甲型H1N1流感肺炎的影像学表现

目的 探讨甲型H1N1流感合并肺炎的影像表现.方法 回顾性分析15例甲型H1N1流感并发肺炎患者的临床及影像资料,按照肺内病变程度分为轻度型(3例)、中度型(5例)、重度型(7例),所有患者均行X线检查,其中3例行CT检查.结果 轻度型患者3例,X线表现为肺内局限性小片状阴影;中度型5例,X线表现为肺内片状阴影超过2个肺野,单侧病变1例,双侧病变4例;重度型(7例),X线表现为双侧肺野中内带分布的、边缘模糊的小斑片和结节状阴影,1例CT表现为左下肺大片状实变影,2例CT表现为双肺弥漫分布的、沿支气管走行的斑片状磨玻璃密度影,胸腔积液.成人呼吸窘迫综合征(ARDS)4例,并发皮下气肿1例.结论 甲型H1N1流感合并肺炎以片状影及磨玻璃密度阴影为主,可见间质病变,重型患者部分可进展为ARDS.     

甲型H1N1流感肺炎治疗后转归CT影像表现

目的:观察甲型H1N1流感肺炎治疗前后影像变化,探讨其转归影像表现。方法:回顾性分析25例甲型H1N1流感并发肺炎患者临床及治疗前后影像资料,其中男18例,女7例。结果:轻症12例,病变仅限于1个肺叶内,表现为片状磨玻璃密度影,临床以流感样症状为主,治疗后9例完全吸收,3例基本吸收。重症6例,病变累及单侧2个或双侧2个肺叶的片状阴影,以肺实变为主,临床表现为重症肺炎,治疗后1例炎症基本吸收,2例部分肺叶病变基本吸收,部分肺叶病变吸收后残留间质增生及纤维化,另3例炎症吸收后残留间质增生及纤维化。危重症7例,表现为双肺广泛分布的大片状实变影和/(或)磨玻璃密度影,临床表现为病情危重,治疗过程中3例病情存在反复,无明显吸收;4例治疗后炎症部分吸收并残留间质增生及纤维化。结论:甲型H1N1流感肺炎以磨玻璃密度影及斑片状阴影为主,影像表现多样,治疗后轻症者多完全吸收,重症及危重症者多残留间质增生及纤维化。     

重症及危重症甲型H1N1流感肺炎的影像表现

目的 探讨重症及危重症甲型H1N1流感病毒肺部感染的胸部影像表现.方法 回顾性分析18例甲型H1N1流感并发肺炎患者的临床及影像资料,将其分为重症组(11例)及危重症组(7例),所有患者均经胸部X线检查,其中2例行CT检查.结果 重症组11例,8例X线表现为双侧肺野中内带分布的、边缘模糊的小斑片和结节状阴影,3例X线表现为局灶性边缘模糊的片状阴影,其中1例胸部CT表现为右下肺大片实变影.危重症组7例,4例X线表现为双肺弥漫分布的磨玻璃密度阴影伴部分实变,其中1例出现胸颈部皮下气肿,1例胸部CT表现为双肺广泛分布的、沿支气管走行的斑片状磨玻璃密度影,双下肺结节状实变病灶和胸腔积液;其他3例表现为双侧肺野内大范围实变影.结论 甲型H1N1流感肺炎的影像表现包括重症患者肺内的结节样和斑片状阴影,危重患者肺内弥漫的支气管周围分布的磨玻璃密度灶和多灶性实变.     

甲型H1N1流感肺炎63例影像分析

目的:探讨甲型H1N1流感肺炎的胸部影像学表现。方法:收集63例甲型H1N1流感肺炎患者的X线及CT资料,回顾性分析其影像学特征。结果:63例甲型H1N1流感肺炎胸部X线表现为:肺实质性病变48例(76.19%),实质间质混合性病变15例(23.81%),弥漫性病变14例(22.22%)。其中单侧肺受累16例(25.40%),双侧受累47例(74.60%);肺部多发散在病变49例(77.78%),局限性病变14例(22.22%),其中表现为斑片状影25例(39.68%)。结论:双肺受累、病变为多发散在斑片状阴影,部分呈磨玻璃样征合并实变是甲型H1N1流感肺炎的主要影像学表现。     

