流感病毒性肺炎22例CT影像分析

目的分析成人病毒性肺炎CT影像表现,为肺炎的临床诊断提供参考。方法对2012年6月至2013年6月在我院接受临床检查并确诊为流感病毒性肺炎的22例患者进行胸部CT扫描,分析成人病毒性肺炎的医学影像学表现。结果基于胸部CT检查结果,54.5%的患者被诊断为间质性肺炎,其中8例无胸腔积液,4例有胸腔积液;肺炎病变部位双侧9例,单侧肺炎病变3例。36.37%的患者被诊断为支气管肺炎;9.09%的患者被诊断为隐源性兼机化性肺炎。经支气管镜检查,22例患者肺不张的发生部位:左侧肺病变比例稍高于右侧肺,两侧肺的上叶和下叶病变比例较高,肺下叶比肺上叶严重;在患者出现肺部阴影后,病变在2~10 d内都有不同程度的进展,主要表现为原始肺叶处的斑片状阴影扩大,同时,其他肺野出现新斑片状阴影,部分相互融合,且积液量随病情进展而增多,90.9%的患者在发病20 d后病情好转,肺部阴影开始逐渐消散、吸收。结论病毒性肺炎的一般CT影像学表现为患者双侧肺叶有毛玻璃样影出现,这是与典型细菌感染性肺炎的重要区别,结合流行病学特点和其他检查方法,则能够进一步提高病毒性肺炎的正确诊断率,对指导临床治疗具有重要的意义。     

AIDS合并肺结核肺部影像学分析

目的探讨AIDS合并肺结核的肺部影像学特征。方法收集89例AIDS合并肺结核患者的临床资料、X线胸片和肺部CT影像学检查资料,并进行分析。结果原发型肺结核5例（5．62％）,以儿童原发综合征为主,表现为肺内原发灶、淋巴管炎和肿大淋巴结组成的哑铃状“双极影”。血行播散型肺结核19例（21．35％）,其中12例为急性血行播散型肺结核,表现为全肺野大小、密度、分布“三均匀”特点,7例为亚急性或慢性血行播散型肺结核,表现为两肺多发大小不等的结节。继发型肺结核65例（73．03％）,病变累及单叶多见,两叶受累次之,三叶以上受累较少;右上肺叶为最易发部位,≥3个肺叶受累患者多伴空洞形成和播散病灶;病变形态多样复杂,但以典型浸润病灶常见（43／65）。结论AIDS合并肺结核主要为继发型肺结核和血行播散型肺结核。     

军营中腺病毒7型呼吸系统感染的临床特点分析

目的 通过调查军事院校一起腺病毒7型感染暴发流行疫情,总结呼吸系统腺病毒7型感染的临床特征。方法 选取2015年1月20日—2月21日某医院收治的某军事院校暴发腺病毒7型呼吸系统感染并符合入组标准的患者82例,收集并分析患者的一般信息、发病时间、临床症状、体征、既往史、肺部影像学检查及实验室检查结果等。结果 82例患者均为青年男性,其中上呼吸道感染42例(51.22%),腺病毒肺炎30例(36.59%),重症腺病毒肺炎10例(12.20%)。所有患者均存在高热[体温(39.40±0.59)℃],咳嗽、咳痰是常见临床表现。30.00%的重症腺病毒肺炎患者存在呼吸衰竭和心率减慢,20.00%的重症腺病毒肺炎患者合并胸腔积液和出血性膀胱炎。影像学检查发现35.00%肺炎患者存在2个以上肺叶或者双侧肺浸润。60.00%重症腺病毒肺炎患者出现多肺叶或肺段的实变。结论 军营腺病毒7型呼吸系统感染临床症状重,并发肺炎比率高,易转成重症或危重症,是一项须重视和深入探讨的公共卫生问题。     

