应用多层螺旋CT诊断肺实质钝性撕裂伤18例分析

Analysis of 18 patients with blunt pulmonary lacerations diagnosed with multi-slice spiral CT

目的探讨肺实质钝性撕裂伤多层螺旋CT(MSCT)特征及其机制。方法 18例胸部钝性伤后出现肺实质撕裂患者行MSCT检查,观察肺实质损伤的部位、范围、内部特征、合并表现及转归情况,并结合文献分析其潜在的损伤机制。结果18例患者均有不同程度的肺挫伤,表现为一侧或双侧肺内浸润影像,分布与肺段、肺叶无关;肺撕裂伤表现为创伤性假性囊肿,其中肺含气囊肿9例,气液囊肿7例,血肿2例;CT随访肺挫伤在1周左右基本吸收,肺撕裂伤吸收较慢,可完全吸收或残留少许纤维灶,2例囊肿继发出血演变为血肿。此外可见气胸、血气胸、胸壁骨折、膈疝及纵膈气肿等合并症。结论 MSCT能较全面的评价肺实质钝性撕裂伤情况及其合并表现,通过CT征象有助于理解肺实质钝性撕裂伤的潜在机制。

Objective To evaluate the clinical application of multi-slice spiral CT in blunt pulmonary lacerations and analyze its mechanism. Methods The chest CT data of 18 patients with blunt pulmonary lacerations were retrospectively analyzed. The site, scope,internal features, complications and outcome of the pulmonary parenchyma were observed, and the potential mechanism was ana-lyzed. Results The 18 patients had varying degrees of pulmonary contusions. Contusions appeared as geographic, non-segmental areas of ground-glass or nodular Opacities or consolidation on CT that did not respect the lobar boundaries. The pulmonary lacerations were characterized with traumatic pulmonary pseudocysts in which there were 9 cases of simplex gas-bearing cysts ,7 cases of gas-liquid cysts and 2 cases of hematomas. Clearance of uncomplicated contusions began at 24 to 48 hours with complete resolution after lweek. Lacera-tions resolve was more slowly than contusions, and clearance may take weeks or even months, and may end in residual scarring. There were 2 cases of gas-bearing cysts evolving into hematomas secondary to hemorrhage. In addition,the pneumothorax, haemothorax, hemo-pneumothrax, chest wall fracture, diaphragmatocele and mediastinal emphesema were also shown in the CT images. Conclusion MSCT could comprehensively evaluate the blunt pulmonary lacerations and their combined performances. The CT features are helpful to under-stand the potential mechanism of blunt pulmonary lacerations.