肺部弥漫性磨玻璃阴影的CT诊断与鉴别诊断

目的探讨以弥漫性磨玻璃阴影为主要表现肺部疾病的CT特征,提高对本类型肺部疾病的诊断以及鉴别诊断水平。方法回顾分析经病理证实以及临床综合诊断121例以弥漫性磨玻璃阴影为主要表现肺部疾病的CT、HRCT及临床资料,总结其各自CT特征,并寻求具有诊断及鉴别诊断价值的CT及HRCT征象。结果121例中,以肺固有结构异常为主的疾病主要为间质性肺炎18例和结缔组织病5例,磨玻璃影主要分布于中、下肺的外周部,且均伴有间质增厚及纤维化征象。以肺气腔充气状态异常为主的疾病有：过敏性肺炎10例、肺出血5例、肺转移瘤3例及肺泡癌2例,磨玻璃影按照肺叶、肺段分布,且伴有或不伴有小叶中心结节、腺泡结节或肿块性病变。以肺内血管外体液量增加为主的疾病有肺水肿21例及肺挫伤5例,肺水肿性磨玻璃影具有沿下垂部分布的趋势,可伴有心影增大及胸腔积液;而肺挫伤性磨玻璃影与外伤部位相关,且在外伤区肺内也具有沿下垂部分布的趋势。以血流灌注异常为主的疾病有肺栓塞11例和白塞氏综合征4例,磨玻璃影位于正常血管所属的高灌注区,而低密度区是栓塞血管所属的低灌注区,多发细小血管栓塞或多发细小动脉炎可形成马赛克样密度。两种因素或两种以上因素异常的疾病有慢性阻塞性肺病25例、肺泡蛋白沉积症7例及病毒性肺炎5例,慢性阻塞性肺病为通气-血流障碍所致,其磨玻璃影与低密度区形成马赛克样改变,常伴有桶状胸;而肺泡蛋白沉积症及病毒性肺炎同时具有气腔和固有肺结构异常,其磨玻璃影是间质性病变与实质性病变共同作用的结果。结论双肺弥漫性磨玻璃影见于多种疾病,通过对其形态、分布、伴随征象及疾病动态变化的分析,可以初步了解其发生的病理学基础和发病机制,结合临床可以缩小拟诊的范围。     

Prognostic value of ground glass opacity on computed tomography in pathological stage I pulmonary adenocarcinoma: A meta-analysis

BACKGROUNDThe clinical role of ground glass opacity (GGO) on computed tomography (CT) in stage I pulmonary adenocarcinoma patients currently remains unclear.AIMTo explore the prognostic value of GGO on CT in lung adenocarcinoma patients who were pathologically diagnosed with tumor-node-metastasis stage I. METHODSA comprehensive and systematic search was conducted through the PubMed, EMBASE and Web of Science databases up to April 3, 2021. The hazard ratio (HR) and corresponding 95% confidence interval (CI) were combined to assess the association between the presence of GGO and prognosis, representing overall survival and disease-free survival. Subgroup analysis based on the ratio of GGO was also conducted. STATA 12.0 software was used for statistical analysis.RESULTSA total of 12 studies involving 4467 patients were included. The pooled results indicated that the GGO predicted favorable overall survival (HR = 0.44, 95%CI: 0.34-0.59, P < 0.001) and disease-free survival (HR = 0.35, 95%CI: 0.18-0.70, P = 0.003). Subgroup analysis based on the ratio of GGO further demonstrated that the proportion of GGO was a good prognostic indicator in pathological stage I pulmonary adenocarcinoma patients, and patients with a higher ratio of GGO showed better prognosis than patients with a lower GGO ratio did.CONCLUSIONThis meta-analysis manifested that the presence of GGO on CT predicted favorable prognosis in tumor-node-metastasis stage I lung adenocarcinoma. Patients with a higher GGO ratio were more likely to have a better prognosis than patients with a lower GGO ratio.     

超声引导经皮肺肿物穿刺自动活检术的临床价值

目的 探讨超声引导经皮肺肿物穿刺自动活检方法及其临床应用价值。方法 采用B型超声仪对40例肺肿块术前体表定位，确定穿刺线路，术中在超声实时监测下应用自动活检枪配套切割式活检针进行穿刺活检，术后观察并发症。结果 40例均取材成功。病理诊断35例为肺癌，3例为炎性假瘤，2例为结核球，均可确诊。穿刺后无一例出现气胸、出血等并发症。结论 超声实时引导经皮肺穿刺自动活检是一种安全、准确、经济的确诊外周部肺肿物的方法。     

