新型冠状病毒肺炎临床表现与影像学特征分析

目的:分析新型冠状病毒肺炎(COVID-19)的临床表现与影像学征象,提高对该病的认识。方法:回顾分析解放军总医院第五医学中心确诊的58例COVID-19患者的临床资料和胸部影像学表现。根据新型冠状病毒肺炎诊疗方案(试行第6版),将所有患者分为轻型(7例)、普通型(34例)、重型(7例)和危重型(10例)并分析影像学表现。结果:COVID-19患者常见临床表现为发热(47例,81.0%)、咳嗽(31例,53.4%)、乏力(10例,17.2%)。实验室检查:白细胞计数正常或减低52例(89.7%),淋巴细胞计数减低14例(24.1%),C-反应蛋白升高18例(31.0%)。CT表现为双下肺分布阴影(46例,90.2%),COVID-19普通型患者CT主要表现为磨玻璃影(23/34,67.6%)或混合型(17/34,50.0%),周边分布为主(28/34,82.4%),重型及危重型患者CT主要表现为实变(13/17,76.5%)及混合型(14/17,82.4%),周边及中心同时受累(14/17,82.4%)。其他常见征象包括胸膜平行征、晕征、血管增粗征、铺路石征、空气支气管征等。5例重型及危重型患者有胸腔积液。结论:COVID-19患者的胸部影像学表现具有一定特征,不仅能做为早期诊断参考,还能对临床病程及严重程度进行评估。

Clinical and CT imaging features of COVID-19

Objective: To analyze the clinical manifestations and CT imaging characteristics of COVID-19 to improve the understanding of the disease. Methods: The clinical data and chest CT imaging findings of 58 COVID-19 patients diagnosed by the Fifth Medical Center of PLA General Hospital were analyzed retrospectively. According to the diagnosis and treatment scheme of COVID-19 (trial version 6), all patients were divided into mild type (n=7), ordinary type (n=34), severe type (n=7) and critical type (n=10) and the imaging findings were analyzed.Results: The common clinical manifestations of COVID-19 patients were fever (47 cases, 81.0%), cough (31 cases,53.4%), and fatigue (10 cases, 17.2%). Laboratory examination showed white blood cell count was normal or decreased in 52 cases (89.7%), lymphocyte count decreased in 14 cases (24.1%), C-reactive protein increased in 18 cases (31.0%). The main manifestations of CT was shadow in double lower lungs in 46 cases (90.2%). The main CT manifestations of patients with common COVID-19 were ground glass shadow (23/34,67.6%) or mixed type (17/34,50.0%), and was mainly peripherally distributed (28/34,82.4%); the main CT manifestations of severe and critically ill COVID-19 patients were consolidation(13/17,76.5%) and mixed type(14/17,82.4%). Periphery and center were involved at the same time (14/17,82.4%). Other common signs included pleural parallel sign, halo sign, vascular thickening sign, paving stone sign, air bronchus sign, and so on. 5 cases of pleural effusion were critical patients.Conclusions: The chest imaging findings of patients with COVID-19 have certain characteristics, which can be used as a reference for early diagnosis, and evaluate the clinical course and severity of the disease.