小儿肺炎支原体感染胸部CT表现的研究

目的了解儿童肺炎支原体感染胸部CT表现。方法分析我科确诊支原体肺炎的49例住院患儿肺CT病灶的分布与形态。结果儿童肺炎支原体感染胸部CT特点:病变位单侧27例,双侧22例。左上叶17例,左下叶24例,右上叶18例,右中叶11例,右下叶27例,节段性病变9例。病灶呈大斑片状影43例,肺门影增浓19例,肺纹理增多18例,斑点状影17例,条索状影13例,磨玻璃样影10例,肺实变12例,肺不张6例,支气管充气征9例,肺门、纵膈淋巴结肿大4例,胸腔积液11例,空洞2例。结论肺CT对儿童支原体肺炎诊治有一定意义。     

伴肺炎与低氧血症的新型甲型H1N1流感二例报告

目的 分析2例重症新型甲型H1N1流感(简称甲型流感)合并肺炎患者的临床表现、影像学特点和治疗经过,提高对本病的认识.方法 回顾性分析2009年9月入住南京市第二医院南山分院的2例确诊为甲型流感合并肺炎患者的临床表现、胸部CT特点及治疗经过.结果 2例患者中1例为女性,54岁,无基础疾病;1例为男性,31岁,有支气管哮喘史.主要症状和体征为发热、咳嗽,肺部可闻及湿性哕音.2例患者胸部CT主要表现为实变影及磨玻璃影,以双下肺和胸膜下分布为主,累及多个肺叶、肺段,实变影内可见支气管充气征.2例患者咽拭子甲型H1N1流感病毒核酸阳性,确诊为甲型流感.2例患者入院时均存在低氧血症,白细胞计数和淋巴细胞计数下降,血乳酸脱氢酶(LDH)水平和肌酸激酶(CK)水平明显升高.2例患者均接受奥司他韦、糖皮质激素以及吸氧等对症支持治疗,其中1例间断接受无创通气.治疗后,临床症状缓解,胸部CT示实变影和磨玻璃影较入院时明显吸收.白细胞计数、LDH及CK水平恢复正常,复查咽拭子甲型H1N1流感病毒核酸阴性,康复出院.结论 部分甲型流感患者可合并肺炎,临床表现无特异性,胸部CT主要表现为双肺弥漫性分布的实变影及磨玻璃影;及时动态复查胸部CT对诊断和了解病情进展非常必要;糖皮质激素可缓解甲型流感合并肺炎患者咳嗽及气喘等症状,有助于肺部病变的吸收.     

20例艾滋病病人免疫重建中合并结核相关性重建炎性综合征的胸部CT影像特点

目的探讨艾滋病(AIDS)病人在免疫重建过程中,合并与肺结核相关重建炎性综合征的胸部计算机层析成像(CT)影像特点。方法采用回顾性分析的方法,对20例AIDS病人免疫重建过程中,合并结核相关性重建炎性综合征的胸部CT影像进行分析。结果 20例AIDS免疫重建合并肺结核相关重建炎性综合征病人的胸部CT影像,表现为急性血行播散型肺结核与继发型肺结核,急性血行播散型肺结核9例(45.0%,9/20),继发型肺结核11例(55.0%,11/20)。病灶分布3个肺叶及以上者7例(35.0%,7/20),病灶局限于1～2个肺叶者4例(20.0%,4/20)。病变形态为粟粒影、结节影、肺段与亚段实变影,分别为13例(65.0%,13/20)、9例(45.0%,9/20)、5例(25.0%,5/20),肺空洞3例(15.0%,3/20)。胸部CT影像出现纵隔淋巴结肿大伴液化坏死17例(85.0%,17/20),胸腔积液15例(75%,15/20)。结论 AIDS免疫重建合并肺结核相关重建炎性综合征时,胸部CT影像特点是病变呈弥漫、多肺叶分布,粟粒影、结节影、肺段与亚段实变影为肺部病变主要形态,纵隔淋巴结肿大伴液化坏死、胸腔积液常见。其发生机制与重新激活的异常免疫应答相关。在高效抗反转录病毒治疗同时,积极给予抗结核治疗后,病变吸收明显。     

