112例胸片阴性X线表现的咯血性疾病分析

引起咯血的疾病，大部分经X线胸片检查能作出病因诊断，但也有不少咯血患者X线胸片表现为正常，医生难以诊断，必须根据病史进一步检查。本文收集从1995年1月至2006年6月，112例X线胸片表现阴性的咯血性疾病患者后经CT及纤维支气管镜（纤支镜）检查确诊的病例进行回顾性分析。     

纤维支气管镜检查对不明原因咯血的临床意义

1997年 1月— 2 0 0 2年 10月 ,我院对 177例不明原因的咯血患者进行纤支镜检查 ,为及时进行下一步治疗争取了时间 ,获得满意效果 ,现报告如下。1　材料和方法1.1　一般情况　本组 177例 ,其中男 137例 ,女 4 0例 ,年龄 2 178岁 ,平均 4 9.8岁。纤支镜检查前 ,胸部X线片未见异常 ,痰脱落细胞学及细菌培养均阴性。患者均在 2周内有咯血史 ,咯血量以 2 4h计算 ,少量咯血 (<10 0ml) 14例 ,中等量咯血 (10 0 5 0 0ml) 10例 ,大量咯血 (>5 0 0ml) 3例。1.2　纤支镜检查时机选择　小量咯血可在咯血期间进行纤支镜检查 ;中等量咯血但不至于立刻…     

158例纤维支气管镜检查与胸片、胸部CT检查对比分析

目的 探讨纤维支气管镜检查对肺部占位性病变、炎症、肺不张等肺部疾病的诊断价值。方法 对患者的肺部X线检查结果与纤支镜的检查结果对比，X线正常的胸部CT检查结果与纤支镜的检查结果对比，分析确诊率。结果 纤支镜检查对这四种改变的确诊率，分别为70．7％，76．1％，100．0％和42．9％。28例X线检查正常的患者，均做了纤支镜检查，12例发现异常，异常确诊率为42．9％；有16例同时做了胸部CT检查，其中6例发现异常，异常确诊率为37．5％。结论 纤支镜检查是一种有效的检查手段，可以弥补胸片及胸部CT对肺部疾病诊断的缺陷，将纤支镜与胸片、胸部CT等检查手段更好地结合，能大大提高对肺部疾病的诊断率。     

咯血200例病因分析

我院从 1993年— 1998年共收治咯血病人 2 0 0例 ;现就咯血的病因分析如下。1　临床资料1.1　一般资料　本组病例中小量 (咯血在 10 0ｍｌ以内 2 4ｈ或一次咯血在 5 0ｍｌ以内 )、中量 (咯血在 10 0～ 5 0 0ｍｌ 2 4ｈ或一次咯血在 10 0～ 2 0 0ｍｌ)咯血 134例 ,大量 (咯血在5 0 0ｍｌ以上 2 4ｈ或一次咯血 2 0 0～ 30 0ｍｌ)咯血 6 6例。女78例 ,男 12 2例 ;年龄 18～ 87岁 ,平均 4 3.5岁。1.2　诊治经过　入院后经Ｘ线胸片检查、结合痰菌 (抗酸杆菌 )检查 ,35例 (占咯血病例的 1⒎ 5 % )确诊为肺结核 ,予以抗结核、止血治疗 ,咯血好转…     

经纤维支气管镜泛影葡胺胶液支气管造影32例报告

1991年10月至1993年10月，我们对32例不明原因的咯血、X线胸片与临床疑为支气管扩张、肺癌患者经纤维支气管镇（纤支镜），采用泛影葡胺胶液行双侧、单侧或部分支气管造影检查，支气管显影满意，获得了明确诊断，现报告如下。资料与方法一般资料：男性别例，女性11例；年龄20～72岁，平均42．6岁，临床及X线胸片初诊为支气管扩张症11例，疑为肺癌5例，支气管炎需排除支扩IO例；咯血原因未明6例。临床症状：全部患者均有不同程度的咳嗽、咳痰，伴有咯血者14例，痰中带血者13例，本组患者均采用01yITPUSBFO型纤支镜、PR－213型塑胶导管…     

