急性氯气中毒的分期肺部影像表现

The pulmonary imaging manifestations in patients with various stages of acute chlorine gas poisoning

目的:探讨急性氯气中毒后各时期的影像学表现及其发展变化的规律。方法:某次氯气泄漏事故中24例中毒患者,男14例,女10例,平均年龄29岁,其中轻度中毒8例,中重度中毒16例。回顾性分析其接受治疗期间(1个月内)的所有肺部影像资料,按急性期、消散期和恢复期分期观察和统计其肺部的各种影像改变。结果:急性期:24例患者接受X线胸片检查,示肺部大片云絮状影13例(13/24),散在点片状影3例(3/24),肺部透亮度弥漫性减低18例(18/24);18例患者行CT检查,CT示肺内出现大片渗出性改变10例(10/18),散在小片状渗出灶3例(3/18),肺部磨玻璃密度影17例(17/18),纵隔气肿3例(3/18),胸腔积液4例(4/18)。消散期:X线平片显示肺内大片状影部分或绝大部分吸收,肺部透亮度增高;CT示肺部大片影部分或绝大部分吸收,以磨玻璃密度影为主,可见纤维条索影出现,纵隔气肿和胸腔积液减少或消失。恢复期:X线平片示双肺透亮度基本恢复正常,肺内可残留少许条索状或小片状高密度影;CT示肺内弥漫性大片状磨玻璃密度影消失,但可残留散在腺泡结节样磨玻璃密度影或小片状及条索状高密度影。结论:临床上有明确的氯气吸入病史及相应的临床表现,结合影像表现可作出急性氯气中毒的诊断并对肺损害的严重程度作出判断。

Objective：To discuss the pulmonary imaging features in patients with various stages of acute chlorine gas poisoning and to investigate the patterns of development. Methods：24 patients with acute chlorine gas poisoning in an accident of chlorine gas leakage,including 14 males and 10 females. The mean age was 29 years. There were mild poisoning （8 patients） and severe poisoning （16 patients）. All of the pulmonary imaging data during the course of treatment （within 1 month） were retrospectively analyzed. The imaging findings were studied according to acute stage, resolving stage and recovery stage respectively. Results：In acute stage, 24 patients had chest radiography, large patchy cloudy shadows were found in 13 （13/24） patients, and scattered spotty shadows in 3 （3/24 ） patients, diffusely decreased lung transparency in 18 （18/ 24） patients. 18 patients had CT examination, large patchy exudative changes were found in 10 （10/18） patients, and scat tered small patchy shadows in 3 patients,ground-glass opacities in 17 patients,mediastinal emphysema in 3 patients, pleural effusion in 4 patients. In resolving stage, chest radiography showed partial or nearly total absorption of the large patchy shadows and increase of lung transparency. Partial or nearly total absorption of the large patchy shadows in lung and substituted by large area of ground glass opacity with some linear fibrous shadows, and reduce or disappearance of mediastinal emphysema and pleural effusion could be assessed on CT. In recovery period,the lung basically appeared as normal on radiography,but some linear or small patchy opacities might be found. The diffuse large patchy ground glass opacity disappeared on CT, but some scattering small nodular/alveolar like ground glass opacities and linear or small patchy shadows might be founded. Conclusion：With definite history of chlorine gas inhalation and the corresponding clinical manifestations, correlated with the imaging manifestations, the diagnosis as well as the severity of pulmonary damage could be made.