肺隔离症的影像诊断

目的：分析肺隔离症的影像所见，以便于早期诊断。材料和方法：１３例患者中，男性６例，女性７例，年龄６～６９岁，平均２５岁。最常见症状是咳嗽、咳痰，９例患者有反复或持续性肺部感染。１２例手术证实；１例未手术，结合影像所见及病史做出诊断。结果：胸像及ＣＴ主要表现为肿块或囊肿，８例ＣＴ中２例显示异常动脉供血，１２例为肺内隔离症，１例为肺外隔离症。结论：当患者有反复肺部感染病史，Ｘ线平片发现肺下叶后基底段囊状或肿块状阴影，经抗炎治疗长期不吸收，应怀疑本病。Ｂ超、ＣＴ或ＭＲＩ能显示其供血动脉，对诊断非常有帮助。     

肺错构瘤的影像诊断

目的：探讨肺错构瘤的影像诊断问题。方法：回顾性分析经手术病理证实的２６例肺错构瘤，所有病人均有Ｘ线平片，１１例体层及６例ＣＴ检查。并同４５例结核球和９８例周围性肺癌进行对照研究。结果：肺错构瘤的主要Ｘ线征象：中央型３例为叶支气管内或肺门区肿物，周围型２３例均为圆形或椭圆形肿块，病灶平均直径２．２ｃｍ，多数边缘光整，３５％病灶有钙化，以斑点状或环状多见。本病与结核球、肺癌在病灶的大小、边缘及密度等均有不同之处。本病ＣＴ表现病灶内常可显示钙化和脂肪。结论：传统Ｘ线对周围性错构瘤的诊断及其与结核球、周围性肺癌的鉴别很有帮助。ＣＴ检查可补充平片、体层之不足，可显示病灶内钙化或／和脂肪特征。     

肺硬化性血管瘤影像学表现(附2例报告及文献复习)

目的：对肺硬化性血管瘤的影像学表现进行探讨。方法：报告２例肺硬化性血管瘤，均行胸部平片检查，其中１例行ＣＴ扫描检查，并结合文献２１例。结果：其影像学表现是：（１）肺内圆形或类圆形孤立性结节或肿块；（２）边缘光整、锐利，偶有浅分叶；（３）ＣＴ表现为肿瘤明显强化，肿瘤内境界清晰的囊变区，斑点状钙化，“含气新月征”。结论：ＣＴ在本病的诊断及鉴别诊断方面具有重要意义。     

肺泡蛋白沉积症的CT表现并X线平片对照分析（附五例报告）

目的：探讨肺泡蛋白沉积症（PAP）的CT表现。材料和方法：本文总结分析了5例病理证实的肺泡蛋白沉积症的CT（包括HRCT）特点并与胸部X线平片做比较。结果：5例CT表现极为相似：双肺广泛性云雾状肺实变阴影，常常为腺泡结节状或融合成大片状，其边界常较清晰，这些实变阴影由正常肺组织将其包绕或分隔开来，在云雾状肺实变阴影中有网状增粗增多的肺纹理。结论：尽管许多肺疾患在某些方面与PAP有相似之处，但是掌握本病CT特点则有助于做出正确诊断、CT对于此病的范围、程度及病变轮廓和边界的显示较X线平片准确。     

成人纵隔淋巴结核的CT诊断

目的分析纵隔淋巴结核的多层螺旋CT特点，提高其诊断水平。方法回顾性分析8例经手术、穿刺活检或临床抗结核治愈证实的成人纵隔淋巴结结核的CT表现，其中，男2例，女6例，年龄17～65岁，平均35岁。结果8例均有不同程度纵隔或肺门肿大淋巴结，其中，3例平扫时淋巴结内呈不均匀低密度，增强扫描呈边缘环形强化。结论CT扫描，特别是增强CT扫描是确诊本病的首选方法。     

34例肺真菌病的临床影像学表现

目的：加深对各种肺真菌病的临床影像学认识,提高影像学诊断水平。资料与方法：对34例经手术、痰检、脑脊液培养证实的肺真菌病的临床影像学资料进行随访和回顾性分析。结果：影像学表现有：团块状球形病灶共19例（其中6例有“新月征”,4例有“空气支气管征”,3例边缘有“毛刺征”,2例有“晕征”）。两肺或一肺斑点状小结节状病灶共11例。大的肺脓肿改变1例。大片状实变1例。纵隔淋巴结增大伴胸腔或心包积液1例。结论：本病临床症状无特征性,病史有参考价值。在影像表现上球形病灶有新月征、空气支气管征、晕征对本病有提示价值,如发现半月形空洞内有随体改变的“洞中球征”,对肺曲菌病有重要诊断价值。本病的确诊需病理和细菌学检查。     