糖尿病并发肺部感染的CT诊断研究

目的对糖尿病并发肺部感染的CT诊断进行研究分析。方法资料随机选自2011年12月—2013年12月该院收治的糖尿病并发肺部感染患者64例,通过CT检查对其进行确诊,并对其临床资料进行回顾性的分析。结果在64例糖尿病合并肺部感染的患者中,24例患者确诊属于活动性肺结核,病变形态是空洞、增殖结节、渗出的实变;且27个肺段病灶中在结核叶后段、下叶背段的病灶有15(55.56%)个,少见部位12(44.44%)个,并伴有肺门纵隔淋巴结肿大。肺炎29例,大叶性的肺炎16例,其表现为段分布、大片按叶分布的实变影,内部能够看到支气管的气像;小叶性的肺炎9例,其是沿支气管的血管柬进行分布的点片状影。肺曲菌病8例,呈空洞内圆形的软组织结节影,少数结节可在空洞进行滚动。3例肺念珠菌,呈现大片实变影,内部有多个液平面空洞存在。结论临床中糖尿病合并肺部感染疾病的发生率非常高,与普通的肺部感染相比,糖尿病并发肺部感染具有自身独特的影像学特点,利用CT对其进行检查可以更好的体现出肺部感染的病变,进而有利于对其进行及时、准确的诊断、治疗。     

新型甲型H1N1流感患者体内病毒载量与胸部CT表现的关系

目的 观察新型甲型H1N1流感(简称甲型流感)患者体内病毒载量与胸部CT表现的动态变化,探讨病毒载量与胸部CT表现对甲型流感的诊断、鉴别诊断及指导治疗的价值.方法 收集2009年5-12月深圳市第三人民医院收治的51例甲型H1N1流感核酸检测阳性的患者,均符合卫生部颁布的"甲型H1N1流感诊断标准",均行胸部X线及CT扫描(含高分辨率CT)并测定体内病毒载量.根据CT影像检查有否肺炎征象将甲型流感患者分为肺炎组31例和非肺炎组20例,观察胸部CT所见与病毒载量变化的关系.结果 (1)甲型流感肺炎组患者胸部CT主要表现为片状实变影,早期和吸收期表现为磨玻璃影,双肺散在小叶性或节段性阴影,以下肺叶多见,左下肺叶明显,可伴有纵隔淋巴结肿大,肺实质、肺间质及胸膜可同时受累;(2)发病甲期患者体内病毒载量高,肺炎组病毒载量的均值为7.7拷贝/ml,非肺炎组为4.2拷贝/ml;抗病毒治疗4 d(病程第6天)病毒核酸开始转阴;(3)3例肺炎患者中2例病毒核酸转阴时间快于胸部CT病灶吸收时间,而1例年幼患者的病毒核酸转阴时间明显延长.结论 甲型流感合并肺炎患者的病毒载量明显高于未合并肺炎的患者;动态观察甲型流感合并感肺炎患者的影像学表现及病毒载量的变化,有利于对甲型流感患者进行及时有效的治疗.     

