儿童特发性肺含铁血黄素沉着症的影像学诊断

目的:探讨儿童特发性肺含铁血黄素沉着症(IPH)的影像表现。方法:回顾性分析10例经病理证实的特发性肺含铁血黄素沉着症的X线及CT表现。结果:初诊误诊为支气管肺炎3例,肺结核1例,1例先误诊为肺炎后又误诊为肺结核,误诊率50%。X线表现双肺片絮状阴影及磨玻璃样改变3例;双肺中下肺野斑片状影,肺纹理增多模糊3例;弥漫分布粟粒状、小结节状影伴磨玻璃样改变2例;弥漫分布网织状阴影2例。伴肺门影增大模糊3例、心影增大1例等。普通CT表现为两中下肺呈片絮状、小结节状阴影1例;弥漫分布粟粒状阴影伴磨玻璃样改变者2例。2例见空气支气管征,1例见多发小气囊。HRCT表现为两肺内弥漫分布网结节影1例,表现两肺网织影及散在小斑片状阴影、小叶间隔增厚1例。结论:对本病的认识不足是误诊的主要原因,X线及CT检查是发现并提示IPH的基本检查手段,影像表现结合临床,尤其是小儿痰、胃液中发现含铁血黄素巨噬细胞是提高确诊率的关键。     

特发性肺含铁血黄素沉着症的影像学诊断

目的 探讨特发性肺含铁血黄素沉着症（IPH）的影像学诊断。资料与方法 7例均有完整的临床。实验室以及胸片和高分辨率CT（HRCT）检查资料，均经病理证实，对其平片与CT表现进行回顾性分析。结果 X线表现；7例肺野内弥漫分布有片絮状阴影与磨玻璃样改变，4例有散在粟粒状，结节状阴影，5例有弥漫分布的网织状影，HRCT；7例两肺呈弥漫性分布片絮状实变影及磨玻璃样影。5例两肺弥漫分布粟粒状。小结节状影，4例可见多发小囊状影及网状影及网状影，2例可见支气管充气征轼例有小叶间隔增厚。结论 X线平片是发现并提示IPH最基本的检查手段。影像学检查特别是HRCT与临床表现相结合分析。尤其是在痰或胃液中及肺泡灌洗液内查到含铁血黄素巨噬细胞，可明确诊断，并不一定完全依赖于纤支镜或肺活检病理来确诊。     

特发性肺含铁血黄素沉着症的影像学表现及其与肺功能改变的相关性分析

目的分析特发性肺含铁血黄素沉着症(IPH)的影像学表现及其高分辨率CT(HRCT)表现与肺功能改变的相关性。方法回顾性分析15例IPH的影像学表现和临床资料。结果X线平片:毛玻璃样阴影9例;渗出影10例;网格状阴影7例;结节影6例。HRCT:支气管血管束改变12例;毛玻璃影12例;渗出影11例;结节影8例;小叶间隔增厚9例。HRCT上毛玻璃样阴影与肺功能的相关性分析:r=0.5394,P=0.134。HRCT上小叶间隔增厚与肺功能的相关性分析:r=0.9633,P=0.0001。结论HRCT对于病灶的显示较平片佳。小叶间隔的增厚程度与肺功能改变呈正相关,能预测肺功能的损害程度。     

高分辨率CT对焊工肺尘埃沉着病的诊断价值

目的 采用高分辨率CT(HRCT)探讨早期焊工肺尘埃沉着病的影像表现,并评估不同病程阶段的影像表现.方法 对76例X线胸片疑似焊工肺尘埃沉着病的工人(工龄1～18年,平均14年)进行常规胸部CT平扫和HRCT检查,分析其HRCT表现,并对不同影像表现的年龄、工龄进行t检验.结果 18例(18/76,23.7%)表现为边缘模糊的小叶中央磨玻璃密度微结节,20例(20/76,26.3%)表现为分支状细线影,磨玻璃密度结节组的平均年龄[(34±7)岁]小于分支状细线影组[(39±9)岁],但差异无统计学意义(t=-1.648,P＞0.05);磨玻璃密度结节组的平均工龄[(10±5)年]低于分支状细线影组[(15±8)年],差异有统计学意义(t=-2.108,P＜0.05).结论 边缘模糊的小叶中央磨玻璃密度微结节和分支状细线影是焊工肺尘埃沉着病常见的表现.其中磨玻璃密度的微结节可能是焊工肺尘埃沉着病的早期表现.HRCT有助于焊工肺尘埃沉着病的早期诊断.     