肺霉菌病影像诊断的探讨（附20例报告）

目的：探讨肺霉菌病影像诊断的价值及限制。材料及方法：肺霉菌病患者２０例，男１１例、女９例。手术病理证实１１例，尸检证实２例，痰培养霉菌阳性７例。全部病例行Ｘ线检查、７例行ＣＴ检查，５例有系列Ｘ线片。结果：２０例肺霉菌病影像表现为肺炎、支气管肺炎８例，肺脓肿５例，结节性肉芽肿５例，霉菌球２例。影像诊断肺霉菌病７例，误诊１３例。结论：Ｘ线、ＣＴ检查对肺霉菌病的诊断有一定的价值，对不具特征性影像表现者，必须密切结合临床并对影像表现动态观察，对诊断本病有极大的帮助     

肺真菌病的影像学表现及诊断(附12例分析)

目的 评价肺真菌病的影像学表现并分析其价值和限度。方法 肺真菌病患者12例,男7例,女5例。手术病理证实4例,CT导向穿刺活检证实2例,痰培养真菌阳性6例。全部病例均行X线及CT检查,2例行增强CT检查,4例有随访系列X线片。结果 12例肺真菌病影像表现为肺段或叶的实变6例,厚壁空洞2例,结节或肿块2例,霉菌球2例。影像学正确诊断5例,误诊7例。结论 影像学对有特征性表现的肺真菌病可正确诊断,对于无典型表现者,密切结合临床及影像表现的动态观察对诊断本病非常重要。     

肺真菌病的影像学表现及诊断（附12例分析）

目的评价肺真菌病的影像学表现并分析其价值和限度。方法肺真菌病患者12例,男7例,女5例。手术病理证实4例,CT导向穿刺活检证实2例,痰培养真菌阳性6例。全部病例均行X线及CT检查,2例行增强CT检查,4例有随访系列X线片。结果12例肺真菌病影像表现为肺段或叶的实变6例,厚壁空洞2例,结节或肿块2例,霉菌球2例。影像学正确诊断5例,误诊7例。结论影像学对有特征性表现的肺真菌病可正确诊断,对于无典型表现者,密切结合临床及影像表现的动态观察对诊断本病非常重要。     

支原体肺炎临床X线分析

目的 分析支原体肺炎的临床与X线表现，以便提高对本病的诊断与治疗水平。方法 对100例临床上诊断的支原体肺炎之X线表现进行了回顾性分析。结果 在X线胸片上支原体肺炎为各种各样的表现且缺乏特征性。常见的表现有如下3种类型：a)肺泡实质浸润型，病变常局限于1个或2个肺段，表现为云絮状或片状阴影，肺纹理增重，沿增重的肺纹理出现不规则的点片状阴影；b)肺间质浸润型，病变区肺纹理增重，伴有网状阴影；c)合并胸膜炎。通常，肺部X线表现较重而临床表现较轻可看作是本病的一个特点。结论 支原体肺炎的X线表现没有特征性，与细菌性肺炎不易区分。临床上、血清冷凝集试验阳性，血清特异性IgM抗体反应阳性，以及大环内酯类抗生素如红霉素治疗具有显著疗效有助于本病的确诊。     

Multidetector CT angiography in pulmonary sequestration

PURPOSE: To evaluate the role of multidetector CT angiography in the diagnosis and preoperative assessment of pulmonary sequestration with angiographic or surgical correlation. METHODS: Eight patients (5 males, 3 females) in the age range of 2 days to 35 years suspected of having pulmonary sequestration on the basis of clinical history and chest radiographs were included in the study. All patients underwent CT angiography (4 or 16 slice) and MPVR, MIP and 3D volume rendered images were generated. The axial images were also reviewed at soft tissue and lung window settings to evaluate the parenchymal changes. RESULTS: CT angiography showed five pulmonary sequestrations on the left and three on the right, located in the basal segments (n = 7) or paravertebral region (n = 1). Aberrant systemic arterial supply was demonstrated in all cases: from the descending thoracic aorta (n = 2); abdominal aorta (n = 3) and celiac axis (n = 3). Venous drainage into inferior pulmonary veins was demonstrated in 4 patients. The angioarchitecture depicted on CT angiography was confirmed on surgery in five patients and by DSA in two patients who subsequently underwent embolization using PVA particles and/or coils. CONCLUSION: The ability of CT angiography to simultaneously image the arterial supply, venous drainage and parenchymal changes in a single examination makes it the imaging modality of choice for the diagnosis and preoperative assessment of pulmonary sequestration.     