成人腺病毒肺炎胸部CT特征和症状相关性分析

目的探讨腺病毒肺炎早期胸部多层螺旋CT的影像特征与临床症状的相关性。方法在健康成人的7型腺病毒感染聚集性发病中,回顾分析45例肺炎病人入院时的临床和胸部CT资料,描述和分析肺炎病灶的部位、数量和形态特征,半定量测量CT实变影和磨玻璃密度影(ground-glass opacity,GGO)的面积,对不同影像特征分组,量化记录各组病人发热、咳嗽时间和程度,采用Spearman相关分析检验胸部CT与临床相关性。结果 45例腺病毒肺炎病人临床发热42例(93.3%),平均体温(38.91±0.85℃)、刺激性干咳39例(86.7%),咳嗽程度评分(3.52±1.38分);胸部CT观察时间为发热后(0~6)d,平均(2.80±2.04)d。肺部单个病灶者25例,2个13例,3个和3个以上7例。病灶形态呈大叶性8例、段或亚段性14例、斑片状20例及小结节影3例;病灶数量共83个;叶、段性病灶22例中实变伴GGO(17例,占77.2%)常见。相对斑片状病灶的病例,大叶性病灶病人发热(40.16±1.04℃,P0.001)和咳嗽(评分4.14±1.13分,P0.01)症状重,高热时间(4.31±1.03d,P0.005)更长;与间质性改变为主的病例比较,GGO为主的病例组,发热(39.18±0.79℃,P0.05)、咳嗽(评分4.23±1.01分,P0.001)症状更重,病程介于实变和间质组之间;GGO面积与发热时间(r=0.506,P0.005)发热程度(r=0.446,P0.005)有正相关;病灶数量和热程正相关(r=0.385,P0.005)。结论胸部影像特征提示腺病毒肺炎相应的临床表现,对肺炎的诊断、病情评估、病情进展的判断有重要作用。     

HIV／AIDS肺部感染的影像学表现

目的探讨HIV／AIDS合并肺部感染的X线及CT表现。方法对已确证(W．B)的HIV／AIDS病人中有胸部影像异常的10例进行分析。结果肺结核5例、军团菌感染2例、卡氏囊虫肺炎1例、非特异性炎症2例。肺结核表现为肺内斑片、大片影，纵隔淋巴结肿大及肺外淋巴结肿大，军团菌肺炎为大片状影像，卡氏囊虫肺炎为弥漫性浸润及间质异常影像。结论HIV／AIDS病人肺内出现斑片、大片或弥漫病变。或有淋巴结肿大时应考虑可能合并肺结核、卡氏肺囊虫肺炎及革兰氏阴性杆菌肺炎。     

A case of secondary pulmonary cryptococcosis complicating diabetes mellitus]

In this case, a 65-year-old man complained of fever and productive cough while being treated for diabetes mellitus at the outpatient clinic. His chest CT scan revealed multiple infiltrative lesions in both the right and left lower pulmonary lobes. He was therefore given an antibiotic on suspicion of having bacterial pneumonia, and he also received nutritional instruction in relation to diabetes mellitus, and remission resulted. However, he could not maintain sufficient glycemic control thereafter, and his pulmonary lesions persisted. Because his lesions changed into cavitied multiple nodular lesions, as seen on a chest CT scan, a transbronchial lung biopsy was performed. Histopathological examination of the biopsy specimen demonstrated Cryptococcus organisms, and the Cryptococcus antigen titer was high, which led to a diagnosis of pulmonary cryptococcosis. After oral treatment with fluconazole for 1 year and 4 months, only a small nodule in the right lower lobe and a funicular lesion in the left lower lobe remained on a chest CT scan, and the patient had neither subjective symptoms nor evidence of inflammation, although he still had a positive antigen titer for Cryptococcus. Thus, the treatment was terminated. Improvement of the clinical symptoms and of the laboratory and radiological findings demonstrated the therapeutic efficacy of this treatment.     

Disease state prediction for 2019 novel coronavirus (COVID-19) pneumonia using CT manifestations and body temperature dynamic analysis: A SQUIRE-compliant study

2019 Novel Coronavirus (COVID-19) is a new acute infectious disease of respiratory system, posed a great threat to human health because of its strong infectivity and rapid progress. This study aimed to assess the severity of COVID-19 Pneumonia by analyzing the change of CT manifestations and body temperature.This retrospective review included 22 patients with COVID-19 pneumonia. The imaging manifestations and clinical features were observed and evaluated.Most of the infected patients were men (13/22, 59%). Fever (>38°C) (17/22, 77%) and cough (6/22, 27%) were the main symptoms. Leukocytes count decreased in 23% of patients and lymphocyte decreased in 41%. Twenty-one patients with pneumonia had abnormal findings on chest CT. The special CT manifestations were observed at the first CT examination when the lesions progressed, including a single ground glass nodule with uneven density, multiple ground glass opacities distributed in subpleural, and the ground glass opacities confined in superior lobe. The special CT manifestations were observed at the first CT examination when the lesions resolved, including ground glass opacities with homogeneous density. The lesion involved in the bilateral lungs and the absorption of the lesions mainly occurred in bilateral inferior lobes. Three patients had normalized body temperature increased more than 1°C within 1 to 2 days after admission. Ten patients fluctuated more than 1°C within 1 to 7 days after admission and the second CT scans showed the disease was at the progressive stage.Dynamic analysis of CT manifestations and body temperature have the potential to predict the severity of COVID-19 pneumonia.     

