MDCT对吸入性肺炎的诊断价值

目的 吸入性肺炎是社区获得性肺炎（community acquired pneumonia,CAP）和医疗机构相关性肺炎（health care-associated pneumonia,HCAP）的常见表现形式,但由于其诊断往往较困难,其重要性尚未得到充分评估.该研究旨在探讨吸入性肺炎的多层螺旋CT（multi-slice CT）表现,以提高对本病的诊断水平.方法 回顾分析28例吸入性肺炎患者的MDCT资料,该研究中将吸入性肺炎定义为满足：①存在误吸危险因素（吞咽困难、意识障碍等）;②胸部CT提示存在肺部炎症或气道内异物阻塞的证据.结果 28例中表现为肺内磨玻璃影17例;肺实变影21例,多位于两下肺背侧;支气管血管束增粗者7例;胸腔积液12例;肺不张24例;在所有上述病变中,横断面上病变的分布情况为：前部4例,后部15例,弥漫性分布9例;头足方向的病变分布情况为：上部2例,中部3例,下部15例,弥漫性8例;两侧的分布情况为右侧15例,左侧11例,双侧2例;可观察到气道内异物阻塞者6例.结论 吸入性肺炎的HRCT具有特征性,炎症表现以下肺背侧分布为主,可表现为磨玻璃影、肺实变、支气管血管束增厚、胸腔积液及肺不张等.观察到气道内异物阻塞者为直接征象,MDCT能准确显示病灶的细节,从而确定吸入物的类型和所在位置,为做出正确诊断和积极的临床干预提供了依据.

The value of multi-slice CT in the diagnosis of aspiration pneumonia

Objective Aspiration pneumonia is one of the common presentations of community acquired pneumonia （CAP） and healthcare associated pneumonia （HCAP）.However,its significance has not yet been fully evaluated due to the difficulties associated with the diagnosis of this condition.This study aimed to evaluate abnormalities seen on MDCT of aspiration pneumonia and to improve the diagnostic accuracy of this disease.Methods We analyzed CT images of 28 aspiration pneumonia patients diagnosed clinically or pathologically retrospectively.It＇s defined that aspiration pneumonia has both risk factors for aspiration （dysphagia or disturbance of consciousness） and evidence of pneumonia or foreign bodies in airways on CT examination.Results In all 28 patient＇s CT images,ground-glass opacities were seen in 17 cases,airspace consolidation in 21 cases （mainly distributed in the posterior area of lower lobes）,thickening of the bronchovascular bundles in 7 cases,pleural effusion in 12 cases,and atelectasis in 24 cases.Above findings in cross sectional distributions were classified as follows：‘anterior’ was found in 4 cases,‘posterior’ 15 in cases,and ‘diffuse’ 9 in cases.The craniocaudal distributions were classified as follows：‘upper’ in 2 cases,‘middle’ in 3 cases,‘lower’ in 15 cases and ‘diffuse’ in 8 cases.The laterality was expressed as ‘right’ in 15 cases,‘left’ in 11 cases or ‘bilateral’ in 2 cases.Foreign bodies in airways were seen in 6 cases.Conclusion MDCT manifestations of aspiration pneumonia were mainly distributed in the posterior area of the lower lobes,consisting of ground-glass opacities,airspace consolidation,thickening of the bronchovascular bundles,pleural effusion and atelectasis.Foreign bodies in airways were the direct sign of aspiration pneumonia.We may analyse full spectrum of disease processes associated with aspiration and complications of the lung comprehensively by MDCT examination.Recognition of the CT finding characteristics of a specific type and locations of the aspiration are valuable to make definitive diagnosis,which may facilitate optimal clinical management.