肠梗阻的腹部X线平片和CT诊断

目的 :探讨腹部X线平片和CT检查在肠梗阻诊断中的价值。方法 :经手术病理证实的 5 6例肠梗阻病人 ,男性2 9例 ,女性 2 7例 ,平均 4 2 .3± 11.5岁。术后均行腹部CT和X线平片检查。将腹部CT和X线平片表现与手术病理对照 ,分析其在判断肠梗阻有无、部位、类型及病因的准确性。结果 :5 6例肠梗阻中 ,判断肠梗阻的有无 :CT检查诊断 5 5例(98% ) ,X线平片诊断 4 5例 (80 .4 % ) (P <0 .0 5 )。肠梗阻部位的判断 ,CT正确诊断 5 0例 (89.3% ) ,平片正确诊断 38例(6 7.9% ) (P <0 .0 5 )。肠梗阻类型的判断 ,39例单纯机械性肠梗阻 ,CT诊断 36例 (92 .3% ) ,平片诊断 35例 (89.7% )(P >0 .0 5 ) ;10例绞窄性肠梗阻 ,CT诊断 9例 (85 .7% ) ,平片仅 1例做出诊断 (10 .0 % ) (P <0 .0 5 ) ;8例动力性肠梗阻 ,CT诊断 7例 (87.5 % ) ,平片诊断 5例 (6 2 .5 % ) (P >0 .0 5 )。肠梗阻病因的判断 ,CT诊断 5 0例 (89.3% ) ,平片诊断 2 8例(5 0 0 % ) (P <0 .0 1)。结论 :腹部X线平片和CT检查均可准确诊断肠梗阻 ,但在判断肠梗阻的部位、类型和病因方面 ,CT检查优于X线平片。     

支气管内膜结核52例临床分析

目的:探讨支气管内膜结核(EBTB)的临床特征、确诊方法及疗效分析.方法:回顾性分析52例经纤维支气管镜(纤支镜)确诊的EBTB患者的临床表现、胸部影像、纤支镜检查和治疗效果.结果:本组患者女多于男,临床症状主要以咳嗽、咳痰、发热、气急、咯血、胸痛为主,46.2%的患者胸部影像学无异常.纤支镜检查:右侧多于左侧,干酪样坏死型28.8%,充血水肿型23.1%,瘢痕狭窄型21.1%,肿瘤型17.3%,溃疡型9.7%.全部病例经纤支镜病理活检和(或)刷检找到抗酸杆菌确诊.经抗结核化疗临床治愈45例,7例遗留有不同程度的支气管狭窄.结论:EBTB缺乏特异性的临床表现,胸部影像学检查正常不能除外,纤支镜检查是确诊EBTB最重要的手段,EBTB早期抗结核治疗效果好.     

HRCT对类风湿性关节炎早期肺损害的诊断价值

目的 :研究胸片正常的类风湿关节炎患者早期肺损害在HRCT上的影像学表现 ,探讨HRCT对类风湿关节炎早期肺损害的诊断价值 ,及其与临床肺功能检查的相关性。方法 :对 2 4例临床诊断为类风湿关节炎且无吸烟史的患者 ,进行临床体检、普通X线胸片、HRCT扫描及临床肺功能检查 ,剔除 4例胸片有明显征象与类风湿无关的患者。结果 :2 0名患者CT扫描发现 1 4例 (70 %)肺部有间质性病变 ,其中为小叶间隔增厚 1 1例 (5 7%) ,气管壁增厚及其牵拉性支气管扩张 6例(43%) ,胸膜肥厚 5例 (36 %) ,壁胸膜肥厚粘连 4例 (2 9%) ,长瘢痕线 1例 (7%) ,胸部小结节影 2例 (1 4 %) ,磨玻璃样改变 2例 (1 4 %) ,蜂窝样改变 1例 (7%)。 6例 (30 %)患者无肺间质改变。 1 4例患者HRCT异常的患者中有 7例 (5 0 %)有临床肺功能损害 ,6名HRCT显示正常的患者中有 2名 (33%)有肺功能损害。结论 :类风湿性关节炎患者早期病变细微而胸片正常 ,HRCT检查常有异常 ,但与临床肺功能检查结果相关性较差 ,小叶间隔增厚与气管壁增厚牵拉性支气管扩张及胸膜肥厚是类风湿性关节炎累及肺最常见的表现 ,HRCT对类风湿早期肺损害的诊断意义是有限的。     

