肺癌肺切除术后肺动脉残端充盈缺损的CT表现

CT finding of filling defect in pulmonary arterial stump after pneumonectomy for cancer

目的：探讨多层螺旋CT检查,肺癌肺切除术后肺动脉残端充盈缺损的发生率及其CT表现。方法：回顾性分析1999年-2003年间132例患者的胸部平扫和增强CT图像,男85例,女47例,平均年龄62.3岁（25岁-80岁）。56例行右肺切除手术,76例左肺切除手术。观察增强CT是否出现肺动脉残端充盈缺损、大小、形态和随访CT上的变化。测量平扫和增强CT的CT值。测量肺动脉残端的长度,观察远离肺动脉残端的其他肺动脉内是否出现血栓。结果：肺动脉残端的充盈缺损见于17例肺癌肺切除患者（12.9%）,充盈缺损局限于血管腔内,右侧肺动脉残端充盈缺损发生率为26.8%,左侧发生率为2.6%（P〈0.001）。右肺动脉残端的平均长度长于左侧（P〈0.001）。平扫和增强CT的CT值无明显变化。随访CT,大部分病灶无变化或缩小。结论：肺癌肺切除术后在CT上出现肺动脉残端充盈缺损并不罕见,原位血栓形成应与肿瘤复发、肺血栓栓塞相鉴别。

Objective：To evaluate the prevalence and findings of filling defects in pulmonary arterial stumps on multi-detector row spiral CT after pneumonectomy. Methods： Retrospectively reviewed 132 subjects （85 male and 47 female） who had undergone plain and contrast-enhanced chest CTs in 1999-2003. The mean age of patients was 62.3 years （25-80 years）. They have undergone pneumonectomy for lung cancer. Fifty-six patients underwent right pneumonectomy and 76 patients left pneumonectomy. The investigator evaluated the CT images regarding the presence or absence of filling deect in the vascular stump and its size, shape, and interval change on follow-up CT. CT values were measured on the plain and contrast-enhanced CT. CT findings were also evaluated for the length of the vascular stump and the presence of embolism in the other pulmonary arteries. Results： Of the 132 scans, 17（12.9%）had filling defects in the vascular stump after pneumonectomy. All filling defects were inside the vascular stumps. It was more frequently found in the right-side stump （26.8%） than in the left-side stump （2.6%） （P〈0.001）. The length of vascular stump was longer in the right-side stump than left-side stump （P〈0.001）. No change of CT value was seen on the plain and contrast-enhanced CT. Most of filling defects remained stable or showed reduction in size in follow-up CT. Conclusion： A filling defect in the pulmonary arterial stump after pneumonectomy is not rare on contrast-enhanced chest CT images. In situ thrombosis should be differentiated from tumor recurrence and thromboembolism.