螺旋CT对肺撕裂伤的诊断及动态观察应用价值

The Application Value of Spiral CT in Diagnosis and Dynamic Observation of Pulmonary Laceration

目的:探讨螺旋CT在肺撕裂伤的诊断及动态观察中的应用价值。方法:回顾性分析20例肺撕裂伤的CT表现。结果:20例患者共发现45个病灶,右肺25个,左肺20个。CT表现为肺气囊9个、肺气液囊12个、胸膜下气泡影15个、肺血肿7个及楔形含气裂隙2个。肺撕裂伤周围均合并不同程度的肺挫伤。45个病灶中,26个病灶位于肺表面或胸膜下,5个病灶位于肺深部,14个病灶位于脊柱旁。20例患者均伴有肋骨骨折,8例患者合并血气胸。CT动态观察,发现7个肺气囊腔内见液体进入,形成肺气液囊;胸膜下气泡影6例形成血气胸,5例出现肺血肿伴胸腔积液;1~2月肺气囊、肺气液囊及肺血肿吸收和缩小。结论:肺气囊、肺气液囊及胸膜下气泡影是肺撕裂伤特征性CT表现,肺楔形含气裂隙是该病特有的CT征象。CT检查是早期发现、诊断和动态观察肺撕裂伤最有效的影像检查方法。

Objective： To investigate the application value of spiral CT in the diagnosis and dynamic observation of pulmonary laceration. Methods： CT results of twenty patients with pulmorary laceration were retrospectively analyzed. Results： A total of 45 lesions were found in the 20 patients, with 25 on the right side and 20 on the left side. CT manifestations were pneumatocele（n = 9）, pulmonary liquid-air cavity（n = 12）, sub-pleural gas-bubble shadow（n= 15）, intrapulmonary hematoma（n = 7） and wedge shaped gas fissures（n = 2）. Various degrees of lung contusion around the pulmonary laceration could be observed in all patients. The locations of the 45 lesions of laceration included lung surface or sub-pleural region（n = 26）, deep site of lung（n = 5） and paravertebral area（n = 14）. Rib fracture was detected in all patients and hemopneumothorax was found in 8 patients. The results of CT dynamic observation are as follows： liquid was seen and pulmonary liquid-air cavities were formed in 7 lung cavities, 6 sub-pleural gas-bubble shadow formed into hemopneumothorax, while 5 patients were diagnosed as pulmonary hematoma with pleural effusion. Besides, pneumatocele, pulmonary liquid-air cavity and absorption and shrinkage of pulmonary hematoma were found in one or two months. Conclusion： The characteristic manifestations of pulmonary laceration are pneumatocele, pulmonary liquid-air cavity and sub-pleural gas-bubble shadow, while the wedge shaped gas fissures is a specific sign of the disease. Spiral CT examination plays the most effective role in early detection and diagnosis and dynamic observation of the pulmonary laceration.