SARS肺内空洞的影像学表现

目的　探讨SARS患者肺内空洞的X线及CT影像学表现与临床特征。方法　对 180例临床确诊SARS患者的临床及影像学资料进行回顾性分析 ,对肺内出现空洞病例的影像学表现及临床特征 (年龄、病程、治疗措施、临床症状及实验室检查等 )进行评价。结果　X线胸片和胸部CT发现肺内出现空洞者 5例 (占 2 8% ) ,多表现为圆形或不规则形厚壁空洞。该组病例病程较长 (4 4～ 6 6d) ,住院期间 1例诊断为糖尿病 ,4例出现空腹血糖升高 (7 99～ 14 33mmol/L) ,血白细胞升高 [(14 1～ 2 0 4 )× 10 9/L]或伴中性粒细胞百分比增高 ,抗生素、抗病毒药物及糖皮质激素使用量较大、使用时间较长 ;其中糖皮质激素的使用时间为 2 5～ 6 5d ,且最初 10～ 15d每日用量均为 16 0～ 2 4 0mg ;实验室检查均出现乳酸脱氢酶 (LDH)、谷氨酸脱氢酶 (GLDH)、α 羟丁酸脱氢酶 (HBDH)升高 ,其值分别在 2 2 8 0 0～ 4 75 0 0U/L、10 0 8～ 6 0 0 0U/L、190 0 0～ 4 4 4 0 0U/L范围内。结论　SARS患者治疗后期肺内可有空洞形成 ,CT检查能早期准确发现空洞 ;认识其影像学特点有助于鉴别诊断、指导治疗、评价预后。     

脓毒性肺栓塞的多层螺旋CT诊断

目的 探讨脓毒性肺栓塞的多层螺旋CT(MSCT)表现,以提高对该病的认识.方法 回顾性分析12例脓毒性肺栓塞MSCT表现,并与X线胸片比较.结果 所有12例患者,X线胸片和CT表现比较,分别见结节(8、12例),滋养血管征(0、9例),空洞(6、10例),楔形阴影(4、7例),局灶浸润影(2、4例),气囊(2、5例)及胸腔积液、脓胸(3、6例),肺门或纵隔淋巴结肿大(0、3例).发现病灶分布在外周或胸膜下分别为8和12例,CT较X线胸片可更清晰地显示病灶.多平面重组(MPR)、最大密度投影(MIP)显示大多数滋养血管环绕结节周围,MPR显示结节边缘规整.结论 脓毒性肺栓塞的CT表现多样,但MIP、MPR能更好显示滋养血管征及结节的特征.     

导致胸部结节病初诊困难的原因分析

目的　分析胸部结节病的影像学表现 ,探讨造成结节病初诊困难的原因。资料与方法　回顾性分析 5 7例胸部结节病临床资料及其影像学 (X线平片及CT)表现。其中有 32例初诊为其他疾病 ,但需进一步检查除外结节病。结果　 5 7例均可见胸部淋巴结增大 ,其中 4 2例纵隔、双侧肺门淋巴结均增大 ;8例纵隔、单侧淋巴结增大 ;7例仅见纵隔淋巴结增大。 36例出现肺部病变 (包括 2 6例肺内多发结节 ,8例斑片状阴影 ,2例肺纤维化 ) ;4例胸膜病变。结论　结节病的胸部影像及临床表现缺乏特异性 ,肺部病变及不典型胸部淋巴结增大是导致结节病初诊困难的主要原因     

重型SARS患者的转归及胸部影像学随访观察研究

目的 探讨重型SARS患者的转归并随访观察其恢复期胸部影像学表现。方法 回顾性分析54例重型SARS患者的转归，随访观察25例重型SARS患者恢复期的胸片、CT扫描表现。结果 54例重型SARS患者，死亡15例(其中1例尸检)，临床治愈39例。随访观察的25例中21例随访时间为发病后158—238d，CT扫描发现8例有肺间质增生(38．10％)；4例有纤维性病灶(19．05％)；12例有磨玻璃样密度病变残留(57．14％)；7例双肺未见异常改变(33．33％)。结论 肺间质增生、纤维性病灶、磨玻璃样密度病变残留是重型SARS患者恢复期的主要胸部表现，其发生率高于普通型SARS患者。     

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.     

