肺栓塞的CT诊断及与深静脉血栓形成临床类型的相关性研究

目的:通过22例患者的CT诊断,探讨肺栓塞的影像学特征和病变特点,以及下肢深静脉血栓形成临床类型与肺栓塞发生之间内在的相关性,总结其发病规律,为合理应用预防和治疗措施提供依据。方法:肺部检查应用多层螺旋CT机,采用轴位像扫描,扫描层面从肺尖至肺底,均行强化,了解肺栓塞发生部位及特点。应用彩色多普勒超声诊断仪检查患肢深部和浅部静脉,主要观察静脉腔内有无血流、管壁结构及血栓状况。统计下肢深静脉血栓形成患者临床发病类型。结果:双侧肺栓塞者17例,右侧肺栓塞者4例,左侧肺栓塞者1例。病变累及部位涵盖主肺动脉至亚段动脉等各级肺动脉,肺栓塞直接征象以充盈缺损和附壁血栓最多见,间接征象以肺纹理稀疏、胸腔积液和肺梗死病灶出现率最高。肢体静脉彩色超声检出静脉血栓病变部位58处,股腘静脉血栓病变发生率为70.69%。临床类型属中央型者4例,混合型者13例,周围型者5例。结论:下肢深静脉血栓形成混合型病变发展血栓蔓延,新鲜血栓松软不稳定且与静脉壁附着不紧密而极易脱落造成肺栓塞。病变部位静脉管腔不完全闭塞及溶栓治疗过程,对肺栓塞的发生有一定影响。

The relationship between spiral computer tomography angiography (SCTA) in the diagnosis of pulmonary embolism (PE) and deep venous thrombosis of the lower extremity

Objective:To explore the relationship between pulmonary embolism(PE) in the SCTA and different type of deep venous thrombosis of the lower extremity for prevention and treatment.Methods: Twenty-two cases were examined with enhanced CT using a 16-slice CT,vein of the lower extremity was examined with color Doppler flow imaging(CDFI).Results: Seventeen cases were found embolism in the trunk of bilateral pulmonary artery,4 cases in right,1 case in left.The lesions involved pulmonary arteries and branches in all cases.The typical findings in CT image were partial filling defect and completely filling defect;secondary signs were decreasing of pulmonary markings,pleural effusion and pulmonary infarction.Fifty-eight lesions of venous thrombosis were examined with CDFI in 22 cases,4 were central type,5 were peripheral type and 13 were mixed typy.Conclusion: Thrombosis in the mixed type is tend to propagate,and the thrombosis is fresh and un-firmly adherent to the vein wall,so is easily chipped off and resulting in PE.The thrombolytic therapy and partial obstructive veins may be associated with PE.