CT引导下经皮肺穿刺活检术的临床应用

目的探讨CT引导下经皮肺穿刺活检术在临床应用中的价值。方法采用Dltra2 Cut型18G软组织切割活检针在SEMENS64排螺旋CT引导下穿刺68例肺周围病变患者。结果68例经皮肺穿刺活检,经病理诊断明确61例,诊断率为91％,术后气胸5例,肺出血3例,咳血2例均愈。结论CT引导下经皮肺穿刺活检术安全、经济、准确率高、创伤小,具有临床应用价值。     

CT引导下肺内病变穿刺活检技术的探讨

目的:探讨在CT导向肺内病变穿刺技术中CT准确定位、正确取材方法对诊断准确率的影响。方法:搜集CT导向肺内病变穿刺活检的CT资料71例,按术者操作方法不同分成3组:平静浅短呼吸组,直接屏气组和深吸气后屏气组,进行回顾性分析。结果:①平静浅短呼吸组:36例,诊断准确率94.4%(34C36),气胸发生率8.3%(3C36),穿刺取材次数为1次;②直接屏气组:31例,诊断准确率为83.9%(26C31),气胸发生率为5%(6C31),穿刺活检次数为2～3次;③深吸气后屏气组:4例,诊断准确率为50%(2C4),气胸发生率为75%(3C4),穿刺活检次数为2～4次;④并发症:主要为气胸,发生率16.9%(12C71),未出现咯血、空气栓塞等并发症。结论:CT准确定位、取材方法正确对提高CT导向肺内病变穿刺活检技术的诊断准确率,减少并发症的发生有重要的临床意义。     

超声引导经皮肺活检在周围型肺癌诊断中的应用

目的探讨超声引导下经皮肺活检在周围型肺癌诊断中的应用价值。方法回顾分析39例超声引导下经皮周围型肺癌穿刺活检的病例。结果39例均一次取材成功,成功率100%,病理确诊阳性率94.9%,并发症发生率10.3%。结论对于周围型肺癌的诊断,只要超声能清楚显像宜首选超声引导经皮肺活检肿瘤组织。     

CT引导下肺穿刺活检诊断肺部肿块准确性的影响因素分析

目的探讨影响CT引导肺穿刺活检诊断准确率的因素。方法回顾性分析CT引导肺部病变穿刺活检264例,对穿刺活检术的诊断正确率与病灶的大小、位置、进针深度进行Logistic回归分析,并分析并发症发生情况。结果CT引导肺穿刺活检诊断正确率分别为87.5%,气胸及病灶周围出血的发生率均为1.9%。Logistic回归发现,病灶的大小是影响穿刺活检正确率的主要因素(Wald=12.891,P=0.00034,OR=0.96)。结论CT引导肺穿刺活检灶诊断准确率均较高,病灶的大小影响穿刺活检的正确率。     

CT引导下经皮肺穿刺活检并发症的观察及护理

探讨CT引导下经皮肺穿刺活检术并发症的观察及护理。方法：对CT引导下行经皮肺穿刺活检术980例患者进行观察,统计气胸、咯血、胸腔积血、皮下血肿等并发症发生率及护理方法。结果：178例患者出现气胸,占18．16％,发生少量、中量及大量气胸的例数分别为165例、10例及3例,其中有2例发生迟发性气胸;咯血99例,占10．10％,其中血丝痰、片状血痰分别分95例及4例,均未见大咯血患者;CT显示肺内针道出血156例,占15．92％;出现少量胸腔积血4例,占0．41％;皮下局部血肿7例,占0．71％。经有效治疗及护理,大部分患者均在2-3d痊愈。结论：CT引导下经皮肺穿刺活检术并发症均不严重,经过有针对性的治疗、精心护理、严密观察,可使并发症在短期内完全康复。     

Pulmonary contusion mimicking COVID-19: A case report

BACKGROUND Coronavirus disease 2019(COVID-19)is a major public health emergency with obvious characteristics of human-to-human transmission,and there are infective asymptomatic carriers.Early identification and proper management of patients with COVID-19 are important.Features in chest computed tomography(CT)can facilitate identifying newly infected individuals.However,CT findings of some lung contusions are similar to those of COVID-19,as shown in the present case.CASE SUMMARY A 46-year-old woman was admitted to hospital for backache and foot pain caused by a fall injury 1 d before hospitalization.She was suspected of having COVID-19,since there was a confirmed COVID-19 case near her residence.But she had no fever,cough,chest tightness,difficult breathing,nausea,vomiting,or diarrhea,etc.On physical examination,the lower posterior chest of both sides showed dullness on percussion and moist rales at the end of inspiration on auscultation.The white blood cell count and lymphocyte count were 10.88×109/L and 1.04×109/L,respectively.CT performed on February 7,2020 revealed that both lungs were scattered with patchy ground-glass opacity.The patient was diagnosed with pulmonary contusion with thoracic spinal fracture(T12),calcaneal fracture,and pelvic fracture.On day 9 after conservative treatment,her condition was alleviated.On review of the chest CT,the previous shadows were significantly reduced.CONCLUSION Differential diagnosis of lung contusion and COVID-19 must be emphasized.Both conditions require effective prompt actions,especially COVID-19.     

