进展期SARS与巨细胞病毒肺部感染的影像学研究

The imaging study of lung in advanced SARS and CMV infection

目的 :初步探讨严重急性呼吸综合征 (SARS)和巨细胞病毒 (CMV)肺部感染的影像特征及其病变进展规律。方法 :我院确诊SARS组 3 0例 ,CMV组并发成人呼吸窘迫综合征 (ARDS)者 14例 ,均动态追踪胸部平片检查 ,各 1例行CT检查。结果 :SARS在出现发热症状后 ,一般在 2、3天内迅速出现双肺中下肺野多发片状影。 6例出现ARDS ,表现为病灶迅速发展或部分吸收后又重新加重 ,无明确的游走发展趋势 ,1周左右进展为肺水肿。 5例轻症患者仅累及单肺叶或肺段 ,最早在第 3天有好转。 3例出现少量胸腔积液 ,而 2例在治疗中出现少量气胸 ,处理后好转。CMV组病变的ARDS进程类似 ,首先双肺纹理增粗、模糊 ,然后双肺中外带多发小片状影 ,7天内融合成实变的大片状影 ,10例死亡患者表现为肺水肿 ,呈磨玻璃样胸片改变。结论 :SARS冠状病毒直接侵犯肺泡上皮细胞 ,巨细胞病毒在成纤维细胞生长 ,均导致肺泡通透性增加 ,形成透明膜样改变 ,可导致肺水肿、实变。胸部影像多为肺纹理增多、模糊 ,演变成多发的肺叶渗出病灶 ,进展迅速 ,可全肺实变 ,但一般不破坏肺泡空间结构形成空洞。二者影像征象无明显差异。

Objective:To study pulmonary imaging features in severe acute respiratory syndrome (SARS) and cytomegalo virus infection (CMV) patients.Methods:30 cases of SARS and 14 cases of CMV infected patients,who all complicated with acute respiratory distress syndrome (ARDS),were included in the study.All cases of the two groups were examined by chest X-ray,and one patient of each group was examined by CT scans.Results:The SARS patients with fever may have no evidence of chest abnormality at early period.2～3 days later,multiple patchy lesions were found in both lungs,mostly located at the middle and lower field.In six severe cases accompanied with ARDS,the lesions developed quickly.In all these patients pulmonary edema developed in one week.3 cases of SARS group developed mild hydrothorax,and 2 cases developed pneumothorax,all recovered after treatment.The patients with CMV infection had similar appearances and courses to those of SARS with ARDS.At beginning there were thickening and haziness of lung markings,then there were patchy shadows at middle and outer lung fields which confluenced to large consolidations in 10 days.Pulmonary edema was observed in 10 patients and they died.Conclusion:The pulmonary manifestations of SARS and CMV infection appear as exaggeration and haziness of lung markings,the lesions may rapidly progress to multiple exudative lesions and consolidation of the whole lung.In general thers is no cavity formation.It is difficult to make definite differentiation between the two diseases.