肺郎格汉斯细胞组织细胞增生症的临床、X线、CT表现(2例报告并文献复习)

目的探讨肺郎格汉斯细胞组织细胞增生症(PLCH)的临床、X线及CT表现,以提高对该病的影像学认识。方法回顾性分析2例病理证实的PLCH患者的临床、X线和CT资料。2例患者均行胸部螺旋CT、高分辨CT(HRCT)扫描及X线胸部平片摄影,1例行头颅CT扫描。结果 2例患者CT及HRCT均为双中上肺野广泛分布的高密度小结节状影、纤维条索影及囊状和蜂窝状影。1例头颅CT示右枕骨局限性骨质破坏;胸部平片示双肺野透光度减低,双肺纹理模糊;另1例胸部平片示双肺纹理紊乱,右肺中野可见多个小囊状低密度区;纵隔影明显增宽。结论 PLCH的X线、CT及HRCT表现有一定的特征性,尤其是HRCT显示病变更加清晰,结合临床资料可提高对此病的诊断,确诊仍需病理学诊断。     

儿童特发性肺含铁血黄素沉着症HRCT表现分析

目的探讨特发性肺含铁血黄素沉着症(IPH)的高分辨CT表现,提高诊断水平。方法对2010年~2013年间经我院收治并临床确诊的10例IPH患儿的胸部影像及临床资料进行回顾性分析。结果胸部高分辨CT检查10例出现不规则磨玻璃影,7例出现斑片状实变影,1例出现碎石路征,5例出现腺泡结节,6例出现肺内粟粒影,2例出现节段性肺实变,4例出现网状阴影。急性发作期表现以磨玻璃影及实变影为主,慢性稳定期以粟粒影及网状阴影为主。各种影像学表现左右肺分布无明显差异。结论高分辨CT能清晰的显示IPH在肺内的形态、分布、病理分期,结合化验检查并排除其他疾病导致的继发性肺出血,即可诊断。     

儿童特发性肺含铁血黄素沉着症临床与影像学分析

目的：探讨儿童特发性肺含铁血黄素沉着症的临床及X线表现。方法：经病理检查证实的特发性肺含铁血黄素沉着症15例，男6例．女9例。15例患儿行胸片检查42次．其中4例行高分辨率CT检查8次。结果：面色苍白、咳嗽为主要临床症状。影像学特点为：肺纹理增多，呈网状、毛玻璃样表现、斑片状模糊影、粟粒状结节影、心影增大等。结论：影像学检查对特发性肺含铁血黄素沉着症的诊断具有重要意义，高分辨CT检查较胸部平片能更早地发现病变。     

肺泡蛋白沉积症的X线与CT诊断(附4例报告并文献复习)

目的分析肺泡蛋白沉积症的X线与CT表现,提高对本病的认识。方法回顾性分析4例经X线与CT检查并经病理证实的肺泡蛋白沉积症,分析其X线与CT征象。结果4例病变中皆见到弥漫性斑片影与磨玻璃影,CT扫描病灶呈地图样分布。结论CT对肺泡蛋白沉积症的范围、程度及病变轮廓的显示较X线平片准确,根据CT和HRCT表现的典型特征,可以作出可靠的诊断。     

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.     

肺泡蛋白沉积症的HRCT表现及诊断价值

目的:探讨肺泡蛋白沉积症(PAP)的HRCT表现及诊断价值.方法:回顾性分析经病理证实的13例PAP的临床和X线胸片、普通CT和HRCT表现.结果:X线表现:自肺门向外放射的"蝶翼征"6例、两肺广泛片影4例和密布的小结节影3例.普通CT表现为片影和磨玻璃影5例和粟粒小结节影3例.胸部HRCT表现为两肺弥漫性斑片影、磨玻璃影4例,"地图样"改变2例、"铺路石样"改变3例、"蜂房征"2例和实变区见"空气支气管征"4例.结论:HRCT表现的"地图样"分布,"铺路石征"及"空气支气管征"具有特征性,对PAP的诊断和预后具有重要应用价值.     