甲型H1N1流感肺炎CT演变特点

目的:探讨甲型H1N1流感肺炎近中期CT演变特点。方法:回顾性分析35例临床确诊的甲型H1N1流感肺炎患者发热后1个月内86次CT资料,分析其肺部病变出现、进展及吸收时间和影像特点。结果:肺部病变发生时CT表现主要为肺部磨玻璃密度影或实变,胸腔积液等。CT复查表现分为3组:完全吸收组4例,表现为肺部磨玻璃密度影或实变在6～13d(平均11.25d)吸收;明显减轻组29例,表现为磨玻璃密度影及实变减轻或缩小,胸腔积液减少或消失;进展组2例,1例发热后第10天进展为ARDS,另1例合并真菌感染,复查后表现为实变及空洞扩大。2例远期复查中1例第73天仍浅淡磨玻璃密度影,1例第90d遗留少许磨玻璃密度影、小叶间隔增厚、小叶性结节及少许索条影。结论:甲型H1N1流感肺炎肺部病变多在发热后3天内出现,2周左右完全或部分吸收,部分病例中期复查可见间质性病变,危重症患者早中期CT即可见病变迅速进展。     

孕产妇甲型H1N1流感肺炎的影像学特点

目的：探讨孕产妇甲型H1N1流感肺炎的临床及胸部影像学表现特点。方法：依据卫生部甲型H1N1流感诊断标准,回顾性分析7例确诊的孕产妇（孕妇4例,产妇3例）甲型H1N1流感肺炎患者的临床及胸部影像学资料。结果：7例孕产妇甲型H1N1流感肺炎患者中,围产期妇女6例,重症型5例,危重型2例,占住院甲型H1N1流感患者的1.3%（7/520）,占重症及危重型患者的9.2%（7/76）。影像学表现特点：病变分布于双肺下叶5例;病变形态呈大片状影4例,呈小片状影5例;病变呈较高密度实变影5例、磨玻璃影4例;合并单侧或双侧胸膜炎或胸腔积液6例;治疗后,肺部病变大片密度较高实变影在短期内有明显吸收,淡薄影磨玻璃密度影完全吸收。结论：孕产妇是发生甲型H1N1流感肺炎的危险群体,特别是围产期伴有并发症的患者,影像学表现为双肺中叶（舌叶）及下叶大片状或小片状密度较高实变影,多伴有胸腔积液,积极有效治疗可完全康复。     

CT findings during the evolvement of influenza A( H1N1 ) pneumonia

目的:探讨甲型H1N1流感肺炎近中期CT演变特点.方法:回顾性分析35例临床确诊的甲型H1N1流感肺炎患者发热后1个月内86次CT资料,分析其肺部病变出现、进展及吸收时间和影像特点.结果:肺部病变发生时CT 表现主要为肺部磨玻璃密度影或实变,胸腔积液等.CT复查表现分为3组:完全吸收组4例,表现为肺部磨玻璃密度影或实变在6～13 d(平均11.25 d)吸收;明显减轻组29例,表现为磨玻璃密度影及实变减轻或缩小,胸腔积液减少或消失;进展组2例,1例发热后第10天进展为ARDS,另1例合并真菌感染,复查后表现为实变及空洞扩大.2例远期复查中1例第73天仍浅淡磨玻璃密度影,1例第90d遗留少许磨玻璃密度影、小叶间隔增厚、小叶性结节及少许索条影.结论:甲型H1N1流感肺炎肺部病变多在发热后3天内出现,2周左右完全或部分吸收,部分病例中期复查可见间质性病变,危重症患者早中期CT即可见病变迅速进展.     

甲型H1N1流感胸部薄层CT的诊断价值及限度

目的：分析甲型H1N1流感（S-OIV）动态胸部CT征象,探讨薄层CT在临床诊断中的价值。方法：回顾性分析经临床和实验室检查确诊的56例甲型H1N1流感患者的胸部CT的完整影像资料,分别由两位从事胸部CT诊断医师评估胸部常规CT表现,包括病变形态、密度、分布范围等特点,并与薄层CT扫描比较其影像表现的动态变化,确定诊断意见。结果：56例甲型H1N1患者中,薄层CT与常规CT扫描均有异常所见,薄层CT对病灶细节的显示优于常规CT检查。本组病例早期表现为磨玻璃密度影35例,病变进展期在磨玻璃影内出现类圆形或多发小片状实变24例,直接表现为肺叶或肺段的大片状炎性实变者13例,出现肺不张3例,肺间质增生2例,胸膜病变41例。本组CT动态变化特点是早期小片状渗出的磨玻璃状改变,进展期向大片状磨玻璃密度影和多发片状实变影过渡,最后常见有肺内病变范围减少,密度不均和肺间质性改变。结论：薄层CT可为鉴别具有甲型H1N1流感典型表现的患者与其它类型肺炎患者提供重要信息。薄层CT能反映甲型H1N1患者肺部病变的密度、形态和范围及其动态变化,对S-OIV的早期诊断和了解病变的全部影像动态变化过程具有较重要的意义,并可为临床诊疗提供可靠信息。     

