卧床老年人肺基底部隐匿性肺炎胸部X线和CT影像学的特征及其差异

Radiological inspection and presentation of latent pneumonia at base of lung in bedridden patients

目的探讨卧床老年人肺基底部“隐匿性”肺炎的影像学特点及其差异。方法对17例有呼吸道感染症状的卧床老年人分别进行X线胸片及CT检查,分析其影像学改变。结果17例X线胸片均未发现肺部异常;CT则于肺基底部发现局限性炎性病灶,右肺9例、左肺4例、双肺4例。所有病灶均位于膈顶平面以下,即膈穹窿前、后方肺组织内,其中膈穹窿前方2例,后方15例。病灶形态呈斑片状及小片状高密度影,边缘模糊;13例可见局部肺纹理增粗、紊乱;9例见有局部胸膜反应。结论卧床老年人肺炎好发于肺基底部,病灶较小且相对局限,X线胸片检查易被隐匿,CT扫描则易检出病灶,对卧床老年人肺基底部隐匿性肺炎的诊断具有明显的优越性。

Objective To investigate the radiological presentation of latent pneumonia at base of lung in bedridden patients. Methods Sventeen bedridden elderly patients with symptoms in respiratory tract infection were scanned with chest radiography and CT respectively. The radiological change data were analyzed. Results There was no abnormility on sternums in all 17 cases. However there were localized inflammatory loci at base of lung on CT scan. The abnormal sites were located on right lung in 9 cases, on left in 4 cases and on both lung in 4 cases. The loci were all in the lung tissues under the top midriff plane or just before and behind the midriff vault. Among them there were 2 on the frontage and 15 on the bedridden of the midriff vault. The foci conformation presented high density pictures of spots and small spots with blurry margin, and local lung texture appeared wide and inordinate with local pleura reaction. Conclusions The pneumonia of bedridden elderly patients prefer to occur in lung base. The focus is usually small and localized. On X-ray sternum there is no evident discovery. But on CT scanning the loci are easily to be found. Thus CT has sigaificant advantage on diagnosis of latent pneumonia at the lung base in bedridden elderly patients.