Bronchioloalveolar carcinoma complicated by a lesion resembling bronchiolitis obliterans organizing pneumonia in the opposite lung]

A 50-year-old woman with abnormal shadows in her chest radiograph was admitted for a more detailed examination in April 2000. A chest CT scan showed infiltrates surrounded by ground-glass opacities in the right upper lobe, and ground-glass opacities with partial infiltrative changes in the left lower lobe. A diagnosis of adenocarcinoma like bronchioloalveolar carcinoma (BAC) was made for the lesion in the right upper lobe by means of a transbronchial biopsy. However, the specimen from the left lower lobe showed nonspecific changes, and bronchiolitis obliterans organizing pneumonia (BOOP) or a metastatic lesion from the BAC was suspected. We prescribed steroids for the short term. Since the lesion in the left lobe disappeared, we performed a right upper lobectomy. In cases of primary lung carcinoma, BOOP in the opposite lung is rare and it was difficult to decide on the operability. We concluded that steroid therapy is useful for distinguishing between inflammatory and tumorous lesions in cases in which a detailed examination is difficult.     

老年人肺结核的CT表现

目的　分析老年人肺结核的CT表现,评价CT检查对肺结核诊断的价值。方法 1993年8月至2000年3月间160例老年 (65～89岁,平均72.5岁)肺结核患者做CT检查,其中112例行病灶高分辨扫描 (HRCT)、84例做增强扫描。并进行综合回顾分析。结果 CT表现为：(1)结核病灶分布在一叶以上占78.6%;上、下叶均受累占56.4%,上叶受累占20.5%,下叶受累占23.0%。 (2)病变以纤维化为主占89.4%;伴有空洞者占48.5%;伴有钙化占40.8%;胸膜增厚占18.4%;结核瘤占6.8%。 (3)增强扫描显示病灶呈明显不均匀强化者占90.5%。 (4)具有结核活动征象者占76.8%,HRCT表现为2～4mm小叶中心结节和分支状结构,或5～8mm模糊结节、小叶间隔增厚及邻近支气管壁增厚。 (5)肺结核合并肺癌占9.4% (15160)。结论 老年肺结核的CT表现以纤维化为主,累及下肺叶比例较高,增强CT病灶呈明显强化,合并肺癌的发生率较高。HRCT可作为判断结核有无活动性的方法。     

Delayed closure of persistent postpneumonectomy bronchopleural fistula

A 73-year-old man with a history of postpneumonectomy empyema and a long-term chest tube since 1979 presented with fever, chills, leukocytosis, and purulent fluid from the left tube thoracostomy. CT scan and bronchoscopy demonstrated a right lower lobe pneumonia and a left mainstem dehiscence with direct communication to the left tube thoracostomy. He underwent primary closure of the bronchopleural fistula with latissimus dorsi muscle flap coverage after antibiotic therapy for right lower lobe pneumonia.     