Pulmonary sequestration in the adult. Diagnostic contribution of angiography

PURPOSE: The diagnosis of pulmonary sequestration is based on demonstration of mal-developed lung tissue, feeding on abnormal systemic level. We investigate the role of angiography in the diagnosis of pulmonary sequestration in adult patients. MATERIAL AND METHODS: 1987 to 1998 we examined 9 patients with suspected pulmonary sequestration who were subsequently submitted to surgery. The patients were 3 women and men; 6 of them were symptomatic and 3 asymptomatic. Six patients were examined with CT of chest and upper abdomen, thoracoabdominal aortography and selective arteriography of the abnormal vessel; one patient also submitted to left angiopneumography. One patient underwent bronchography and another one MRI. RESULTS: An unquestionable diagnosis was made in 8 cases, namely 6 of intralobar and 2 of extralobar sequestration, and confirmed surgically. The only questionable case was diagnosed at histology as extralobar pulmonary sequestration atypically fed by thin branches from the left diaphragmatic artery. CONCLUSIONS: Angiography demonstrated the abnormal arterial feeding typical of pulmonary sequestration in all cases but one. The evidence of venous drainage was the key sign to diagnose extra-versus intralobar sequestration. Therefore we conclude that angiography remains an essential tool in the diagnosis of pulmonary sequestration, notwithstanding the great potentials of Helical CT of MR angiography.     

飞行员肺隔离症的诊断、治疗及医学鉴定原则——附二例临床病例

目的 探讨肺隔离症的影像学表现、治疗和飞行员的医学鉴定原则. 方法 回顾分析两例确诊为肺隔离症的飞行员的临床诊治过程及医学鉴定,并进行相关文献复习. 结果 肺隔离症临床症状不典型,1例叶外型肺隔离症无任何临床症状,在体检过程中发现;另1例叶内型肺隔离症反复咯血,多次按肺炎等诊治,存在误诊、漏诊.影像学检查对诊断有重要意义,其中胸部X线片多作为初筛,薄层CT、CT增强及血管重建对发现异常动脉有意义,但最可靠的方法为主动脉血管造影检查.对诊断明确者多主张积极治疗,本文中1例叶内型肺隔症者采用先进的经导管动脉栓塞治疗,最终恢复飞行;另1例叶外型肺隔离症者已恢复飞行至最高年限. 结论 肺隔离症临床少见,飞行员更是罕见,易误诊、漏诊,应重视年度体检中胸部X线检查.肺隔离症在无临床症状的非战斗机飞行员可个别评定,有临床症状者采用微创介入治疗对肺功能影响小,有望恢复飞行.同时提示航空医师加强对少见先天性疾病的诊断意识,治疗时综合考虑各种治疗手段对飞行能力的影响,一些先进的治疗方法能最大限度地挽救飞行员的职业生涯.     

三维动态增强磁共振血管造影诊断肺隔离症的价值

目的：评估三维动态增强磁共振血管造影（3D DCE MRA）对显示肺隔离症异常血管的价值。方法：5例肺隔离症患者作了胸部正侧芯片，CT和MRI检查后，均行胸部和上腹部3D DCE MRA检查，并进行最大信号强度投影（MIP）和多平面重建（MPR）。结果：5例肺隔离症均为肺叶内型，位于左肺下叶。胸片表现隔离的肺组织均位于左下叶，呈圆形或椭圆形，密度较均匀的团块影。CT示降主动脉后方软组织密度肿块，2例肿块周围伴有肺气肿。增强CT显示2例供血动脉。平扫MRI示隔离肺组织在T1WI和T2WI较正常肺组织信号高的软组织块影，并显示3例供血动脉，但未能显示其作貌，行程，分支及引流静脉。另2例异常供血动脉未能显示，而3D工DCE MRA均显示了其异常供血动脉和引流静脉，并清楚显示了其分支和行程，与术中所见完全一致。结论：3D DCE MRA较能较好地显示肺隔离症的异常供血动脉和引流静脉，有利于确诊此病和制订手术治疗方案。     

High-resolution CT in renal transplant patients with suspected pulmonary infections

