in 7 of 10 patients with mediastinal widening on chest radiographs. Six other patients had aortography, four for mediastinal hematoma with a normal-appearing aorta on contrast medium-enhanced CT, and two for mediastinal hematoma and aortic injury on CT.Despite detection of significantly more pneumothoraces and hemothoraces on chest CT, clinical management was affected in only a small minority (5%) of cases. CT did prove useful in evaluating the mediastinum, obviating the need for aortography in 7 of 10 patients with a widened mediastinum on chest radiography and accurately diagnosing the presence and site of aortic injury in the two patients with that diagnosis.     

创伤后肺血肿影像表现及病理机制探讨

目的 讨论创伤后肺血肿的影像表现及创伤机制。方法 4例创伤后肺血肿患者均经正侧位X线胸片检查，1例又经CT检查。2例分别于创伤后7d及3个月至6个月经随访复查。结果 X线胸片显示，4例的不同肺野均有大小不等的囊状透亮区，囊壁薄而光滑，囊底有气液平面．CT对该种病变显示更为清晰。这些影像表现随不同的创伤机制和时期而有多种变化。结论 肺血肿的影像表现与创伤机制及时期密切相关，需与一些其他疾病进行鉴别。     

The radiological diagnostic and clinical approach to the patient with stab and cut wounds of the chest. The authors' personal experience

PURPOSE: To report our personal experience with the clinical and radiological diagnostic approach to stab and cut wounds of the thoracic cage and its content, a type of injury whose diagnosis and treatment, as well as the surgical approach, vary case by case. CT of deep penetrating wounds permits correct assessment of severe changes such as pneumothorax, hemothorax and pneumomediastinum. MATERIAL AND METHODS: In the last three years we examined 57 patients (48 men and 9 women; mean age 34 years, range 16-54): chest radiography was performed in 51 of them, with orthogonal projections in the standing and sitting positions. Chest CT was performed in emergency with i.v. contrast agent injection, with scans from the midneck to the diaphragm insertion to study border regions. Thoracostomy with pleural drainage was performed in 35 patients with pneumothorax and hemothorax while thoracotomy was performed in 8 patients, namely 4 with injury to the diaphragm, 2 to the heart, 1 with tear of the main bronchial artery and 1 of the aortic arch. RESULTS: The most frequent symptoms we found were chest pain (100% of cases) and dyspnea (84%); laboratory data showed anemia and decreased hematocrit levels in 28 cases. Chest radiography was negative in 14 cases. The patients were then examined with CT to exclude radiographic underestimation of minimal pneumothorax, small lacerocontusive or hemorrhagic foci and hemothorax, which were observed in 4, 2 and one cases, respectively, and where radiography was actually negative for traumatic changes. Chest radiography was positive in 43 cases: the most frequent finding was pneumothorax, with 37 cases (86%)--8 of them associated with hemothorax and 5 with pneumomediastinum. Lacero-hemorrhagic foci of lung parenchyma were found in 5 cases and single pulmonary hematoma from punch crossing was seen in 1 case. DISCUSSION AND CONCLUSIONS: CT was an accurate tool and had higher sensitivity than chest radiography in detecting and detailing pneumothorax, pneumomediastinum and lacero-hemorrhagic foci, as well as in quantifying hemothorax. Chest radiography had 12% false negatives and therefore we decided to perform CT in all the patients with penetrating wounds to prevent radiographic underestimation. Given the low rate of false negatives (7/57 cases) CT might appear superfluous but since in 2 of these 7 cases we had massive pneumothorax and pneumomediastinum associated with neck emphysema we suggest its use to prevent complications, clinical failures and medicolegal problems. CT permits correct assessment of penetrating stab and cut wounds of the chest and efficient and targeted treatment, which can be conservative, with thoracostomy with pleural drainage, or surgical.     

Classification of parenchymal injuries of the lung

Pulmonary contusion, implying interstitial and alveolar injury without significant laceration, has been accepted as the primary lung injury in nonpenetrating chest trauma. Computed tomographic (CT) findings were compared with those of chest radiography in 85 consecutive patients with chest trauma in which there was a pulmonary radiodensity consistent with pulmonary contusion or patients with a history of severe chest trauma with normal parenchyma despite rib fractures, hemothorax, pneumothorax, or widened mediastinum. CT was found to be more sensitive than radiography in that 151 abnormalities (excluding rib fractures) were demonstrated on radiographs versus 423 abnormalities on CT scans, and 99 lacerations were seen on CT scans versus five on radiographs. Pulmonary lacerations were classified into four types on the basis of CT findings and mechanism of injury: compression rupture, compression shear, rib penetration, and adhesion tears. In these cases, pulmonary laceration was shown to be an integral component of the mechanism of injury in pulmonary contusion, pulmonary hematoma, pulmonary cyst or pneumatocele, or cavitation in pulmonary contusion.     