20例女性乳腺结核患者的CT特征分析

目的 分析女性乳腺结核的CT征象,探讨CT扫描对此类患者的诊断价值。方法 收集重庆市公共卫生医疗救治中心2015年8月至2019年5月行胸部CT检查时发现乳腺病变并经手术病理证实的20例女性乳腺结核患者,分析其CT表现及邻近组织及器官受累情况。结果 20例乳腺结核中12例发生于右乳,8例发生于左乳;13例为单发,7例为多发;16例呈结节状,1例呈团块状,3例呈片状;病灶大小1.0cm×1.5cm~5.1cm×3.2cm。CT平扫显示,11例病灶呈等密度,9例呈稍低密度,4例病灶内见结节状钙化,17例显示边界模糊;12例邻近皮肤呈均匀性增厚。CT增强扫描显示,15例病灶表现为环形强化,3例表现为不均匀强化,2例表现为均匀强化,2例伴窦道形成;其中13例并发同侧或双侧腋窝淋巴结结核,伴环形强化;5例并发同侧胸壁结核,伴边缘强化;10例并发肺结核。结论 乳腺结核的特征性CT表现为环形强化,同时常并发同侧腋窝淋巴结结核、胸壁结核及肺结核。     

正电子发射体层成像在肺癌诊断和分期中的价值

目的了解正电子发射体层成像(PET)在肺癌诊断和分期中的价值。方法收集1998年9月至2003年4月间行PET和CT检查,且诊断明确的肺部疾病患者的临床资料,对PET和CT检查结果与病理检查结果进行对比分析。结果在此期间共收集104例患者,其中肺癌64例(60%),肺部良性疾病40例(40%)。肺癌患者PET的标准摄取比值(SUV值)中位值为4.5(1.2～11.7),明显高于良性患者的1.0(0～7.7);且肺癌患者的SUV值与肺癌组织学类型、分化程度、临床分期和病灶大小均无关(P>0.05)。PET诊断肺癌的敏感性、特异性和准确性分别为88%、85%和87%;CT的敏感性、特异性和准确性分别为73%、28%、57%,PET的特异性和准确性显著高于CT(P<0.05)。对于胸腔淋巴结转移诊断的敏感性、特异性和准确性CT:N1期分别为33%、73%、59%,N2期分别为80%、79%、79%,N3期特异性及准确性均为97%;PET:N1期分别为33%、82%、65%,N2期分别为60%、83%、85%,N3期特异性及准确性均为85%;两者差异无统计学意义(P>0.05)。结论PET在鉴别肺内病灶良恶性质上有优势,对胸腔内淋巴结转移的诊断要结合CT结果综合判断。     

Pasteurella multocida liver abscess

A previously healthy 61-year-old woman was seen with an abnormal chest roentgenogram and a 3-week history of fever, chills, malaise, and right upper quadrant pain. Blood cultures revealed Pasteurella multocida sensitive to penicillin. Liver spleen radioisotope scan and CT scan revealed space occupying lesions in the right lobe of the liver. The patient was a gardener with no pets or animal exposure. This case illustrates P. multocida septicemia and a liver abscess in a patient without animal exposure. In addition, the possibility of soil as another reservoir of infection is raised.     

Exogenous lipoid pneumonia: serial chest plain roentgenography and high-resolution computerized tomography findings

Between May 1988 and July 2002, six patients with pneumonia due to diesel, animal, or vegetable oil aspiration were admitted to Kaohsiung Medical University Hospital. The purpose of this study was to demonstrate distinctive radiographic findings of oil-induced lipoid pneumonitis on initial serial chest roentgenograms and high-resolution computerized tomography (CT) scans. Initial chest roentgenograms (n = 6), CT scans (n = 6), and roentgenography and CT follow-up studies were analyzed retrospectively by two chest radiologists and two surgeons, focusing on the pattern and distribution of parenchymal abnormalities. The most common location was the right middle lobe, followed by the right lower lobe, the left lower lobe, and the lingular lobe. Follow-up chest roentgenograms (n = 6) showed complete disappearance of the parenchymal lesions in only one patient and partial decrease in the extent of lesions in five patients. Lipoid pneumonia presents non-specific findings on chest roentgenography. It is commonly located in both lower and the right middle lobes. On high-resolution CT, the lesions appear most commonly as areas of consolidation, ground-glass attenuation mixed with paving pattern, and poorly defined nodules.