6例重症甲型H1N1流感的肺部CT影像分析

目的:探讨重症甲型H1N1流感患者的肺部CT影像表现。材料和方法:回顾性分析6例经临床综合确诊的重症甲型H1N1流感患者的临床和CT资料,男4例,女2例,年龄25～61岁,平均39.83±12.41岁,所有患者均于住院期间行2～4次胸部64层螺旋CT扫描。结果:所有患者肺部阴影均较明显,发展迅速,表现为两肺多叶弥漫性渗出,病灶位于中下叶并呈外周分布居多。异常胸部CT表现包括:多发斑片状磨玻璃阴影6例,单发小圆形磨玻璃阴影4例,小结节状高密度影4例,大结节状高密度3例,磨玻璃密度影内出现结节或索条影1例,不规则肺实变3例,部分肺不张2例,细支气管扩张2例,少量胸腔积液3例,胸膜增厚2例,纵隔淋巴结肿大3例。当病变逐渐吸收后主要表现为两肺残留索条状或斑片状阴影。结论:发展迅速,双肺受累,弥漫分布,大片磨玻璃阴影伴有实变、结节,多累及两肺中下叶呈外周分布是诊断重症甲型H1N1流感的相对特征性表现。     

31例重症和危重症甲型H1N1流感患者的临床与影像学表现特点

目的：探讨重症和危重症甲型H1N1流感患者的临床与影像学表现特点。方法：回顾性分析31例重症和危重症甲型H1N1流感患者的临床表现及胸部影像学资料。其中重症甲型H1N1流感患者19例,平均（15.9±5.6）岁,体重指数（BMI）平均19.3±4.2。危重症患者12例,平均（23.5±13.6）岁,BMI平均22.2±5.5。结果：重症和危重症患者均有发热、咳嗽、咳痰、乏力等症状,两肺可闻及湿啰音、哮鸣音？V刂⒆榛颊咄怀霰硐治粑？少数出现胸痛、紫绀及咳血痰。重症组有肺炎病灶17例,影像表现均为斑点片状影,两肺受累7例,累及全肺2例,急性肺损伤3例;危重症组患者均有肺炎病灶,斑点片状影4例,大片状阴影8例,双肺受累9例,累及全肺7例,超过2/3的患者发生重症肺炎、中重度低氧血症、急性肺损伤/急性呼吸窘迫综合征（ARDS）和呼吸衰竭。结论：发热、咳嗽及咳痰等仍然是重症和危重症甲型H1N1流感患者的临床特征。高危人群感染甲型H1N1流感病毒后较易发展为重症或危重症病例。有基础疾病的患者在出现持续发热的同时,两肺见广泛磨玻璃密度影及大片状实变影,应警惕ARDS或病毒性肺炎合并细菌或真菌感染。     

儿童重症甲型H1N1流感病毒性肺炎的胸部X线及CT表现

目的 初步探讨儿童重症甲型H1N1流感病毒性肺炎的胸部X线及CT表现特点.方法 回顾性分析6例经病毒核酸检测确诊的重症甲型H1N1流感病毒性肺炎的胸部影像资料,病初6例摄胸部X线片,其中4例复查,1例行胸部CT检查.结果 6例病初胸部X线表现为肺纹理增多、增粗,均有不同程度的肺实质浸润和间质改变,其中实质浸润累及双肺3例,左肺3例;肺门增大3例.病程中复查4例,影像表现变化较快,与临床表现一致.CT检查表现为双肺中内带实变和磨玻璃密度影、胸膜下小结节影,肺门和纵隔淋巴结增大,右侧胸腔积液.结论 儿童重症甲型H1N1流感病毒性肺炎的胸部X线及CT表现有一定特点.最终诊断需结合流行病学和实验室检查.     

Pulmonary Complication of Novel Influenza A (H1N1) Infection: Imaging Features in Two Patients

Novel influenza A (H1N1) virus is the pathogen of recent global outbreaks of febrile respiratory infection. We herein report the imaging findings of pulmonary complication in two patients with novel influenza A (H1N1) infection. The first patient without secondary infection showed the ill-defined ground-glass opacity nodules and patch areas of ground-glass opacities. The second patient with secondary pneumococcal pneumonia showed areas of lobar consolidation in the right middle lobe and left lower lobe and ground-glass opacities.     

