急性肺动脉栓塞肺部异常的CT征象及演变特点:附34例报告

目的探讨急性肺动脉栓塞患者肺部异常的CT征象及其演变特点。方法回顾性分析34例急性肺动脉栓塞患者的临床及CT影像资料，观察肺动脉栓塞的直接征象即肺动脉充盈缺损，及肺部异常的CT征象，包括肺梗死、“马赛克”征、磨玻璃影、局限性肺气肿、肺不张等，分析病灶的分布、影像特征等，及复查时病灶演变特点。结果初查CT可见肺梗死累及18名患者，共28个病灶；“马赛克”累及6名患者，10个病灶，磨玻璃影累及12名患者，28个病灶，局限性肺气肿累及5名患者，6个病灶，肺不张累及13名患者，19个病灶。13名患者CT复查，随着肺动脉栓子缩小，绝大部分肺部异常征象消失，仅肺梗死区遗留纤维条索灶。结论肺梗死、“马赛克”征、磨玻璃影、局限性肺气肿、肺不张等肺部异常是急性肺动脉栓塞常见CT征象，熟悉CT征象及其演变特点将有助于肺动脉栓塞的诊断及治疗效果的评估。 

CT features and evolution of lung abnormalities in patients suffered from acute pulmona.ry embolism

ObjectiveTo investigate the CT features and evolution of lung abnormalities in patients suffered from acute pulmonary embolism.MethodsThe CT and clinical data of 34 patients suffered from acute pulmonay embolism were analyzed retrospectively. The direct sign, that is, thefilling defect within the pulmonary arteries, and the abnormal CT signs in the lungs, including pulmonaryinfarction, mosaic sign, ground-glass opacity, Westermark'ssign, and pulmonary atelectasis were assessed, and their location and radiologic features of lesions were described too. On the follow-up CT examinations, the evolution of lesions were carried out by comparing to their appearance shown on previous CT images.ResultsOn initial CT exminations, pulmonaryinfarction involved 18 patients, resulting to 28 lesions, while mosaic sign involving 6 patients, resulting to 10 lesions, ground glass opacity involving 12 patients, resulting to 28 lesions, Westermark'ssign involving 5 patients, resulting to 6 lesions, and pulmonary atelectasis involving 13 patients, resulting to 19 lesions. Thirteen patients peformed at least one time follow-up CT exminations in various period. As the filling defectdecreased while followed up, almost of the lung abnormalities shrinked or disappeared on CT, but the pulmonaryinfarction turned to be focal fibrosis lesions.ConclusionPulmonaryinfarction, mosaic sign, ground-glass opacity, Westermark'ssign, and pulmonary atelectasis were common signs on CT in patients suffered from acute pulmonary embolism, and acknowledging the signs and their evolution would contribute to the diagnosis and therapeutic effects evaluation of pulmonary embolism.