成人H5N1亚型禽流感病毒性重症肺炎的CT表现与动态变化

CT manifestation and dynamic changes of grave pneumonia in adults caused by H5N1 subtype of human avian influenza virus

目的探讨成人高致病性H5N1亚型禽流感病毒性重症肺炎的CT表现及动态变化。方法2006年6月所确诊的H5N1亚型禽流感病毒性重症肺炎成人男性患者于发病第7天、30天、40天、50天、65天及95天分别行螺旋CT及HRCT扫描。回顾性分析其CT资料并结合文献复习。结果病情严重时,CT显示肺叶或肺段大片状实变影伴支气管充气征、小淡片影及胸腔积液。病情稳定后,表现为多肺叶斑片状实变影、磨玻璃影,病灶内仍见支气管充气征。同时部分肺叶体积缩小,小叶间隔增厚、胸膜下细弧线影,相邻胸膜增厚。临床治愈出院以及近期复查时,大部分病灶消失,肺间质病灶吸收缓慢,以中叶、下叶为著。两肺散在多处条索状影,肺纹理聚集,胸膜下小叶间隔增厚,间隔旁小气肿,支气管扩张、扭曲。结论成人高致病性H5N1亚型禽流感病毒性重症肺炎的CT表现为早期肺叶实变影,逐渐发展肺实质与间质病变并存,恢复期则以肺间质病变为主。CT动态观察能较客观的反映本病的病理改变过程。

Objective To explore CT manifestations and dynamic changes of grave pneumonia in adults caused by H5N1 subtype of human avian influenza virus. Methods Patient was a male adult, with grave pneumonia caused by HSN1 subtype of human avian influenza virus with diagnosis confirmed in June of 2006; he received a spiral CT and HRCT scanning on the 7^th ,30^th, 40^th,50^th, 65^th and 95^th day respectively. A retrospective analysis of his CT materials associated with review of literatures was carried out. Results At the time of high severity of the disease, CT manifested presence of large confluent consolidation shadows of pulmonary lobes or large section of the lungs accompanied by air bronchogram with small light patchy shadows and pleural effusion. After the disease became steady, the condition was manifested as con- solidation shadows of multilobular patches in the lungs and ground-glass shadows but still with symptom of air bronchogram seen in the pathologic foci.. In the meantime, there revealed shrinkage of size of the lung lobes with thickening of interlobular septa; appearance of f infer-pleural linea arcuata shadows and thickening of the contiguous pleural membrane. Examinations done at the time of discharge of the patient after a cure as well as in near-term re-examinations of the case, it was found there was disappearance of major part of the foci; the absorptive process of the pulmonary foci in the interstitial tissue was slow, and this was particularly prominent in the middle and lower lobe.There was again presence of cord-like shadows scattered in many places of both lungs, with coalescence of the pulmonary markings; thickening of the interlobular septa beneath the pleural cavity accompanied by small emphysema in intermission side, bronchiectasis and bronchial distortion. Conclusion CT manifestations of grave pneumonia HAI are presence of early-stage pulmonary consolidation shadows in the lobes which develop gradually to coexistence of parenchymatous changes together with pathological changes in the interstitial tissue, while pathological changes of the interstitial tissues of the lungs form the main changes at the stage of convalescence. CT dynamic observation can give an objective reflection to the course of the pathological changes of this disease.