Objective: This prospective study was carried out to assess the usefulness of high-resolution CT (HRCT) of the chest in immunocompromised renal transplant patients with suspected pulmonary infections.Material and Methods: Twenty-one consecutive renal transplant patients with clinically suspected pulmonary infections underwent chest radiography, HRCT and other tests including bronchoalveolar lavage (BAL). HRCT was performed using a high spatial frequency algorithm with 2-mm-thick sections at 10-mm intervals from apices to domes of the diaphragm. The findings on chest radiography and HRCT were interpreted by two thoracic radiologists and the usefulness of HRCT was evaluated. The images were interpreted independently by two radiologists, who were blinded to the findings of other imaging modalities and the final diagnosis. Any differences regarding the imaging findings were resolved through consensus.Results: Final diagnosis was obtained in 17 patients, and no cause for symptomatology was established in 4 patients. The spectrum of infections included pulmonary tuberculosis (TB) in 11 patients, cytomegalovirus pneumonia (CMV) in 2 patients, cryptococcal and streptococcal pneumonia, pulmonary aspergillosis and esophageal candidiasis in 1 patient each. Compared to chest radiography, HRCT revealed additional findings in 11 patients. HRCT findings were suggestive of underlying infection in 11 patients. The final diagnosis coincided with HRCT diagnosis in all but 1 patient. HRCT findings were non-specific in 3 patients and normal in 7. The findings were concordant in 19 cases. The results were not in agreement in only 2 cases.Conclusion: HRCT can provide useful information and suggest the diagnosis in a significant proportion of renal transplant patients with pulmonary infection.     

肺栓塞的影像学诊断

探讨肺栓塞与肺梗死的影像学的诊断价值。方法对２０例临床疑诊为肺动脉栓塞的病人进行了胸部Ｘ线平片,核素肺灌注扫描和数字减影肺动脉造影诊断对比。结果数字减影肺动脉造影阳性发现１０例,以此为金标准,胸部Ｘ线平片检查,敏感性４２．９％特异性３３．３％;核素肺灌注扫描检查,敏感性７２．７％特异性７７．８％。     

多层螺旋CT及三维重组技术对肺隔离症的诊断价值

目的:探讨螺旋CT三维血管成像(3D SCTA)对显示肺隔离症异常血管的价值.方法:回顾性分析15例经手术和病理证实的肺隔离症患者的胸部CT平扫、增强及病灶区最大密度投影(MIP)和多平面重组(MPR)的影像资料.结果:12例为肺叶内型,3例为肺叶外型;10例位于左下肺,5例位于右下肺;增强CT显示13例有异常供血动脉自胸主动脉进入两下肺病灶;MIP或MPR显示了经手术证实的16条异常供血动脉中的15条,并清楚显示了其分支和行程,与术中所见基本一致.结论:螺旋CT血管成像(SCTA)及其重组技术能很好地显示肺隔离症的异常血管,对肺隔离症的诊断具有重要的临床应用价值,可以取代血管造影.     

Echography of pulmonary sequestration

Pulmonary sequestration is a rare congenital disorder in which a portion of normal lung tissue lacks normal connections with the tracheo-bronchial tree and the pulmonary arteries. We report on three cases of left lower lobe extrapleural sequestrations that have been studied with ultrasound since 1980. In the two more recent cases demonstration of the feeding vessel originating directly in the abdominal aorta by real-time ultrasound permitted very rapid non-invasive diagnosis of the malformation. We recommend that a search should be made for such an aberrant vessel with real-time ultrasound whenever a pulmonary sequestration is suspected.     

肺内良性肿块的CT与手术对照分析

目的：探讨肺内良性肿块的CT表现及其诊断价值。方法：对照分析经手术及病理证实的102例肺内良性病变的CT表现，其中肺炎性假瘤45例，结核瘤42例，肺血管瘤5例，错构瘤3例，肺隔离症3例，曲霉菌病2例，肺纤维瘤和肺血肿各1例。结果：肺炎性假瘤、肺结核瘤、肺血管瘤、肺隔离症及曲霉菌病的CT符合率分别为33．3％、73．8％、20％、100%和100％。结论：通过仔细对照分析和重新评判，对大多数肺内良性肿块可以作出定性诊断。     

产前超声及磁共振成像在胎儿肺隔离症诊断中的价值探讨

目的 探讨超声及MRI诊断胎儿肺隔离症的临床应用价值.方法 对12例产前超声怀疑胎儿肺隔离症者,24h内进行MRI检查,诊断结果均经尸检病理及产后随访证实.对12例胎儿的超声和MRI图像资料进行分析,并与随访结果对照.结果 产前超声诊断的12例胎儿肺隔离症,超声诊断符合率83.3％,误诊2例,（1例为隔疝,1例为肺囊腺瘤）;产前MRI检查诊断准确率为91.7％,误诊1例（隔离肺误诊为腹腔肿瘤）.结论 产前超声检查是诊断胎儿肺隔离症主要筛选方法,MRI可以作为胎儿超声检查的重要补充,二者联合应用,可进一步提高该病的诊断率.