甲型H1N1肺炎初诊CT表现

目的：探讨甲型H1N1肺炎特征性CT表现。方法：回顾性分析46例经咽拭子RT-PCR法检测确诊的甲型H1N1流感病毒肺炎的临床与CT资料,CT检查包括常规平扫、高分辨力CT（HRCT）及多平面重组（MPR）,4例行CT增强扫描。结果：46例H1N1肺炎累及双侧45例、累及单侧1例,40例侵犯3个肺叶及以上、6例侵犯2个肺叶及以下,均呈多灶性与弥漫性,32例沿支气管血管束分布、其中28例合并胸膜下分布,39例为GGO或GGO合并实变,20例可见马赛克征,15例见少量或中等量胸腔积液,仅1例合并肺栓塞。HRCT显示26例小叶间隔及小叶内间隔增厚、2例小叶中心模糊结节。结论：H1N1肺炎具有较特征性的CT表现,HRCT与MPR有助于其肺内病变的评价。     

Serial high resolution CT findings in nonspecific interstitial pneumonia/fibrosis

PURPOSE: The purpose of this work was to evaluate the radiographic and serial high resolution CT (HRCT) findings in patients with nonspecific interstitial pneumonia/ fibrosis (NSIP). METHOD: We identified 15 patients with biopsy-proven NSIP. Radiography and initial and follow-up CT findings were reviewed. RESULTS: Predominant radiographic findings were bilateral infiltrates distributing in the middle and lower lung zones and decreased lung volumes. At initial CT, predominant patterns were peribronchovascular interstitial thickening (n = 6), parenchymal bands (n = 8), intralobular interstitial thickening (n = 12), and traction bronchiectasis (n = 14). Mixed pattern of ground-glass opacity and consolidation (n = 11) were predominant findings of increased lung opacity. At follow-up CT in 14 cases, the abnormalities had disappeared completely in 3, improved in 9, persisted in 1, and worsened in 1. CONCLUSION: The pulmonary abnormalities observed in NSIP on HRCT can disappear or be diminished in most cases after corticosteroid therapy. Intralobular interstitial thickening and traction bronchiectasis, which have been considered to be indicators of irreversible fibrosis, also show favorable responses.     

Chest computed tomographic findings and clinical features of legionella pneumonia

OBJECTIVE: To describe the chest radiographic and computed tomographic (CT) findings of legionella pneumonia. METHODS: Serial chest radiographs and CT scans obtained in 12 patients with serologically proven Legionella pneumophila pneumonia were retrospectively reviewed. Chest CT findings were analyzed with regard to patterns and distributions of pulmonary abnormalities. RESULTS: Nine of the 12 patients were in an immunocompromised state, that is, steroid therapy (n = 8) and myelodysplastic syndrome (n = 1), and 6 of the 8 steroid users were on high-dose steroid. All patients showed multilobar or multisegmental pulmonary infiltrates on CT scans. The CT findings were categorizable as; predominantly airspace consolidations (n = 6), mixed lesions with lobular consolidation and ground-glass opacity (GGO) (n = 3), and pure GGO lesions (n = 2). Five of the 6 patients on high-dose steroid therapy had lobar consolidations with (n = 4) or without a cavity (n = 1), and 1 patient had a mixed lesion. CONCLUSIONS: The most common CT findings in legionella pneumonia were multilobar or multisegmental consolidation and GGO. Cavitary lobar consolidation occurred commonly in patients on high-dose steroid therapy.     

Goodpasture综合征的HRCT诊断

目的 探讨Goodpasture综合征的高分辨率CT(HRCT)影像学表现及随访变化特点.方法 回顾性分析本院15例经临床确诊的Goodpasture综合征患者的HRCT表现及随访复查情况.分别记录病变范围、形态及动态变化情况.结果 病变累及2叶1例,累及3叶2例,累及4叶5例,累及5个肺叶7例.右肺上叶最易受累.双侧以肺门为中心分布实变伴边缘磨玻璃密度影(GGO)7例,5例呈双肺弥漫分布GGO.病变实变区短期复查呈GGO改变,GGO能短期吸收.结论 咯血并贫血患者,双肺多叶的肺内实变混杂GGO,不累及肺尖及肺外带胸膜下是Goodpasture综合征的特征性表现.HRCT是Goodpasture综合征诊断和疗效观察的有效手段.     

Drug-induced lung disease: high-resolution CT and histological findings

AIM: To compare the parenchymal high-resolution computed tomography (HRCT) appearances with histological findings in patients with drug-induced lung disease and to determine the prognostic value of HRCT. MATERIALS AND METHODS: Drug history, HRCT features, histological findings and outcome at 3 months in 20 patients with drug induced-lung disease were reviewed retrospectively. The HRCT images were assessed for the pattern and distribution of abnormalities and classified as most suggestive of interstitial pneumonitis/fibrosis, diffuse alveolar damage (DAD), organizing pneumonia (OP) reaction, or a hypersensitivity reaction. RESULTS: On histopathological examination there were eight cases of interstitial pneumonitis/fibrosis, five of DAD, five of OP reactions, one of hypersensitivity reaction and one of pulmonary eosinophilia. The most common abnormalities on HRCT were ground-glass opacities (n = 17), consolidation (n = 14), interlobular septal thickening (n = 15) and centrilobular nodules (n = 8). HRCT interpretation and histological diagnosis were concordant in only nine (45%) of 20 patients. The pattern, distribution, and extent of HRCT abnormalities were of limited prognostic value: all eight patients with histological findings of OP, hypersensitivity reaction, or eosinophilic infiltrate improved on follow-up compared to only five of 13 patients with interstitial pneumonitis/fibrosis or DAD. CONCLUSION: In many cases of drug-induced lung injury HRCT is of limited value in determining the histological pattern and prognosis.     