The radiological diagnostic and clinical approach to the patient with stab and cut wounds of the chest. The authors' personal experience

PURPOSE: To report our personal experience with the clinical and radiological diagnostic approach to stab and cut wounds of the thoracic cage and its content, a type of injury whose diagnosis and treatment, as well as the surgical approach, vary case by case. CT of deep penetrating wounds permits correct assessment of severe changes such as pneumothorax, hemothorax and pneumomediastinum. MATERIAL AND METHODS: In the last three years we examined 57 patients (48 men and 9 women; mean age 34 years, range 16-54): chest radiography was performed in 51 of them, with orthogonal projections in the standing and sitting positions. Chest CT was performed in emergency with i.v. contrast agent injection, with scans from the midneck to the diaphragm insertion to study border regions. Thoracostomy with pleural drainage was performed in 35 patients with pneumothorax and hemothorax while thoracotomy was performed in 8 patients, namely 4 with injury to the diaphragm, 2 to the heart, 1 with tear of the main bronchial artery and 1 of the aortic arch. RESULTS: The most frequent symptoms we found were chest pain (100% of cases) and dyspnea (84%); laboratory data showed anemia and decreased hematocrit levels in 28 cases. Chest radiography was negative in 14 cases. The patients were then examined with CT to exclude radiographic underestimation of minimal pneumothorax, small lacerocontusive or hemorrhagic foci and hemothorax, which were observed in 4, 2 and one cases, respectively, and where radiography was actually negative for traumatic changes. Chest radiography was positive in 43 cases: the most frequent finding was pneumothorax, with 37 cases (86%)--8 of them associated with hemothorax and 5 with pneumomediastinum. Lacero-hemorrhagic foci of lung parenchyma were found in 5 cases and single pulmonary hematoma from punch crossing was seen in 1 case. DISCUSSION AND CONCLUSIONS: CT was an accurate tool and had higher sensitivity than chest radiography in detecting and detailing pneumothorax, pneumomediastinum and lacero-hemorrhagic foci, as well as in quantifying hemothorax. Chest radiography had 12% false negatives and therefore we decided to perform CT in all the patients with penetrating wounds to prevent radiographic underestimation. Given the low rate of false negatives (7/57 cases) CT might appear superfluous but since in 2 of these 7 cases we had massive pneumothorax and pneumomediastinum associated with neck emphysema we suggest its use to prevent complications, clinical failures and medicolegal problems. CT permits correct assessment of penetrating stab and cut wounds of the chest and efficient and targeted treatment, which can be conservative, with thoracostomy with pleural drainage, or surgical.     

Ga-67 citrate scintigraphy for the early detection of radiation pneumonitis.

To evaluate the usefulness of Ga-67 citrate scintigraphy in the early detection of radiation pneumonitis, scintigrams from 103 patients who were treated with radiation therapy for lung cancer were retrospectively analyzed with regard to abnormal Ga-67 uptake after radiation therapy in sites other than the original or recurrent tumors. Sixteen (20%) of the 80 asymptomatic cases showed positive Ga-67 scintigrams. All of the other 23 symptomatic cases showed positive Ga-67 scintigrams. Thirteen (57%) of these 23 cases had negative chest radiographs although their Ga-67 scintigrams were positive. Detection of radiation pneumonitis by Ga-67 scintigraphy was significantly earlier than that possible by chest radiography (P less than 0.01). These data suggest that Ga-67 scintigraphy is more useful and sensitive than chest radiography for the early detection of radiation pneumonitis.     

Computerized tomography in the study of thoracic-pulmonary complications after liver transplantation

PURPOSE: To review the role of Computed Tomography (CT) in thoracic complications following orthotopic liver transplantation (OLT). MATERIAL AND METHODS: In a post-OLT population of 567 patients transplanted in our institution, 100 patients (17.6%) were examined with chest CT. We reviewed data relative to the total number of examinations, clinical and/or radiographic indications, the CT technique--i.e., conventional (with(out) intravenous, i.v., contrast material) or high-resolution (HRCT). We also reviewed the radiologic patterns and their correlation with the other clinical, bronchoscopic and/or laboratory results. RESULTS: Of 152 chest CT examinations, 45 (29.6%) were performed because of clinical indications, 31 (20.4%) because of a radiographic abnormality, 64 (42.1%) because of clinical and radiographic indications, while in 12 cases (7.9%) the reasons were unknown; 133/152 (87.5%) examinations had been performed with conventional CT scanning (100 with i.v. contrast agent and 33 without) and 19/152 (12.5%) with HRCT. Twenty of 152 (13.2%) examinations, in 16 patients, were normal; in the other 84 patients, 132/152 (86.8%) CT/HRCT studies showed 247 pathological findings (99 pleural effusions, 3 pericardial effusions, 62 cases of atelectasis, 1 pulmonary calcification, 70 suspected inflammatory parenchymal consolidations, 64 of them alveolar and 6 interstitial, 4 cases of interstitial edema and finally 8 neoplastic infiltrates). DISCUSSION: Correlated with clinical data, CT findings are very useful in detailing clinical-radiographic screening findings, despite the limitations in typifying pleural effusions, in differentiating atelectases from inflammatory parenchymal consolidations and in assessing pneumonia etiology. Also, despite its high sensitivity (94.1%) and specificity (92.8%), CT was not accurate enough in the differential diagnosis of pneumonia. History data were necessary to characterize the histology of neoplastic infiltrates. CONCLUSIONS: Chest CT has relatively uncommon, and sometimes only clinical, indications in post-OLT patients. The technique is chosen based on clinical-radiographic findings. CT proved useful in showing negative cases and in detailing clinical and radiographic findings but must be integrated with clinical findings to define inflammatory and neoplastic conditions.     

