肺气肿的CT表现和临床应用研究

CT appearances of emphysema and clinical application

目的研究不同类型肺气肿的 CT 表现及临床应用。方法将33例尸检标本从气管灌注10%福尔马林,使肺膨胀至正常状态,1周后经气管注入氧气,直至液体全部从胸膜表面逸出,制成固定的充气标本,类似正常状态下肺组织,再将标本行冠状面及横轴面扫描。选取标本内有肺气肿的23例,分析其内肺气肿的表现及分布,然后将标本切成10 mm 厚层,进行 CT、病理对照。对15例经病理或临床综合诊断证实的病例行螺旋 CT 扫描,包括肺气肿合并感染11例,合并孤立性结节4例,分析肺气肿合并症的 CT 特征。结果 (1)23例肺气肿的标本中,小叶中心型肺气肿21例,全小叶型肺气肿5例,均与小叶中心型并发,间隔旁型肺气肿19例,瘢痕旁型肺气肿3例。(2)肺气肿均累及双侧肺野,呈大致对称或相近分布,17例(17/23)表现为2种或2种以上类型肺气肿并发。(3)肺气肿合并感染的14例(临床病例11例,标本3例)中,均见“假空洞”或“假蜂窝”影(实变肺野内未被充填的气肿腔);肺气肿合并结节者4例,见“假胸膜凹陷征”(间隔旁气肿或肺大泡的壁与结节相连)。结论肺气肿的 CT 表现、分布及多种类型合并存在等特点对空腔性病变的鉴别有帮助。提出肺气肿合并症的 CT 特征,“假空洞”影、“假蜂窝”影、“假胸膜凹陷征”及其对临床诊断与鉴别诊断的作用。

Objective To investigate CT appearances of different types of emphysema and to determine the clinic value for differential diagnosis. Methods Twenty-three specimens with emphysema selected from 33 autopsy specimens were included in this study. All specimens were inflated and fixed by Heitzman＇s method, then examined by spiral CT scan. The CT appearances of different types of emphysema in every specimen were analyzed. After the specimens were cut into 10 mm thickness slices, the CT- pathologic correlation was done. Fifteen clinical cases confirmed by pathology or clinical process were all performed spiral CT scan and analyzed, including emphysema-accompanying pneumonia 11 cases, emphysema-accompanying nodule 4 cases. Result Centriacinar emphysema （ CAE ） can be seen in 21 of 23 specimens, pancinar emphysema（PAE） can be seen in 5 of 23 specimens, all coexisting with CAE. Distal acinar emphysema（DAE） can be seen in 19 of 23 specimens, irregular emphysema can be seen in 3 of 23 specimens. In all specimens, emphysema can be seen in bilateral lung fields, distributing similarly. Seventeen of 23 cases （ 17/23 ） showed no less than two types of emphysema. Fourteen cases of emphysemaaccompanying pneumonia （ clinic： 11 cases, specimen： 3 cases ） showed ＂ pseudocavity ＂ or ＂pseudohoneycombing＂ （emphysema lesion that had not been filled in the consolidation）. Four cases of emphysema-accompanying nodule showed ＂ pseudopleuralhollow＂ （ wall of DAE or bulla connecting with nodule）. Conclusion The CT manifestations of emphysema, the characteristics of distribution and multitype of emphysema coexisting can help differentiate cystic air space diseases. The characteristics of complications of emphysema, the ＂ pseudocavity＂, ＂pseudohoneycombing＂ and ＂pseudopleuralhollow＂, may be help for differential diagnosis.