Role of CT in excluding major arterial injury after blunt thoracic trauma

The role of CT in the diagnosis of major vascular rupture following blunt decelerating chest trauma is controversial. Its value in excluding major arterial injury has not yet been determined. During a 12-month period we obtained dynamic enhanced thoracic CT studies in 20 patients with blunt decelerating thoracic trauma who had abnormal or equivocal mediastinal contours on chest radiographs. In all cases diagnosis was confirmed by either digital subtraction (18 patients) or conventional thoracic angiography (two patients). CT scans showed evidence of direct aortic injury in three patients and evidence of mediastinal hematoma in five others. Four of these eight patients had major arterial injury verified angiographically and at surgery. In two patients the CT scan was considered equivocal; both patients had normal thoracic angiograms. CT excluded direct vascular injury or mediastinal hematoma in 10 patients. All 10 had normal thoracic angiograms. This preliminary study suggests that, in patients sustaining blunt decelerating thoracic trauma, thoracic CT may be more valuable than chest radiography in excluding major vascular injury and, in some cases, may reduce the need for thoracic angiography.     

新生儿支气管肺发育不良的影像学表现(附21例分析)

目的：探讨新生儿支气管肺发育不良的影像学特征，提高对该病的认识。方法：搜集新生儿支气管肺发育不良21例，全部病例均摄胸片，其中18例行螺旋CT扫描，对所有病例的影像学表现进行回顾性分析。结果：21例中，胸片显示两肺野模糊，肺透光度减低．类似肺透明膜样病改变j例，局限性肺气肿4例，弥漫性间质纤维化病变4例。胸片无异常8例。18例CT检查，表现为毛玻璃样病变和实变影5例，多发囊泡状阴影11例，肺间质纤维化改变5例。结论：新生儿支气管肺发育不良的诊断主要根据临床病史及影像学资料。胸片、CT表现虽无特征性，但具有诊断意义，尤其是高分辨率CT能提供更多有价值的征象，有助于本病的诊断。     

CT对外伤性隐性胸膜肺损伤的诊断价值

目的探讨外伤性隐性胸膜肺损伤的CT表现，评价CT检查的诊断价值。方法回顾性分析68例外伤性隐性胸膜肺损伤的X线平片、CT检查结果和临床治疗情况。结果68例常规X线胸片均未能检出隐性胸膜肺损伤，CT检出气胸32例、血胸24例和肺出血12例。根据CT诊断结果，采用对症处理治愈55例(81％)，胸穿处理治愈9例(13％)，胸腔闭式引流处理治愈4例(6％)。结论相对于常规X线胸片检查，CT对于外伤性隐性胸膜肺损伤的诊断有极其重要的临床意义。     

Pulmonary manifestations of Hodgkin's disease: radiographic and CT findings

The aim of this study was to assess the radiological and CT findings in patients with pulmonary Hodgkin's disease and to analyse to what extent CT provides more diagnostic information. In 37 patients with 41 episodes of pulmonary manifestation of Hodgkin's disease (histological diagnosis: 11, clinical diagnosis: 30) 39 radiographs and 33 CT scans were analysed by two readers in consensus. Pulmonary nodules were recorded in 77% of radiographs (CXR) and 88% of CT scans. Nodules were multiple in 67% (CXR) and 86% (CT) and bilateral in 43% (CXR) and 66% (CT) of cases, respectively. Nodule size ranged from 2 to 100 mm. Of the nodules, 83% at radiography and CT, respectively, were < or =30 mm, and again 83% at radiography and CT, respectively, were irregularly marginated. Diffuse infiltration with and without nodules was less common. With pulmonary manifestations at initial diagnosis of Hodgkin's disease there was always hilar or mediastinal lymphadenopathy. Of 20 episodes, in which radiograph and CT had been obtained within 8 days, CT demonstrated pulmonary involvement when chest radiography was normal in 3 cases and demonstrated more lesions in 12 cases. The typical appearance of pulmonary HD consisted of multiple, irregularly marginated pulmonary nodules. Diffuse infiltration was less common. Computed tomography was superior to radiography not only in characterization of lesions but could also demonstrate pulmonary involvement when the radiograph was normal and should, therefore, be used liberally in addition to radiography.     

外伤性脾破裂的CT诊断 (附35例分析)

目的探讨CT对外伤性脾破裂的诊断价值以及对临床治疗的指导意义.方法35例外伤性脾破裂,其中32例经手术证实.35例均做CT平扫,4例加做增强,平均年龄为42岁,男女比例为52.结果脾包膜下血肿19例,脾内血肿8例,脾撕裂伤6例,多发性脾撕裂伤2例.结论CT对脾脏破裂能做出明确诊断和分型,也可同时发现脾脏周围器官的损伤,为临床治疗方案提供充分的依据.