SARS的胸部X线表现及动态观察

目的 研究严重急性呼吸综合征(SARS)患者胸部X线影像及变化规律。方法临床诊断为SARS者46例，每间隔2～4d摄胸片复查，分析全部胸片的影像表现和动态变化。结果 首次胸片正常但不能排除SARS，在拍摄病变初期X线胸片的30例中，4例在发病10d后才发现胸部异常。病变早期胸片表现以单发小片状阴影为主(66．7％，20／30)。动态观察病变的影像变化快，而且病程中严重程度有反复，8例患者肺内病变吸收缓慢。死亡患者肺内有多发弥漫病变及病变逐渐减轻者各3例。结论 胸部X线检查可用于SARS的早期发现及显示病程的变化。但对于早期诊断和判断预后需结合临床及实验室检查。     

胸片和CT诊断SARS价值的对比研究

目的 :评价CT对胸片正常严重急性呼吸综合征 (SARS)患者的诊断价值。材料和方法 :对临床疑似SARS而X线胸片正常的 2 1例患者进行了胸部螺旋CT扫描及系列床边X线胸片复查。分析肺部病变的CT表现特征。结果 :2 1例疑似SARS患者中CT显示 12例有肺部病变 ( 5 7.1% )。根据系列复查胸片结果将 12例患者分成 2组 :第一组 ,复查胸片异常组 ,共 7例。其中单发磨玻璃样影 3例、多发磨玻璃样影 4例 ;第二组 ,复查胸片正常组 ,共 5例。其中单发磨玻璃样影 1例、多发磨玻璃样影 3例和左下叶实变影 1例。磨玻璃样影多位于肺周边部 ( 2 7/ 3 5 ) ,均为圆形 ,直径小于 3cm。结论 :胸片阴性SARS患者肺部病变的CT特点是以周围性分布为主的磨玻璃样影。CT可早于胸片发现肺部病变 ,并可提高SARS的肺部病变检出率。     

结核性心包积液的临床与影像学诊断(附29例分析)

目的探讨结核性心包积液的临床与影像学诊断。方法29例临床上高度怀疑结核性心包积液(TPE)患者均经超声心动图和胸部X线检查。8例患者又经胸部CT研究。回顾性分析了全部患者的影像与临床资料。结果超声心动图证实了所有患者的心包积液伴胸腔积液及心脏疾患。X线(透视,胸片)发现18例心包与胸腔积液及3例肺结核。CT检查不但能发现全部患者的心包与胸腔积液,而且还发现了X线胸片上未显示的3例肺内云絮状钙化灶与3例心包壁增厚。29例患者中,最常见的症状是胸疼(100%),气急(41.4%),及心悸(24.1%)。心包液的实验室检验表明,ADA>45UL-1见于8例,TR-PCR阳性5例,PPD阳性10例。结论及时影像检查与临床资料的综合分析是早期确诊TPE关键性因素。     

Problematic diagnosis of bronchial foreign bodies in children

Bronchial foreign bodies by children are dangerous and require immediate therapeutic measures. Findings and significance of chest film in the diagnosis of bronchial foreign bodies in 24 children were analysed. All patients were symptomatic. 18 patients had an abnormal and 6 normal auscultation finding. In three cases the physician did not suspect aspiration, and the diagnosis was delayed, which caused the death of one child. Roentgenpositive foreign bodies were found in 8 and -negative in 16 cases. Secondary changes (obstructive emphysema, atelectasis, pneumonia) were seen in 16 cases. In emergency cases the chest films were analysed by physician and later by a radiologist, who found 88% of them to be abnormal. Fluoroscopy of expiratory chest film helps to detect the unilateral emphysema more distinctly. The diagnosis must always be confirmed with bronchoscopy and extraction thereby is the adequate treatment of bronchial bodies.