成人麻疹病毒肺炎的影像表现

目的 探讨成人麻疹肺炎的胸部影像表现.方法 对163例成人麻疹患者行胸部X线平片检查,其中3例行MSCT扫描,共确诊10例成人麻疹肺炎患者.结果 10例肺炎患者中8例X线胸片异常,特征性表现为磨玻璃密度影(6例)和支气管增粗(2例);2例X线胸片正常者行MSCT检查.MSCT表现为双肺磨玻璃密度灶1例,右上叶呈肺小叶分布的磨玻璃密度灶2例.结论 了解麻疹肺炎的X线胸片和MSCT表现可以缩小鉴别诊断范围,首次X线胸片正常患者不能除外肺部受累.

Abstract：

Objective To illustrate the chest radiography and MSCT findings of measles pneumonia in adults. Methods One hundred and sixty three measles patients underwent chest radiography, MSCT was performed in 3 of them. Measles pneumonia was confirmed in 10 patients (6.13%). Results Eight of 10 patients had abnormal appearances in initial chest radiography. The characteristic chest radiographic findings were ground-glass opacities (n=6) and bronchial wall thickening (n=2). MSCT showed bilateral multiple ground-glass opacities in 1 patient,unilateral patchy ground-glass opacities with lobular distribution in the right upper lung in 2 patients. Conclusions Familiarizing with radiographic and MSCT appearances of measles pneumonia in adults is very important for the differential diagnosis and appropriate management of measles pneumonia. Normal initial chest radiography cannot exclude the involvement of the lungs.     

儿童甲型H1N1流感患者胸部影像表现

目的:分析儿童甲型H1N1流感患者胸部影像特点,为临床合理诊断和评价病情提供依据。方法:回顾性分析80例确诊甲型H1N1流感患者胸部影像资料及特点。患者图像资料由两位高年资医师独立阅片并达成一致意见。结果:甲型H1N1流感患者肺部影像特点8例X线表现正常;50例肺部X线表现为两肺下野斑片状影(10例病灶有融合);6例患者表现为大叶性肺炎;16例重症患者行胸部X线检查,均表现为两肺弥漫性大片状实变影,其中6例行CT平扫,表现为两肺弥漫性大片状实变影和肺间质改变;5例表现为两肺弥漫性大片状实变影者,3个月后HRCT复查显示小叶间隔增厚。结论:儿童甲型H1N1流感患者胸部影像多表现为两肺下斑片状阴影,其次为两肺弥漫大片状实变影,影像表现为正常或大叶状实质变性相对较少。     

甲型H1N1流感的胸部X线及CT表现(附13例分析)

目的 探讨甲型H1N1流感的胸部影像表现.方法 对13例临床确诊的甲型H1N1患者的胸部X线和CT的影像征象进行分析.结果 甲型H1N1流感的胸部X线和螺旋CT影像征象主要表现为两肺的磨玻璃状与实变共存或磨玻璃状影,病变以两下肺及周围分布为主,实变的肺组织内可见支气管气像.13例中9例病变分布超过3个肺叶.2例显示边界不清的磨玻璃状小结节.2例在磨玻璃状病变中可见空腔.2例X线平片仅显示慢性支气管炎的异常征象.多层螺旋CT扫描于磨玻璃状密度、磨玻璃状密度与实变共存肺组织中可见明显的肺间质增厚.结论 胸部X线和多层螺旋CT检查对于甲型H1N1流感病人的诊断有重要作用,HRCT是显示病变分布和肺间质改变的首选检查方法.     

不同级别甲型H1N1病毒性流感患者胸部影像学表现

目的 探讨不同级别甲型H1N1病毒性流感患者的胸部影像学表现,评价其表现对此病分级及预后评估的临床价值.方法 本院确诊的甲型H1N1流感患者286例行胸部X线检查,其中8例行胸部CT平扫,1例危重病例进行预后胸片及CT扫描追踪.对甲型H1N1病毒性流感患者一般病例、重症病例及危重病例的胸部X线和CT表现进行回顾性分析.结果 286例中一般病例263例,其中235例自发病至出院胸部均未出现异常表现,28例最初X 线表现以肺内轻微渗出为主;重症病例13例,其中8例以间质浸润为主,5例以局灶性斑片状高密度影为主;危重病例10例,其中7例以肺实变为主,2例局限性斑片影伴胸腔积液,1例呈毛玻璃样影,1例危重病例预后随诊肺内有纤维条索形成.结论 甲型H1N1病毒性流感患者一般病例肺部表现轻或正常,危、重病例表现为间质浸润和肺实变.     

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。     

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流感合并肺炎的影像表现

目的 探讨甲型H1N1流感合并肺炎的影像表现.方法 分析确诊的甲型H1N1流感合并肺炎患者51例,均摄床旁X线胸片,44例同期行胸部CT检查.按肺内病变程度将所有患者分为轻度、中度、重度3型.结果 轻度患者4例,表现为肺内局限片状阴影;中度33例,肺内片状阴影超过2个肺野,其中双侧病变30例,单侧病变3例;重度14例,肺内广泛分布片状及磨玻璃密度阴影,可以合并间质改变,其中2例合并感染,成人呼吸窘迫综合征(ARDS)6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,合并感染后影像表现多样,部分患者可进展为ARDS.     

