人感染H7N9禽流感的胸部影像表现

Thoracic imaging findings in patients with human infection with avian influenza A H7N9 virus

目的探讨人感染H7N9禽流感的胸部影像表现。方法搜集5例临床确诊为人感染H7N9禽流感的患者，共摄X线胸片6次（复查2例），行CT扫描9次（复查4例）。5例患者均有禽类接触史。结果5例患者中，3例X线胸片表现为两肺大片状影；4例CT表现为双肺多叶、多段实变，无明显肺叶、肺段或特定体位分布趋势，实变内有明显的空气支气管征；3例大片肺实变呈均匀致密实变、磨玻璃样实变；相邻肺段实变融合或在叶间裂处相邻的肺叶实变扩展，2例可观察到病变越过叶间裂蔓延至邻近肺叶的现象；短期复查患者病变进展迅速，呈双肺多发磨玻璃影及广泛肺实变影像；5例均合并少量胸腔积液或胸膜增厚；无肺门、纵隔淋巴结肿大。结论胸部影像异常是诊断人感染H7N9禽流感的必要指标，CT能更清楚地显示人感染H7N9禽流感的影像征象。

Objective To study the imaging characteristics of Human infection with avian influenza A H7N9 virus patients. Methods Six chest X-ray examinations and Nine CT examinations were performed in 5 cases of Human infection with avian influenza A HTN9 virus that were verified by the Clinic. Results In the 5 cases ,3 of 4 cases showed large areas of lung consolidation and bilateral lung involvement on chest X-ray. ALL the 4 cases showed multi-lobar or muhi-segmental consolidation in bilateral lungs on CT images. There was no distribution tendency for any specific pulmonary lobes or segments. There was obvious air bronchogram in the consolidation. In 3 cases, The big consolidation appeared as homogeneous opacities and ground-glass appearance. Consolidation expanded along the pulmonary segment and coalesced together to form a pulmonary segment consolidation, The loci that crossed the interlobular fissure were observed in 2 cases. Early repeated examination showed rapid lesion progress with extensive lung consolidation or ground-glass opacity in both lungs. Small amount of pleural effusion or pleural thickening was noticed in 5 cases. The meditational lymph nodes enlargement was not observed. Conclusion The imaging abnormalities on the thoracic plain film are the clues to make the diagnosis of Human infection with avian influenza A H7N9 virus, and CT can detect the pulmonary abnormalities for more details.