脓毒性肺栓塞的多层螺旋CT诊断

Multi-slice spiral CT diagnosis of septic pulmonary embolism

目的 探讨脓毒性肺栓塞的多层螺旋CT（MSCT）表现，以提高对该病的认识。方法回顾性分析12例脓毒性肺栓塞MSCT表现，并与X线胸片比较。结果所有12例患者，X线胸片和CT表现比较，分别见结节（8、12例），滋养血管征（0、9例），空洞（6、10例），楔形阴影（4、7例），局灶浸润影（2-4例），气囊（2、5例）及胸腔积液、脓胸（3、6例），肺门或纵隔淋巴结肿大（0、3例）。发现病灶分布在外周或胸膜下分别为8和12例，CT较X线胸片可更清晰地显示病灶。多平面重组（MPR）、最大密度投影（MIP）显示大多数滋养血管环绕结节周围，MPR显示结节边缘规整。结论脓毒性肺栓塞的CT表现多样，但MIP、MPR能更好显示滋养血管征及结节的特征。

Objective To study the multi-slice spiral CT （MSCT） manifestations of septic pulmonary embolism（ SPE ） in order to get a better understanding of the disease. Methods The MSCT manifestations of 12 patients with septic pulmonary embolism were retrospectively analyzed and compared with chest radiograph. Results Of the 12 patients, Chest radiograph and CT scanning showed multiple peripheral pulmonary nodules in 8 and 12 cases, a feeding vessel sign （0,9 cases）, cavitations （6,10 cases） and wedge-shaped opacities（4,7 cases）, focal infiltrates（2,4 cases）, air cyst（ 2, 5 eases）, pleural lesions （3,6 cases）, hilar or mediastinal lymphadenopathy（0,3 cases）. Peripheral or subpleural zones were most commonly affected （8, 12 cases ）. CT was more useful in revealing nodules and a feeding vessel sign. Multiplanar reconstructions （ MPR）, maximum intensity projection （MIP） showed that most of these vessels passed around nodules and wedge-shaped lesions. MPR showed regular nodular margin. Conclusion SPE presents with variable and often nonspecific clinical and radiographic features. MPR and MIP showed the features of nodules and feeding vessels better. The diagnosis is usually suggested by the presence of a predisposing factor, febrile illness, and CT findings of multiple, periphery pulmonary nodules, with or without cavitation and a feeding vessel sign.