甲型H1N1流感并发急性呼吸窘迫综合征的影像学表现分析

目的 探讨重症甲型H1N1流感并发急性呼吸窘迫综合征(ARDS)的影像学表现.方法 回顾分析12例重症甲型H1N1流感患者并发急性呼吸窘迫综合征(ARDS)的X线和CT表现.X线检查包括普通胸部DR摄片和床边DR摄片,CT检查包括常规螺旋CT扫描和高分辨率CT(HRCT)扫描.结果 (1)X线表现分为初期、进展期、恢复期3期.初期:X线检查发现单发斑片状或云雾状密度影3例.双侧多发病灶9例,其中两下肺多发片状模糊影5例,两上、中、下肺中外带多发节段性片状模糊影2例,右下肺大片实变影,同时左肺出现散在斑片状模糊影1例,两肺门影增浓、模糊,肺门周围分布点片状模糊影1例.进展期:所有病例病灶迅速扩大,表现为多肺段或多肺叶浸润,两肺均受累及,病灶多变,呈现出游走性浸润.恢复期:病灶逐渐吸收,残留有纤维条索影7例,网格状肺纹理2例,栗粒结节影2例,两下肺小片状均匀密度影1例.(2)CT表现:实变影,表现为两肺单发或多发的斑片状或大片状模糊影12例, 支气管充气像8例.磨玻璃样密度影6例.肺间质性改变包括肺纹理呈网格状5例,胸膜下弧线影3例,胸膜下斑片状磨玻璃影5例,小叶间隙增厚4例,这些征象可同时存在.(3)合并症:气胸4例,纵隔皮下气肿4例,腹膜后积气1例,真菌性空洞3例,蜂窝肺1例.结论 重症甲型H1N1流感并发ARDS影像学表现复杂、多变,并发症多,影像学检查能及时准确地显示甲型H1N1流感并发ARDS各阶段的病变过程,有利于指导和评估临床治疗效果.     

甲型H1N1流感胸部影像学表现

甲型H1N1流感是2009年在全球爆发流行的呼吸道传染病.引起胸部异常者少见但病人症状较重.主要胸部影像学表现为肺内磨玻璃影和实变影.胸部X线摄影和CT是常用检查手段.就2009年H1N1流感的胸部影像学表现进行综述.     

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.     

Novel Influenza A (H1N1) Virus Infection in Children: Chest Radiographic and CT Evaluation

Objective

The purpose of this study was to evaluate the chest radiographic and CT findings of novel influenza A (H1N1) virus infection in children, the population that is more vulnerable to respiratory infection than adults.

Materials and Methods

The study population comprised 410 children who were diagnosed with an H1N1 infection from August 24, 2009 to November 11, 2009 and underwent chest radiography at Dankook University Hospital in Korea. Six of these patients also underwent chest CT. The initial chest radiographs were classified as normal or abnormal. The abnormal chest radiographs and high resolution CT scans were assessed for the pattern and distribution of parenchymal lesions, and the presence of complications such as atelectasis, pleural effusion, and pneumomediastinum.

Results

The initial chest radiograph was normal in 384 of 410 (94%) patients and abnormal in 26 of 410 (6%) patients. Parenchymal abnormalities seen on the initial chest radiographs included prominent peribronchial marking (25 of 26, 96%), consolidation (22 of 26, 85%), and ground-glass opacities without consolidation (2 of 26, 8%). The involvement was usually bilateral (19 of 26, 73%) with the lower lung zone predominance (22 of 26, 85%). Atelectasis was observed in 12 (46%) and pleural effusion in 11 (42%) patients. CT (n = 6) scans showed peribronchovascular interstitial thickening (n = 6), ground-glass opacities (n = 5), centrilobular nodules (n = 4), consolidation (n = 3), mediastinal lymph node enlargement (n = 5), pleural effusion (n = 3), and pneumomediastinum (n = 3).

Conclusion

Abnormal chest radiographs were uncommon in children with a swine-origin influenza A (H1N1) virus (S-OIV) infection. In children, H1N1 virus infection can be included in the differential diagnosis, when chest radiographs and CT scans show prominent peribronchial markings and ill-defined patchy consolidation with mediastinal lymph node enlargement, pleural effusion and pneumomediastinum.     

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。     

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.     

肺朗格罕氏细胞组织细胞增多症的影像学诊断

目的探讨肺郎格罕氏细胞组织细胞增生症(PLCH)的影像学表现及鉴别诊断。方法6例经病理证实的PLCH患者均经胸部X线平片和高分辨率CT(HRCT)检查,对其影像学表现进行了回顾性分析,并结合文献复习讨论了鉴别诊断。结果X线胸片与HRCT显示了双肺弥漫网状、星状结节影2例,弥漫性分布的囊疱与星状结节并存2例,两肺实变影、磨玻璃样影是1例,以及单侧肺斑片状浸润性改变1例。结论两肺弥漫性分布的网状、星状结节影及囊疱影表现结合临床及实验室检查可提示PLCH的诊断。PLCH应与肺淋巴管平滑肌瘤病、特发性间质纤维化,以及结节病等鉴别。     

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.     

传染性非典型肺炎首次阳性胸片分析

目的：探讨传染性非典型肺炎初始发病时的胸部X线表现，提高该病的诊断符合率。方法：回顾性分析260例传染性非典型肺炎患者首次阳性胸片的X线表现。结果：260例传染性非典型肺炎首次阳性胸片的胸部X线表现为斑片状影176例(67．7％)，大片状影56例(21．5％)，间质改变72例(27．7％)，44例(16．9％)斑片状影伴间质改变；单肺受累117例(45．0％)，双肺受累143例(55．0％)；163例(62．7％)片状影内可见支气管气像。结论：斑片状影、大片状影、间质改变是传染性非典型肺炎首次阳性胸片的主要X线表现，胸片检查应作为传染性非典型肺炎常规检查方法。最后诊断应结合临床和实验室检查。     

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