甲型H1N1流感胸部高分辨率CT表现

目的 探讨甲型H1N1流感胸部HRCT表现.方法 回顾性分析163例临床确诊为甲型H1N1流感患者的172次胸部HRCT扫描(复查9例)资料,采用标准肺窗和纵隔窗观察图像,分析胸部HRCT影像表现.结果 97例胸部HRCT未见异常,其余66例HRCT主要表现为:(1)肺实质和间质同时受累,磨玻璃密度影35例(53.0%),小叶中心结节30例(45.5%),小叶内间质及小叶间隔增厚31例(47.0%),网状结节影8例(12.1%),单小叶炎症19例(28.8%),实变15例(22.7%),肺不张3例(4.5%),条索影2例(3.0%).(2)胸膜炎症:右侧胸膜炎症8例,左侧胸膜炎症5例,双侧胸膜炎症19例.(3)纵隔淋巴结和腋窝淋巴结肿大7例.(4)抗病毒治疗后病灶吸收快.结论 甲型H1N1流感患者胸部HRCT影像表现多样,类似病毒性肺炎表现,可见肺实质和肺间质炎症、胸膜炎症和纵隔淋巴结肿大.     

76例重症甲型H1N1流感的影像学表现及动态观察

目的：探讨重症甲型H1N1流感的胸部影像学表现。方法：回顾性分析76例重症甲型H1N1流感的影像学资料,将所有病例根据临床特点和病程分为三组：第1组（n=50）：门诊病例或是住院时间很短的病例;第2组（n=14）：临床上有急性呼吸衰竭但未用机械通气的病例;第3组（n=12）：急性呼吸衰竭同时需要机械通气的病例。观察所有患者平片、CT表现,并对病变的大小、形态、数目和分布加以分析。结果：重症甲型H1N1流感的主要影像学表现为双侧或单侧的磨玻璃样改变、实变或混合型病变,第1组以磨玻璃样改变为主,病变一般多发,可侵及所有肺叶,但主要发病部位为双肺下叶,多呈周围性分布;第2组以实变为主,可合并磨玻璃样改变或局灶性实变,恢复期可有少数病例呈纤维性修复;第3组以实变为主,可合并间质性改变,单纯磨玻璃样改变少见;少数病例可合并胸腔积液、心包积液和肺不张;第3组部分病例可伴有继发性气胸、纵膈气肿、皮下气肿以及霉菌感染,继发肺动脉高压、右心衰竭、肝脾淤血。结论：在不同的临床病程中患者有不同的影像学表现。轻症病例影像学表现比较轻微,恢复也比较彻底,一些重症病例可呈纤维性修复,而危重病例,尤其是需要机械性通气的病例其并发症尤其是气胸的发生概率较高,且病情变化比较反复,在病变进展期及时复查X线胸片以了解影像的变化,对于正确地评估病情、采取积极恰当的治疗措施将起到重要的指导作用。     

Radiological findings of pneumonia in patients with swine-origin influenza A virus (H1N1)

Purpose

During spring 2009, a pandemic swine-origin influenza A (H1N1) virus (S-OIV) emerged and spread globally. We describe the chest X-ray and computed tomography (CT) findings of 40 patients with pneumonia due to S-OIV observed in our institution.

Material and methods

Among 534 patients with S-OIV, according to the US Centers for Disease Control and Prevention case definition, seen between June and November 2009, 121 underwent chest X-ray and 40 (median age 44 years, range 16–79) had pneumonia. The initial chest radiographs were evaluated for pattern, distribution and extent of lung abnormalities. Unenhanced chest CT scans were performed in two patients and were reviewed for the same findings. Underlying medical conditions were present in 42% of patients (17/40).

Results

Our patients had predominantly mild illness, and pneumonia was observed in 40 individuals (40/121 patients who had chest X-rays, 33%; and 40/534 patients with S-OIV, 7.5%). However, S-OIV can cause severe illness requiring admission to the intensive care unit for advanced mechanical ventilation and extracorporeal life support, including adult respiratory distress syndrome (ARDS) and death. The major radiological abnormalities observed were interstitial changes (60.0%), with (22.0%) or without patchy ground-glass appearance, mostly bilateral, and located in the lower lung zones (7.5%). Extensive disease was seen in 37.5% (15/40), and ARDS was observed in three individuals (0.30%)with underlying medical conditions. Subtle pleural effusion was noted in four patients.