肺周围性病变CT下经支气管和经皮活检的应用

目的 评价CT引导纤维支气管镜经支气管肺活检（CT－TBLB）和经皮肺穿刺活检（CT－NLB）在肺周围性病变中的综合应用价值。方法 根据病灶处在肺野位置不同,51例选择CT－TBLB,46例采用CT－NLB。结果 综合选择下两组肺活检取材总成功率达100％,阳性率87．6％,诊断符合率97．9％（其中CT－TBLB达100％）,气胸和咯血等并发症明显较少。两种方法阳性率和符合率较高,但组间无显著性差异（P均＞0．05）。结论 CT－TBLB和CT－NLB是肺周围性病变定性诊断可行的和理想的非开胸活检方法,适合不同位置类型病灶。若综合选用可提高肺周围活检的准确性和安全性。     

CT引导下经皮肺穿否则的临床应用价值（附32例报告）

目的：分析CT引导下经皮肺穿刺活检的临床应用价值。材料与方法：对32例病变（包括肺周围性结节29例,肺门1例,纵隔1例,胸膜1例）行CT引导下穿刺活检,采用COOK公司21G抽吸针和自动弹射活检枪,选择最佳层面,进针点,进针角度和深度,作多点抽吸结合活检枪取材,结果：穿刺成功率为100％,肺部病变穿刺活检总阳性率为100％,气胸发生率为6％,结论：CT引导下肺部病变穿刺活检成功率高,并发症少,安全可靠,为临床提供细胞学,组织学,病原学依据,值得临床推广应用。     

高分辨CT评价肺功能正常吸烟者肺组织早期损害

目的:采用高分辨CT(HRCT)观察肺功能正常吸烟者肺组织的早期损害。方法:入选健康者82名,各项肺功能检查指标均正常者82名,无慢性咳嗽、咳痰、呼吸困难及慢性呼吸道疾病,其中吸烟者46名,不吸烟者36名,对其行HRCT扫描。扫描结果由放射科医师采用盲法进行评估。结果:19.6%(9/46)吸烟者HRCT可见肺气肿表现,而非吸烟者中均未出现肺气肿表现,差异有统计学意义(P<0.001)。结论:HRCT能早期发现无临床症状、肺功能正常者的肺部早期变化,如肺气肿及慢支样改变。HRCT有助于肺部疾病的早期诊断,尤其对于吸烟的高危人群。     

经电子支气管镜和经皮肺活检诊断肺外周孤立性肿块

目的：评估综合使用经电子支气管镜肺活检和CT引导下经皮肺穿刺活检经皮肺穿刺活检对疑为周围性肺癌的肺外周孤立性肿块的诊断价值，评估其安全性。方法：对136例经无创检查未能确诊的肺外周孤立性肿块患者，根据病变部位、距胸膜距离及患者病情，对其中62例患者进行了经电子支气管镜肺活检，对另外74例患者使用精细针进行了经皮肺穿刺活检。评估各自诊断准确率、恶性病变诊断敏感度、并发症发生率。结果：经电子支气管镜肺活检和经皮肺穿刺活检均能获取组织标本。病理结果显示经电子支气管镜肺活检组有29例为恶性病变，6例为良性痛变，27例无明确病理诊断结果，诊断准确率为71％；恶性病变诊断敏感度为69．0%；经皮肺穿刺活检组有59例恶性病变．7例为良性病变，8例无明确病理诊断结果，诊断准确率为94．6％；恶性病变诊断敏感度为95．2％（P〈0．01）。两组均未出现严重并发症，经电子支气管镜肺活检并发气胸1例，痰中带血10例。经皮肺穿刺活检组并发气胸11例，痰中带血1例，肺内出血4例。结论：综合使用经电子支气管镜肺活检、经皮肺穿刺活检对疑为周围性肺癌的肺外周孤立性肿块的诊断具有重要价值，安全性高。     

Value of low-dose and optimized-length computed tomography (CT) scan in CT-guided percutaneous transthoracic needle biopsy of pulmonary nodules

