重型新型冠状病毒肺炎41例的HRCT表现

HRCT findings of 41 patients with severe COVID-19.

目的回顾性分析41例重型新型冠状病毒肺炎(COVID-19)患者的临床及高分辨率CT(HRCT)影像变化特点,进一步明确胸部CT在COVID-19重型病例的临床诊疗中的预警价值.方法收集确诊的41例重型COVID-19患者,分析其临床重症期HRCT特点.结果41例重型COVID-19患者入院表现不同程度的流感样症状,发热33例,咳嗽26例,畏寒17例,咳痰14例,乏力13例等.重型患者HRCT双肺损伤范围中度、重度,病变形态密度混杂,呈磨玻璃、条索、实变等不同形态混杂,磨玻璃及斑片影累及肺门;纤维条索累及肺门,网格影;胸膜下平行粗大纤维条索;垂直胸膜纤维条索;沿着支气管分布垂直胸膜小段状实变;远端支气管扭曲扩张;胸膜增厚;胸腔积液及心包积液少见.结论虽然影像学分期与临床分型不完全一致,但胸部HRCT双肺受损达到中度,磨玻璃影累及肺门,出现胸腔积液,平行/垂直胸膜粗大纤维条索并局部实变伴/不伴远端支气管扩张扭曲,都高度预警临床重型COVID-19的发生,从而指导临床治疗,提高重症患者的临床预后.

Objective To retrospectively analyze the clinical data and HRCT imaging features of 41 patients with severe COVID-19,and to further clarify the early warning value of chest CT in the clinical diagnosis and treatment of se-vere COVID-19.Methods Forty-one patients with severe COVID-19 were collected and their HRCT characteristics were analyzed.Results Forty-one patients with severe COVID-19 were admitted to hospital with flu-like symptoms,including 33 with fever,26 with cough,17 with chills,14 with phlegm,13 with fatigue.In severe patients,HRCT showed moderate to severe lung injury,with mixed lesion shape and density.Ground glass,cable,and consolidation changes were mixed presented,and ground glass and speckle shadow changes involved the hilum of lung.Pulmonary hilum was involved with fibrous cord,meshwork shadow.Subpleural parallel thick fibrous cord,vertical pleural fiber cord,verti-cal segmental consolidation of the pleura along the bronchi,distal bronchiectasis,and pleural thickening were presented in severe cases.Pleural effusion and pericardial effusion were rare.Conclusion Although imaging staging and clinical clas-sification is not completely consistent,moderate to severe bilateral lung injury to moderate in chest HRCT,with ground glass shadow involving the lung,pleural effusion,parallel/vertical pleural bulky fiber cords and consolidation of the local distortion with/without the remote bronchiectasis,is highly alert the occurrence of clinical severe COVID-19.