社区获得性肺炎治疗前后的影像学表现

Imaging Manifestations of Community-acquired Pneumonia Before and After Treatment

目的探讨社区获得性肺炎(CAP)治疗前后影像学表现及变化。资料与方法对61例CAP患者的临床及影像学表现进行分析。所有病例治疗前均行CT平扫,其中48例1周后复查,15例2周后复查,6例3周后复查。分析所有病例的CT特征,包括病灶范围、形态、分布、有无积液及是否进展,并随访相应临床症状,观察影像学表现与临床症状的关系。结果61例CAP患者中,38例(62.3%)表现为斑片状模糊阴影,呈单侧小叶性肺炎改变;23例(37.7%)为两侧肺炎。影像学表现:16例(26.2%)呈条索状炎性灶,54例(88.5%)呈斑片状炎性灶,30例(49.2%)出现实变影,5例(8.2%)双侧胸腔积液。治疗结局:41例(85.4%)1周后复查影像学表现及临床症状均好转;6例(12.5%)第1周影像学表现加重,临床症状减轻;1例(2.1%)第1周影像学表现及临床症状均加重;15例(100.0%)第2周影像学表现及临床症状吸收好转;6例(100.0%)第3周影像学表现及临床症状吸收好转。结论CAP的影像学表现多样,部分治疗后临床症状减轻者可出现影像学表现加重,即影像滞后于临床的情况。故治疗后症状好转者不宜早期复查,第2周后复查更为合适。

Purpose To explore the imaging manifestations and changes of community-acquired pneumonia(CAP)before and after treatment.Materials and Methods The clinical and imaging manifestations of 61 cases with CAP were analyzed.All cases underwent CT plain scan before treatment,including review 1 week later in 48 cases,review two weeks later in 15 cases,and review three weeks later in 6 cases.CT features of all patients were analyzed,including range,morphology,distribution,presence or absence of effusion and progression,and the corresponding clinical symptoms were followed up to observe the relationship between imaging manifestations and clinical symptoms.Results For all 61 patients with CAP,38 cases(62.3%)were manifested by unilateral lobuar pneumonia changes with patchy blurred shadows,and 23 cases(37.7%)by bilateral pneumonia.Regarding the imaging manifestations,streak inflammatory lesions were found in 16 cases(26.2%);patchy inflammatory lesions in 54 cases(88.5%);consolidation shadows in 30 cases(49.2%),and bilateral pleural effusion in 5 cases(8.2%).As for the treatment outcome,the imaging manifestations and clinical symptoms reviewed at the first week were improved in 41 cases(85.4%);6 cases(12.5%)showed aggravated imaging manifestations and alleviated clinical conditions at the first week;1 case(2.1%)showed aggravated imaging manifestations and clinical symptoms at the first week;15 cases(100.0%)showed the improved imaging manifestations and clinical symptoms at the second week,and 6 cases(100.0%)showed the improved imaging manifestations and clinical symptoms at the third week.Conclusion The imaging manifestations of CAP are diverse.In some cases,patients with alleviated clinical symptoms may incur aggravated imaging manifestations,imaging manifestation lags behind clinical symptom.Therefore,patients with improved symptoms after treatment should not be reviewed too early,and review after the second week is appropriate.