ObjectiveTo investigate the value of application of low-dose and optimized length CT scan on puncture results, complications and patients’ radiation dosage during CT-guided percutaneous biopsy of pulmonary nodules (PTNB).MethodsA total of 231 patients with PTNB under CT guidance were collected. Low dose scanning utilized tube current of 20 mA as compared with 40 mA in conventional dosage. Optimized length in CT is defined as intentionally narrowing the range of CT scanning just to cover 25 mm (5 layers) around the target layer during needle adjustment. According to whether low-dose scans and optimized length scans techniques were utilized, patients were divided into three groups: conventional group (conventional sequence + no optimization), optimized length group (conventional sequence + optimized length), and low-dose optimized length group (low dose sequence + optimized length). The ED (effective dose), the DLP (dose length product), the average CTDIvol (Volume CT dose index), total milliampere second between subgroups were compared.ResultsCompared with the conventional group, ED, intraoperative guidance DLP, total milliseconds and operation time in the optimized length group were reduced by 18.2% (P=0.01), 37% (P=0.003), 17.5% (P=0.013) and 13.3% (P=0.021) respectively. Compared with the optimized length group, the ED was reduced by 87%, preoperative positioning, intraoperative guidance and postoperative review DLP were also reduced by 88%, total milliampere second was reduced by 79%, with an average CTDIvol was reduced by 86%, in the low-dose optimized length group (P<0.001 for all).ConclusionOptimizing the length during CT scanning can effectively reduce the intraoperative radiation dose and reduce the operation time compared with conventional plan; low-dose and optimized length CT scan can further reduce the total radiation dose compared with optimized length group with no differences on intraoperative complications, biopsy results and operation time.     

Large cystic-solid pulmonary hamartoma: A case report

BACKGROUNDIt now seems that all pulmonary hamartomas (PHs) are large cystic-solid lesions that are difficult to diagnose. However, few cases of large cystic-solid PHs have been reported. The present case report presents a large cystic-solid PH and provides a literature review of the imaging features, formation mechanism and histopathological basis of PHs.CASE SUMMARYA 53-year-old woman with no clinical symptoms underwent a chest computed tomography (CT) examination at our hospital. Nonenhanced CT images revealed a large, flat tumor with multiple air-containing cysts in the left thoracic cavity and a cystic part confined to the medial side of the tumor; the solid part of the tumor showed abundant fat and lamellar soft tissue components. Multiple small blood vessels were detected in the solid part of the tumor on contrast-enhanced CT images. Given the large size of the lesion, the patient elected to undergo surgery. Histological examination revealed PH. A detailed review of the patient’s CT imaging showed that the lesion had a small vascular pedicle to the left lower lobe, which was a clue to its lung tissue histological origin. According to immunohistochemical staining, the confined multiple air-containing cysts were caused by the entrapment of respiratory/alveolar epithelium.CONCLUSIONThis case shows the imaging manifestations of a large PH. Heightened awareness of its formation mechanism and histopathological basis may alert radiologists to consider this diagnosis in their daily workflow.     

Lytic bone lesions suspected for metastasis: Ultrasonically guided fine-needle aspiration biopsy

Ultrasonically guided fine-needle aspiration biopsy (US-FNAB) was performed in 30 patients with a lytic bone lesion suspected for metastasis detected by conventional radiological examinations. The patients were selected for US-FNAB on the basis of the ability of the ultrasound examination to clearly visualize the lesion. The cytological diagnosis was confirmed at surgery in 3 cases, and at clinical and radiological follow-up after more than 6 months in the remaining cases. The lesions were located mostly in the thoracic skeleton (ribs and sternum) and pelvic bone. We diagnosed malignancy in 26 cases and benign lesions in 2 cases. An inadequate sample was obtained in 1 case, and 1 case yielded a false-negative result. According to these results, we obtained a sensitivity of 93%. We conclude that ultrasonically guided fine-needle aspiration biopsy is a useful technique to obtain a pathological diagnosis in cases of lytic bone lesions that can be visualized with this imaging technique. © 1994 John Wiley & Sons, Inc.     

Fatal left atrial air embolism as a complication of percutaneous transthoracic lung biopsy: A case report

BACKGROUNDComputed tomography (CT)-guided percutaneous lung biopsy is a common protocol in the context of diagnostic thoracic oncology, but entails a risk of complications including systematic air embolism (SAE). While SAE is often well tolerated, it can be difficult to treat and may result in rapid mortality in some cases.CASE SUMMARYWe report a rare case of left atrial SAE in a 71-year-old woman who underwent a CT-guided lung biopsy of a pulmonary nodule in the posterior basal segment of the right lower lobe. Shortly following needle extraction, she experienced a mild cough, hemoptysis, rapid-onset unconsciousness, and cardiopulmonary arrest. Cardiopulmonary resuscitation was immediately performed, but the patient died 40 min after the procedure. A closer review of collected CT scans revealed the presence of a large volume of air within the left atrium.CONCLUSIONAlthough SAE is generally well tolerated and asymptomatic, interventional radiologists must be aware of the risk of fatal outcomes and establish appropriate emergency management protocols. In this report, the characteristics, mechanisms, and treatment recommendations associated with SAE are discussed in an effort to improve the survival of affected patients.