高原肺水肿与新型冠状病毒肺炎计算机断层扫描特征及影像鉴别

Differential diagnosis of high altitude pulmonary edema and COVID-19 with computed tomography feature

为了探讨高原肺水肿(HAPE)与新型冠状病毒肺炎(COVID-19)的计算机断层扫描(CT)特征以及影像鉴别,本研究回顾分析了2020年5月1日至5月30日解放军950医院三十里营房医疗站52例诊断为HAPE患者的胸部CT影像资料。分析不同病情阶段肺内感染病灶的数量、位置、分布、密度及形态后,与《新型冠状病毒肺炎的放射学诊断:中华医学会放射学分会专家推荐意见(第一版)》和《新型冠状病毒(2019-nCoV)感染的肺炎诊疗快速建议指南(标准版)》中COVID-19 CT相关影像特征比较,找到两者CT影像鉴别方法。研究发现早期HAPE与COVID-19胸部CT均表现为斑片状磨玻璃影,但后者有特征性“铺路石”(网格状小叶内间隔增厚)征象。进展期HAPE CT多表现为云絮状密度增高影,而COVID-19病灶多见平行于胸膜方向发展,部分病灶可见支气管充气征。重症爆发期两者CT影像均可见“白肺”表现,但HAPE右肺多重于左肺。因此在HAPE与COVID-19 CT的鉴别诊断中,前者病灶云絮状密度增高影可作为特征影像征象,而“铺路石征”和“胸膜平行征”可作为后者的特征CT表现。

To investigate the computed tomography(CT)characteristics and differential diagnosis of high altitude pulmonary edema(HAPE)and COVID-19,CT findings of 52 cases of HAPE confirmed in Medical Station of Sanshili Barracks,PLA 950 Hospital from May 1,2020 to May 30,2020 were collected retrospectively.The size,number,location,distribution,density and morphology of the pulmonary lesions of these CT data were analyzed and compared with some already existed COVID-19 CT images which come from two files,“Radiological diagnosis of COVID-19:expert recommendation from the Chinese Society of Radiology(First edition)”and“A rapid advice guideline for the diagnosis and treatment of 2019 novel corona-virus(2019-nCoV)infected pneumonia(standard version)”.The simple or multiple ground-glass opacity(GGO)lesions are located both in the HAPE and COVID-19 at the early stage,but only the thickening of interlobular septa,called“crazy paving pattern”belongs to COVID-19.At the next period,some increased cloudy shadows are located in HAPE,while lesions of COVID-19 are more likely to develop parallel to the direction of the pleura,and some of the lesions show the bronchial inflation.At the most serious stage,both the shadows in HAPE and COVID-19 become white,but the lesions of HAPE in the right lung are more serious than that of left lung.In summary,some cloudy shadows are the feature of HAPE CT image,and“crazy paving pattern”and“pleural parallel sign”belong to the COVID-19 CT,which can be used for differential diagnosis.