大动脉炎肺动脉病变的血管造影诊断

PULMONARY ARTERY INVOLVEMENT IN AORTO-ARTERITIS: AN ANGIOGRAPHIC 3TUDY

本文分析24例大动脉炎肺动脉病变的血管造影所见,并讨论了有关诊断问题和临床意义。60例大动脉炎患者于静脉数字减影血管造影(IVDSA)检查过程中曾行肺动脉采象,22例(36.7%)发现肺动脉病变。另2例为普通动脉造影。段、叶和(或)亚段动脉支的狭窄和(或)阻塞为本病基本征象,上叶病变多于中(舌)或下叶,两侧多发病变多于单侧病变。单支叶、段病变少见。扩张病变罕见,本组未见一例侵犯主肺动脉者。此类肺动脉病变多无相应的临床表现。肺动脉高压是大动脉炎肺部病变的晚期并发症,也是影响临床病程和预后的重要因素。本组5例示有肺动脉高压,1例可疑,1例兼有右、左心室增大。

Angiographic findings of 24 patients with pulmonary artery involvement in aortoarteritis were analysed with a comment on the diagnostic problems and clinical implication of pulmonary artery involvement. Pulmonary acquisition was obtained during the course of IVDSA in 60 patients with aorto-arteritis. Among them, 22 patients (36.70%) were found to have pulmonary artery lesions. Conventional arteriography was performed in the other two patients. Stenosis and/or obstruction of segmental and/or lobar arteries, and the subsegmental branches as well were the basic angiographic findings in aorto-arteritic pulmnary artery lesions. Pulmonary arterial branches in the upper lobes were more frequently affected than those in the midde (Iinguala) and lower lobes. Bilateral multiple artery lesions were more commonly seen than unitaleral ones, and single, lobar or segmental lesion was rare. Dilative pulmonary artery lesion was rare, and no lesion was found in the main pulmonary artery in cases of the present series. Pulmonary arterial hypertension, an important factor affecting the clinical course and prognosis of patients with eorto-arteritic pulmonary artery lesions, is a late complication of pulmonary artery involve ment. Five patients were found to have pulmo nary arterial hypertension, one doubtful,and another one with combined right and left ventricular enlargement of the heart.