六氯乙烷吸入性肺损伤HRCT随访变化

Initial and Follow up CT Findings of Hexachloroethane Smoke Inhalation

目的初步探讨六氯乙烷吸入性肺损伤高分辨CT(HRCT)表现在随访中的变化。方法 8例六氯乙烷急性肺损伤患者,采用64层螺旋CT在肺损伤后3个月内多次行胸部HRCT扫描。分析其CT表现变化。结果首次CT检查(中位时间9.68 h),7例(87.5%)图像未显示异常;1例(12.5%)图像显示右肺下叶内基底段"毛玻璃"样改变。第二次CT检查(中位时间29.13 h),1例(12.5%)图像显示病变有进展;6例(75.0%)图像首次显示肺呈"毛玻璃"样改变,部分伴实变影,1例(12.5%)并发纵隔气肿;1例(12.5%)正常。第三次CT检查(中位时间53.75 h),6例图像显示病变有进展;1例患者(12.5%)图像首次显示右肺下叶内、外基底段、左肺下叶外、后基底段"毛玻璃"样改变;1例图像显示病变消失。第四次CT检查(中位时间145.10 h),6例图像显示病变基本稳定;1例图像显示病变明显吸收;1例图像显示病变消失。第五次CT检查(中位时间505.00 h),6例图像显示病变消失,1例图像显示病变明显吸收;1例图像显示病变略有吸收。结论六氯乙烷吸入性肺损伤肺部HRCT表现为如下过程:无异常→出现异常(中位时间29.13 h)→明显进展(中位时间53.75 h)→基本稳定(中位时间145.10 h)→病变吸收、消失(中位时间505.00 h)。

Objective To investigate initial and follow up CT findings in patients with hexachloroethane smoke inhala tion lung injury. Methods HRCT scans were performed initially after injury and during the 3 months follow up period in 8 patients with hexachloroethane smoke inhalation lung injury. Results The initial CT scans performed at median time 9. 68h hours after injury showed normal in 7 patients （87.5%） and patchy areas of ground glass opacity （GGO） in the right medial basal segment in 1 patient（ 12.5% ）. The second CT scans performed at median time 29.13 hours after injury showed the lesions were progressive in 1 patient （ 12.5% ）. Initial abnormalities were showed in 6 patients （75.0%） on the second CT scans. The CT scans revealed GGO and consolidation in the 6 patients and pneumomediastinum was found on CT scans in 1 patient （ 12.5% ）. No abnormalities were found on the second CT scans in 1 patient （ 12.5% ）. The third CT scans performed at median time 53.75 hours after injury showed the lesions were progressive in 6 patients. The third CT scans revealed initial abnormalities in 1 patient （ 12.5% ）. The CT scans revealed GGO in the basal segments of the left and right lower lobe. The third CT scans showed the lesions disappeared in 1 patients （ 12.5% ）. The fourth CT scans per formed at median time 145.10 hours after injury showed the lesions were stable in 6 patients, the lesions were considerable improved in 1 patient and the lesions disappeared in 1 patient. The fifth CT scans performed at median time 505.00 hours after injury showed disappearance of the lesions in 6 patients, considerable improvement in 1 patient and improvement in 1 patient. Conclusion HRGT may reliably predict the course of hexachloroethane smoke inhalation lung injury. Initial ab normalities may be showed on CT scans performed at median time 29.13 hours after injury. The diseases may be progres sive between median time 29.13 hours and 53.75 hours and stable between median time 53.75 hours and 145.10 hours. The lesions may disappear at median time 505.00 hours.