Conclusions

In our series, the most frequent pneumonia patterns observed during S-OIV (H1N1) virus were interstitial changes and patchy ground-glass appearance, mostly bilateral, and located in the lower lung zones. CT, performed in severely ill patients, confirmed the ARDS identified with chest X-rays, better depicting the features and extent of lung abnormalities.     

甲型H1N1流感患者胸部CT首诊表现

目的 探讨甲型H1N1流感患者的胸部MSCT首诊表现.方法 回顾性分析19例经实验室检测显示甲型H1N1流感病毒阳性患者的首诊胸部MSCT影像资料.由3名副教授影像医师独立阅读并最终讨论达成一致.影像的异常表现包括实变、磨玻璃密度影、结节影,网格影.病变的分布包括单侧或双侧.病变部位按病变累及肺叶的解剖划分,同时评估胸腔积液单双侧及纵隔和肺门的淋巴结增大、心包积液及胸膜异常.用自建半定量甲型H1N1病变评分表评价磨玻璃密度影及实变影.采用Spearman相关分析检验半定量磨玻璃样变和实变CT评分与患者的发热时间之间有无相关关系.结果 19例患者中18例胸部CT首诊为阳性,肺内见实变影3例、磨玻璃密度影3例、实变影+磨玻璃密度影12例.病变全部为双侧分布,并且主要为弥漫分布(14例),多灶病变均分布在中下叶(4例).2例患者首次胸部CT检查发现心脏增大,其中1例合并心包积液.5例胸腔积液患者中,2例为双侧,3例为单侧.2例纵隔淋巴结增大,1例胸膜增厚.半定量磨玻璃密度影CT评分有2例4.25分,1例3.75分,1例2.25分,1例1.75分,6例1.00分,2例0.75分,2例0.50分,4例0分.半定量实变影CT评分有1例4.25分,1例4.00分,1例3.75分,1例2.75分,3例1.25分,2例1.00分,2例0.75分,1例0.50分,3例0.25分,4例0分.半定量磨玻璃密度影CT评分与发热时间存在正相关性(r=0.776,P<0.01),半定量实变影CT评分与发热时间无相关性(r=0.322,P>0.01).结论 甲型H1N1患者胸部CT首诊表现多以双侧磨玻璃密度病变伴或不伴实变影为主,主要为弥漫分布.甲型H1N1肺炎在发病初期病程进展以磨玻璃密度影范围扩大为标志.     

Radiographic and high-resolution CT findings of influenza virus pneumonia in patients with hematologic malignancies

OBJECTIVE: We sought to describe the radiographic and high-resolution CT findings of influenza virus pneumonia in patients with hematologic malignancies. CONCLUSION: Radiologic findings of influenza virus pneumonia in immunocompromised patients consist of patchy or confluent consolidation and nodular opacities on chest radiography and ground-glass attenuation, consolidation, centrilobular nodules, and branching linear opacities on high-resolution CT.     

Radiological prognostic factors in patients with pandemic H1N1 (pH1N1) infection requiring hospital admission

The aim of this study was to determine the radiologic findings associated with admission to the intensive care unit (ICU) and the development of acute respiratory distress syndrome (ARDS) in patients with pH1N1 infection. One hundred and four patients (15–96 years) with laboratory-confirmed pH1N1 infection seen at the Emergency Department from July to December 2009 who underwent chest radiographs were studied. Radiographs were evaluated for consolidation, ground-glass opacities, interstitial patterns, distribution, and extent of findings. Eighty-seven (83.7%) of the patients were managed in the ward, and 17 (16.3%) patients eventually required admission to the ICU. All patients admitted to the ICU showed abnormalities on the initial radiograph. The presence of consolidation, multifocal, diffuse, and bilateral involvement on the initial radiograph was associated with a statistically higher risk of requiring ICU admission (p < 0.001). There were no significant differences regarding age, sex, and presence of underlying comorbidities. Evolution to ARDS was found in eight cases that necessitated ICU care. All of them had on the initial radiograph patchy multifocal consolidations (p < 0.001) with bilateral lesions in six cases. A higher number of lung zones involved and consolidation on the initial chest radiograph as well as a rapid progression of the radiological abnormalities were identified in patients requiring ICU admission and development of ARDS. Initial chest radiographs show acute abnormalities in all patients with severe disease. The findings of a multifocal patchy consolidation pattern with bilateral or diffuse lung involvement on admission should alert of the impending severity of disease and the risk of necessitating ICU admission