感染性心内膜炎致脓毒性肺栓塞的多层螺旋CT诊断

Multi-Slice CT Diagnosis of Septic Pulmonary Embolism Caused by Infective Endocarditis

目的 分析感染性心内膜炎致脓毒性肺栓塞(SPE)的多层螺旋CT表现,提高对本病的认识及影像诊断能力。资料与方法 回顾性分析2012年6月—2020年11月就诊于昆明医科大学附属延安医院的34例感染性心内膜炎致SPE的多层螺旋CT特征,观察肺动脉表现、心脏原发疾病及赘生物的显示及肺部表现。结果 12例出现霉菌性肺动脉瘤,共18个,8例单发,囊状13个,边缘不规则12个,壁增厚8个,充盈缺损位于周边8个,远端3个,下叶外基底段、右肺中叶内侧段好发,均为3个,肺段动脉近段9个,中段8个。4例动脉瘤周显示晕征,急性期肺动脉轮廓快速增大6例,其中3例抗炎治疗后缩小、变细。治疗前8例栓塞肺动脉稍增粗。17例行心电门控全胸心脏大血管CT血管成像均能清晰显示心脏病变,显示肺动脉内膜炎10例,表现为肺动脉壁毛糙、不规则增厚,其中6例局部膨隆。11例显示赘生物。10例行胸部增强扫描,显示心脏病变、赘生物各6例。34例双肺均存在2种及以上多发、多种形态病灶,包括肺部斑片状浸润影、楔形影、结节、索条,前三者可伴空洞、气囊,楔形影、结节可伴滋养血管征,以肺周分布为主。结论 对于先天性心脏病、右心感染性心内膜炎或感染性血栓静脉炎等高危患者,胸部CT除表现为多发性、多形性、外周分布及滋养血管征,出现特异的霉菌性肺动脉瘤、栓塞肺动脉增粗、肺动脉内膜炎,可及时诊断SPE。心电门控全胸心脏大血管CT血管成像是感染性心内膜炎致SPE的最优CT检查方法。

Purpose To improve the understanding and diagnostic ability of septic pulmonary embolism(SPE) caused by infective endocarditis via multi-slice computer tomography(MSCT) imaging findings. Materials and Methods The MSCT characteristics of 34patients with SPE caused by infective endocarditis in Yan’an Hospital Affiliated to Kunming Medical University from June 2012 to November 2020 were retrospectively analyzed. The pulmonary artery manifestations, primary heart disease, and vegetation appearance, and pulmonary manifestations were observed, respectively. Results There were 12 cases with 18 mycotic pulmonary artery aneurysm, 8 cases with single lesion, 13 cystic lesions, 12 lesions with irregular edges, and 8 lesions with wall thickening, 8 lesions with peripheral filling defects, 3 lesions with distal filling defects, 3 lesions located in the basal segment of the lower lobe and the medial segment of the middle lobe of the right lung,9 lesions located in the proximal segment of the pulmonary artery, and 8 lesions located in the middle segment. There 4 patients with halo signs around aneurysm, and 6 patients with pulmonary artery contour increased rapidly in at acute stage, and 3 of the 6 patients with shrunk and narrowed lesions after anti-inflammatory treatment. Before treatment, pulmonary artery embolization was slightly thickened in 8 cases.The cardiac lesions of 17 patients were clearly showed via ECG gated whole-chest cardiac great vessel CTA examinations, presenting 10 cases with pulmonary endarteritis, rough and irregularly thickened pulmonary artery wall, and 6 of 10 cases with local dilation. There were 11patients with vegetation appearance, 10 of 11 cases underwent chest enhancement scan, showing cardiac lesions, 6 cases with vegetation appearance. There were 34 patients with two or more types of multiple and multiform lesions in both lungs, including features, such as pulmonary patchy infiltrating shadow, wedge shadow, nodules, cords, with cavity, air sac, wedge shadow, as well as nodules with feeding vessel sign and mainly distributed around the lung. Conclusion For high risk patients, such as congenital heart disease, right heart infective endocarditis or infectious thrombophlebitis, the chest CT features include multiple lesions, polymorphism, peripheral distribution, feeding vessel sign, specific mycotic pulmonary artery aneurysm, enlargement of embolism pulmonary artery, and pulmonary endarteritis, timely diagnosing the SPE. ECG gated whole-thoracic cardiac large vessel CTA appears to be effective CT method for SPE caused by infective endocarditis.