Lung findings on high resolution CT in early ankylosing spondylitis

OBJECTIVE: Ankylosing spondylitis (AS) is a chronic inflammatory disease mainly affecting the axial skeleton and pulmonary involvement is a well known feature of the disease. The aim of this study was to investigate the pulmonary high resolution computed tomography (HRCT) findings of patients with early AS. The relationship between pulmonary function tests (PFT) and HRCT findings was also determined. SUBJECTS AND METHODS: Twenty-eight patients with AS (mean age 30.8+/-7.4 and disease duration 7.0+/-2.6) were included in the study. Patients with a disease duration of >10 years or had other pulmonary diseases were excluded. All patients underwent plain chest radiography (posteroanterior and lateral views), thoracic HRCT and PFT. RESULTS: All chest radiographs were normal and HRCT revealed abnormalities in 18 patients. The most common abnormalities seen on HRCT were mosaic pattern (ten of 28), subpleural nodule (seven of 28) and parenchymal bands (five of 28). Seven of ten patients with mosaic pattern revealed air trapping areas on end expiratory scans. Twelve patients had abnormal PFT and all had restrictive type of involvement. Ten of these 12 patients had abnormal HRCT and the remaining two patients had normal HRCT. On the other hand, eight patients with normal PFT had abnormalities on HRCT. CONCLUSION: Patients with early AS frequently have abnormalities on HRCT, even though they have normal PFT and chest X-ray. Small airway involvement was found as frequent as interstitial lung disease in early AS.     

High resolution computed tomographic features of pulmonary alveolar microlithiasis

BACKGROUND: Pulmonary alveolar microlithiasis (PAM) is a rare, chronic lung disease with unknown etiology and with a nonuniform clinical course. Nonuniformity of clinical course might be related to the degree of pulmonary parenchymal alterations, which can be revealed with high resolution computed tomography (HRCT). However, HRCT findings of PAM were not fully described in the current literature. AIM: The aim of this study was to interpret and to contribute to describe HRCT findings of PAM and to investigate a correlation between profusion of micro nodules (MN) and pulmonary parenchymal alterations in patients with PAM. MATERIAL AND METHODS: Ten male patients with PAM (mean age: 22+/-3.2) were included into the study. HRCT images were assessed for patterns, distribution, and profusion of pulmonary abnormalities. Dividing the lungs into three zones, profusion of abnormalities was assessed. A profusion score (1-4) was given and the scores of each zone were then summed to obtain a global profusion score for HRCT ranging from 0 to 12. Also a parenchymal alteration score (PAS) was defined with respect to profusion of abnormalities. Chest X-rays were also scored. RESULTS: All of ten patients with PAM had findings of interstitial lung disease in varying degrees on their HRCTs. HRCT findings of patients with PAM were as following: MN, parenchymal bands (PB), ground glass opacity (GGO) and, sub pleural interstitial thickening (SPIT) in 10 patients; interlobular septal thickening (ILST), in 9 patients; paraseptal emphysema (PSA) in 8 patients; centrilobular emphysema (CLA) in 7 patients; bronchiectasis (BE), confluent micro nodules (CMN) in 6 patients; peri bronchovascular interstitial thickening (PBIT) in 5 patients; panacinar emphysema (PANAA) in 3 patients; pleural calcification (PC) in 2 patients. A significant correlation between MN scores and PAS (r=0.68, p=0.031, MN scores and GGO scores (r=0.69, p=0.027) and, MN scores and CLA scores (r=0.67, p=0.034) was detected. We also found significant correlations between HRCT scores and results of pulmonary function tests (PFTs), HRCT scores and chest X-ray score (CXRS) and, CXRS and results of PFTs. CONCLUSION: We conclude that patients with PAM may have all findings of interstitial lung disease in varying degrees as well as MNs on their HRCTs. More importantly, this study suggests a proportional relationship between profusion of MNs and parenchymal alterations in patients with PAM. This study also suggests that the degree of parenchymal alterations closely related with the degree of pulmonary function loss in patients with PAM.