SARS胸部表现和并发症的CT研究

CT investigation of chest findings and complications in SARS

目的 探讨CT扫描在SARS诊断中的作用。方法 82例SARS患者行螺旋CT扫描 112次 ,其中胸部 10 6次 ,头颅 5次 ,腹部 1次。采用标准肺窗、纵隔窗摄片观察。结果 82例中病变位于双侧肺野 66例 ( 80 49% ) ,单侧 16例 ( 19 51% )。病变累及 4～ 6个肺野的 54例 ( 65 85% ) ,下肺野 63例( 76 83 % )。病变形态表现为胸膜下局灶性实变影 2 6例 ( 3 1 71% ) ,斑片状实变影 53例 ( 64 63 % ) ,大片实变影 9例 ( 10 98% ) ,磨玻璃样模糊影 3 1例 ( 3 7 80 % ) ,肺泡实质影 14例 ( 17 0 7% ) ,间质改变 16例( 19 51% )。发生并发症 6例 ( 7 3 2 % ) ,其中 1例同时并发肺、脑部结核及纵隔气肿 ;余 5例分别为肺部继发感染 2例 ,肺霉菌、气胸、脓胸各 1例。根据上述所见 ,作者提出了SARS的相对特征性肺部表现 :( 1)病灶呈多发性、两侧性分布 ,以两下肺多见。 ( 2 )斑片状、大片实变影 ,胸膜下局灶性实变和磨玻璃样模糊影 ,伴有支气管充气征。 ( 3 )肺泡内点状高密度影。 ( 4 )胸部X线检查和CT扫描动态观察中发现病灶大小、数量及分布部位有迅速变化和进展 (即在 2 4～ 48h内有动态变化 )。上述征象提示为SARS病毒引起的肺部表现可能。结论 CT扫描检查是一种敏感的检查方法 。

Objective To investigate the role of CT scanning in the diagnosis of severe acute respiratory syndrome (SARS) Methods One hundred and twelve spiral CT scanning examinations were performed in 82 cases of SARS, which included 106 chest, 5 brain, and 1 abdomen CT examination CT films were acquired with standard pulmonary and mediastinal window Results Of the 82 patient, pulmonary shadows involved bilateral lung field in 66 cases (80 49%) and unilateral lung field in 16 (19 51%) The shadows involved 4 to 6 lung fields in 54 cases (66 85%) and the low lung field in 63 (76 83%) The lung CT findings included sub-pleural focal consolidation in 26 cases (31 71%), patchy clouding opacity in 53 (64 63%), large consolidation in 9 (10 98%), ground-glass blurring shadow in 31 (37 80%), small nodules opacity shadow filling in the alveolar cavities in 14 (17 07%), and interstitial changes in 16 (19 51%) There were some specific signs of SARS: (1)The lesions tended to be multiple or bilaterally distributed, and bilateral lower lung field involvement was commonly seen (2)Imaging findings in lung included sub-pleural focal consolidation shadows, patchy clouding opacity, large consolidation shadows, and ground-glass blurring shadows There was air bronchogram in the shadows (3)Opacity small nodule shadows filling in the alveolar cavities (4)Dynamic follow-up observation on the chest X-ray films and CT films could reveal the rapid progression on the size, amount, and distribution of the lesions (ie, marked dynamic changes within 24 to 48 hours) These findings may suggest the pulmonary changes induced by SARS-CoV The complications were observed in 6 cases (7 32%) including tuberculosis of the lung and brain, and pneumomediastinum in one case, secondary infection of the lung in 2 cases, pneumotho rax in 1 case, pulmonary fungus in 1 case, and empyema of pleura in 1 case Conclusion CT examination is a sensitive method for SARS CT scanning can provide more accurate assessment of the abnormal changes of the lungs and detect the complications of SARS