肺栓塞的CT表现及误诊分析

Analyze the CT finding and misdiagnosis of pulmonary embolism

目的分析肺栓塞的CT表现及其误诊原因。方法本组收集2002～2006年经CT增强扫描及肺动脉造影证实为肺动脉栓塞患者7例,所有患者皆行CT平扫加增强检查,1例行DSA。结果CT平扫初始诊断为肺炎2例、结核2例、慢支伴局限性肺气肿例、肿瘤3例;CT平扫有价值的表现为局部肺血管纹理明显变细、稀少,肺动脉高压及肺动脉主干内低或高密度改变,增强扫描发现肺动脉栓子。结论导致误诊的原因包括:对肺叶、段性渗出和实变影未及时做二期增强扫描;诊断未充分结合临床表现;增强扫描方法不当;对系列影像片未做合理分析,未认识CT平扫一些栓塞征象等。

Objective To analyze pulmonary embolism＇s CT finding and the reason of misdiagnosis. Methods Collected 17 cases of pulmonary embolism （abbreviate to PE） confirmed by enhancement scanning and Pulmonary arteriography from A.D.2002 to A.D.2006, all patients were performed plain scan and enhancement scanning,3 cases were performed 1）SA. Resealts The ineipient diagnosis was pneumonia （7 cases）, tuberculosis （4 cases）, chronic hronchitis with emphysema （3 cases） and tumor （3 cases） in CT plain scan. The valuable findings of CT plain scan are pulmonary vascular lake getting thinning or scarce, pulmonary hypertension and low or high density in main pulmonary artery. Puhnonary artery embolus, bronchial arteries＇ is thickening. Conclusion The reason of misdiagnosis include the following： two period en- hancement scanning was not done promptly in the lobes or segment of the lungs＇ effusion and consolidation, diagnosis did not full link to elinieal manifestation,enhancement scanning had no appropriate ways, series images had no proper analysis, didn＇t know the sign of PE in plain sean et al.