外伤性肺血肿的CT动态观察分析

目的观察肺撕裂伤产生的气囊、液气囊及液囊的演变规律,探讨其命名、关系和性质、分型及诊断与鉴别诊断等,以期提高和统一认识。资料与方法回顾分析近10余年来通过CT动态观察的外伤性肺血肿25例,根据肺撕裂囊腔壁是否有脏层胸膜构成,分为胸膜下血肿与非胸膜下血肿,重点观察囊腔气液量的演变情况。结果 25例共47个血肿,单发11例(44%),多发14例(56%)。胸膜下血肿15例32个病灶,气囊3个、液气囊19个及液囊10个,其中前二者3、7、14和18天以内分别演变为液囊者16、4、1、1个;追踪到22个(22/32,69%)病灶完全吸收时间为平均72天。非胸膜下血肿10例15个病灶,液气囊9个,液囊6个,无气囊,其中液气囊在3、7和16天以内分别演变为液囊者5、3、1个;11个(11/15,73%)病灶追踪到完全吸收时间平均95天。本组共31个气囊或液气囊均演变为液囊,且对33个(33/47,70%)完全吸收的病灶追踪中未见一个逆变为气囊或液气囊。结论肺血肿可由肺撕裂伤的气囊或液气囊直接或间接演变而来,也可因肺撕裂伤直接形成,且血肿形成后不再逆变。建议将其分为胸膜下和非胸膜下血肿二型。

CT Dynamic Analysis of Traumatic Pulmonary Hematoma

Objective To observe evolution law of cavitaries formed by pulmonary laceration,and discuss the name,relationship and nature,classification,diagnosis and differential diagnosis so as to improve its recognition.Materials and Methods 25 cases with trauma pulmonary hematoma observed by CT dynamic follow-up were analyzed retrospectively in the past 10 years.According to the lung sac chamber wall resulted by pulmonary laceration whether involved visceral pleura or not,divided into the pleural hematoma and non-pleural hematoma,the evolution of cavity volume of liquid was observed.Results A total of 25 patients with 47 hematoma,single lesion in 11 cases(44%),multiple lesions in 14 cases(56%).Pleural hematoma in 15 cases with 32 lesions,3 pulmonary cysts,cavitary lesion with air-fluid level in 19 and sac in 10,the pulmonary cysts and air-fluid sacs were evoluted to sac in 18 days.22/32(69%) lesions were completely absorbed in an average of 72 days.10 cases with non-pleural hematoma 15 lesions,cavitary lesion with air-fluid level in 9 and sac in 6,no pulmonary cyst,and the former were evoluted to sac in 16 days.11/15(73%) lesions were traced to fully absorption in 95 days.31 pulmonary cysts and cavitary lesion with air-fluid level were transformed into fluid sac,and in 33/47(70%) lesions were completely absorbed,which no one inverted to pulmonary cysts and cavitary lesion with air-fluid level.Conclusion Lung hematoma can be evolved directly or indirectly from pulmonary cysts and cavitary lesion with air-fluid level resulted by pulmonary laceration.lung hematoma can also be formed directly by pulmonary laceration.Once the hematoma appears,the inversion no longer occur.